MASSACHUSETTS NURSE NEWSLETTER :: January/February 2003

State Announces Voluntary Smallpox Vaccination Plan

Nurses Will Play Major Role

Nurses will comprise the lions share of more than 12,000 health care workers scheduled to be vaccinated in January and February as part  of the Commonwealth’s pre-event plan to protect the state’s residents against potential bioterrorism event.  Initial plans call for the immunization of 7.500 – 8,000 hospital personnel, 1,000 health care workers to serve on regional community response teams and an additional 3,000 public health nurses  (including  school nurses, visiting nurses and EMS personnel) who would be responsible for immunizing the general public in the event of a smallpox outbreak.

The plan, was drafted by the Mass. Department of Public Health (DPH), with guidance from the Smallpox Working Group of the Statewide Bioterrorism Task Force and Response Program Advisory Committee, which includes more than 60 agencies and organizations, with representation by the MNA.  The plan was submitted to and approved by the Centers for Disease Control in December as part of a national mandate to develop a comprehensive smallpox preparedness plan. 

The Pre-Event Vaccination Plan is the first phase of a three-phase plan to deal with a smallpox event.  While this article will summarize the pre-event plan, future issues of the Massachusetts Nurses will address subsequent phases of the state’s effort to address the smallpox threat.  Readers are encourage to visit the MNA web site at www.massnurses.org for more extensive coverage of this issue as well as links to web sites that may provide additional helpful information for nurses. 

The MNA and other health care provider groups and unions have been actively engaged in this process and have been raising questions about this plan and the best way to implement it to protect health care workers and the public.  As of this writing, while the DPH has submitted the plan and it was approved by the CDC, the specific timeline for implementation was unclear.  Attorneys for the state were charged with reviewing a number of issues and questions related to the vaccine and the process of immunizing health care workers. 

Specific issues raised by the MNA related to this process include: concerns about who would pay for lost work time for employees who become ill from the vaccine, as well as for family members of workers who may become ill; and liability issues related to reactions to the vaccine for employees and the general public who may be exposed to an immunized employee.  The MNA also raised issues about the timeline for educating workers about the process and the need for immediate and comprehensive education around smallpox in general.  Questions were also raised about the safety of the needles to used to vaccinate employees.  Again, as these issues are resolved and responded to, check the MNA web site for further details. 

Hospital-Based Smallpox Response Teams – First Line of Defense

All 76 acute care hospitals with emergency departments (EDs) in Massachusetts have been designated as sites for caring for potential smallpox cases and are included in this phase of the plan. Each hospital will be charged with recruiting approximately 100 employees at each facility to be immunized at selected hospitals sites selected to handle the vaccination process. 

MDPH is in the process of soliciting comments and draft guidance that will provide to hospitals in identifying their health care teams.  The proposed guidelines for nurse involvement in the teams is as follows:

A health care systems approach is being encouraged whereby one hospital in each system will be responsible for implementing a screening, education, vaccination and follow-up program for all hospitals in the system.  There are approximately 16 systems covering most of the hospitals, with the remaining hospitals being unaffiliated.  Small unaffiliated hospitals will be encouraged to develop agreements with larger hospitals to vaccinate their staff, or may have their employees vaccinated at the vendor-run clinics.

 In addition, 7 response teams, corresponding to the 7 bioterrorism preparedness regions being designated by DPH, and a select group of public health and health care workers across the state will also be vaccinated. 

Regional Smallpox Response Teams

In addition to hospital teams, DPH proposes to establish 16-person multi-disciplinary

community response teams comprised of first responders, medical and public safety personnel to be able to respond to smallpox cases within one to two hours of a suspected case. The Commonwealth of Massachusetts is divided into 7 regions for the purpose of bioterrorism preparedness, planning and response.  One Smallpox Response Team will be established for each of the 7 regions.  The Teams will investigate any suspect case of smallpox in the community and mitigate the hazard by closing off access to the area, isolating contacts of the suspect case until they can be interviewed, and safely transporting the suspect case to the hospital.

Under the direction of a Regional Bioterrorism Coordinator, each of the 7 teams will include a total of 150 personnel, who will be available 24 hours/day.

The teams will provide the following functions:  patient care and transport, specimen collection and transport, medical diagnosis, site security, control of the environment, contact investigation and event management.  To fully staff teams, a total of 1,050 individuals will be vaccinated and trained.

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Public Health Nurse/Vaccinators and Emergency Medical Personnel

In addition, 3,000 public health nurses, including municipal nurses, school nurses and visiting nurses, and emergency technicians and paramedics from across the state will be trained and vaccinated to build capacity for future smallpox vaccination activities.  These vaccinated and trained nurses will form the core of a cadre of trained health care providers who will be ready to implement mass smallpox vaccination clinics in the event of a bioterrorism attack.  These nurses will be recruited with the assistance of the Statewide BT Preparedness and Response Program Advisory Committee, the Massachusetts Nurses Association, the MDPH Office for School Health, The Mass. Association of School Nurses and the Mass. Association of Public Health Nurses. 

Timeline for selection of hospitals and individual health care workers and vaccination of the health care response teams

Once legal issues have been resolved regarding the plan, best estimates are that recruitment of volunteers for the vaccinations would begin in January.  The Mass. Hospital Association and the DPH will stagger the vaccination process over a period of 10 – 12 weeks to minimize the impact on staffing in emergency departments across the state. 

Sites for Vaccination

Phase 1 of pre-event smallpox vaccination will take place in two types of clinics.  The first type of clinic will be hospital-based, where multidisciplinary teams of 100 employees from the 76 hospitals will be vaccinated.  The second type of clinic will consist of 4 vendor-run regional clinics to be held at state hospitals.  Members of the 7 regional smallpox response teams, approximately 3,000 nurses, paramedics, public safety personnel will be vaccinated at these sites. 

Description of process for ensuring adequate screening of potential vaccines

At both hospital and vendor-run clinics, all potential candidates for vaccination will undergo a thorough screening process. 

General information sessions will be open to all potential vaccination candidates to explain the pre-event smallpox vaccination program.  Potential candidates will receive an information packet prepared by the CDC that provides detailed information on the vaccine, side effects, informed consent information, a self screening form and other materials to help nurses make an informed decision.