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HHS Conducts Smallpox Vaccination Drill

Cheryl A. Thompson

With states expecting to receive shipments of smallpox vaccine later this month, the U.S. Department of Health and Human Services (HHS) is fine-tuning its proposal for how local authorities should conduct their large-scale preventive vaccination clinics.

At issue is the safe, efficient vaccination of some 440,000 health care workers nationwide who have been identified in states' smallpox-response plans, which were submitted to HHS.

These workers, said President Bush in an announcement last month, would be the first personnel to respond to a case of smallpox in a community.

Arlington County Department of Human Services, under the direction and funding of HHS, carried out a vaccination drill on Saturday at a high school in the Washington, D.C., suburb that is home to the Pentagon.

DeffenbaughHHS recruited the volunteers who acted as vaccination candidates.

County health director Susan Allan said the clinic model under examination at the Virginia high school had the same design as the prophylaxis clinic that she ran in the fall of 2001 for residents who might have been exposed to anthrax at their work site, either the Hart Senate Office Building or a mail-handling facility in Washington, D.C.

Allan said there was no smallpox vaccine at the Saturday drill.

The purpose of the test, said Brian McCue, an operations analyst with the federally funded Center for Naval Analyses, was to time the progression of vaccination candidates through the five-station clinic designed by the Centers for Disease Control and Prevention (CDC). Data from the drill would be used to refine CDC's computerized model of the rate at which vaccination candidates proceed through each station, he said.

McCue said the mock clinic, designed as a "half-size model" of CDC's proposal, could vaccinate 500 people in one day.

Each vaccination candidate received a green sheet of paper with a unique bar code. Once the candidates entered the clinic, which was set up in the cafeteria and a nearby classroom, workers at the entrance and exit of each station scanned the bar code and stamped the time on the sheet as the volunteers passed.

The stations covered:

  • Receipt of vaccination information from the clinic staff,  
  • Small-group viewing of an 11-minute CDC videotape covering the major risks of smallpox vaccination and the safety issues,  
  • Completion of the medical history document,  
  • Interview and vaccination if appropriate, and  
  • Review of the instructions on caring for the vaccination site.

vaccination tableOranges took the place of vaccination candidates when clinic personnel administered the mock vaccine with a bifurcated needle.

In the initial round of testing, McCue's group found that one of the stations took longer to complete than the CDC manual had indicated. McCue said he reconfigured the station in time for the second round of data collection.

Vaccination candidates also received a smallpox disease fact sheet, an instruction sheet on the proper care of the vaccination site, a single-page diary on which to record symptoms for the first four weeks after vaccination, and a medical history form.

Personnel from the county health department examined each medical history to determine whether a candidate had a condition that precluded administration of smallpox vaccine.

Vaccination candidates were asked to indicate on their medical history document whether they or a member of their household was pregnant, had a dermatologic condition that could cause breaks in the skin, was taking prednisone or another corticosteroid for two or more weeks, or had cancer. That information was used by clinic personnel to spot people who had a contraindication to smallpox vaccination. Other information reported in the medical history was used to identify people who needed formal consultation with a health professional and would likely not be vaccinated at the clinic that day.

interviewIn addition to querying vaccination candidates about drug allergies, the form asked specifically about allergies to chlortetracycline, neomycin, polymixin B, or streptomycin—substances used in the processing of the only U.S.-licensed smallpox vaccine. An allergy to one of these substances was a contraindication to smallpox vaccination.

Complete progression through the clinic during the second round of testing took about one and a half hours. By far the longest queue was the wait at the interview-and-vaccination station.

HHS Secretary Tommy G. Thompson said in December that he did not expect states to begin administering smallpox vaccinations until Jan. 24, when official programs will receive liability protection under the Homeland Security Act of 2002.