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From page 349... ... See also Group, 47, 59�60, 183�185, 234, 241 Inadvertent inoculation; Transmission Advisory Committee on Immunization of vaccinia to contacts Practices Smallpox Vaccine Safety Accountability. See also Responsibility Working Group (ACIP SVS WG) Read the entire page →
From page 350... ... See American Nurses Association Bioterrorism. See also Biopreparedness Announcement, of the smallpox vaccination agents that could be used in, 205 program, 41�42 contrasting roles of public health and Anthrax bioterrorism attacks within the traditional responders in, 291 U.S., xv, 23, 305 funding for, 33�34 Antiviral agents, need for development of, 11 grants for, 87 Antiviral T-cell response, 14 media role in, 218 Areas of potential future inquiry, 158�159 only one public health threat, 268 Assessment of Future Scientific Needs for possibility of future, 23 Variola Virus, 11 preparing for, 34�35, 81, 172�174, 217, Assessment of safety profile, 142�149 266 Association of Federal, State, County, and response competencies, 281 Municipal Employees, 52 university-based centers for studying, Association of Professionals in Infection 218 Control, 218 Blood donation forms, 141 Association of Public Health Laboratories, 24 Bush, George W., xv, 9, 26, 41, 52, 84, Association of State and Territorial Health 124�125, 137, 222 Officials (ASTHO) Read the entire page →
From page 351... ... See Community Hazards 99, 122, 288, 308, 318, 320, 326 Emergency Response Capability Health Alert Network, 305 Assurance Program Hospital Infection Control Practices Chickenpox, confused with smallpox, 12 Advisory Committee, 29 China, monkeypox in, 55�56 independence of, 30 Chronology, 4 Laboratory Response Network, 307 Cidofovir, 17, 138, 142, 149, 234 liaison to the FBI, 297 Civilian smallpox vaccination program, 3, needing to speak authoritatively as the 196, 222, 226. See also Public nation's public health leader, 82�83, interest; Vaccination of members of 89, 95�96, 101, 114, 155, 209�210 the general public who insist on Office of Terrorism Preparedness and receiving smallpox vaccine Emergency Response, 99 beginning of, 15�16, 163 providing guidance to state public health much smaller cohort than military, 170 agencies, 207�208 policy options regarding, 28 public fora held by, 30 safety of, 224�243 readiness indicators document, 277�283 voluntary, 9, 48, 128, 188, 213 role in providing scientific and public Clarity issues, 131 health reasoning for policy, 93�96 Clinician Information Line (CDC) Read the entire page →
From page 352... ... See "Search and preparedness, 218�219 containment" strategies; Surveillance recommendations regarding, 115 and containment activities regarding vaccination of members of the Contraindications screening, 2, 32, 61, 112, general public who insist on receiving 116, 136�139, 186 smallpox vaccine, 224 Controlling and eradicating smallpox, 13 specifics of, 171�175 Cooperative Agreement on Public Health Communication planning, 2, 154�158 Preparedness and Response for recommendations regarding, 2, 114, 207 Bioterrorism, 25, 34, 254, 295 Community Hazards Emergency Response compliance, measuring, 274 Capability Assurance Program Continuation Guidance for, 195, 206, 210 (CHER-CAP) , 315�316 Coordinated mass vaccination, 10 Compatibility, ensuring, between the DHS Coordination issues, 292�297, 299 exercise doctrine and public health cross-jurisdictional, 305 preparedness exercises, 319�320 example of intersectoral tension and Compensation, 2, 187�190, 277�278 collaboration, 296�297 for adverse reactions to the smallpox Coronavirus, 55. Read the entire page →
From page 353... ... See also Collecting data on National Vaccine Advisory Committee, adverse reactions 29, 236n ACIP Working Group on Smallpox Office of Public Health Emergency Vaccine Safety, 183�185 Preparedness, 236n active surveillance for serious adverse Department of Homeland Security (DHS) , events and monitoring common 165n, 293�295 adverse events, 179�182 exercise-related activities of, 315�316 Active Surveillance System, 116, 119, experiences with exercises, 286 180�181 Lexicon Project, 298 Hospital Smallpox Vaccination Office of Domestic Preparedness, 121, Monitoring System, 181�182 287, 294, 304, 314�315, 325�326 implications of program expansion for Department of Justice, 297 collection of data on adverse events, CDC Public Health Performance 182�183 Assessment for Emergency pre-event vaccination system, 177�178 Preparedness, 267 recommendations regarding, 116�117 Department of Veterans Affairs (VA) Read the entire page →
From page 354... ... See Data safety and quality Eruption stage, of smallpox, 12 monitoring boards Erythema multiforme major, 50 DynPort Corp., 16 Evaluation need for, 169�170 recommendations regarding, 115, 120 E of risk factors for known adverse reactions, recommendations Eczema vaccinatum, 17, 132, 196, 233 regarding, 113 Educational training materials, 61, 152, Evidence base from disaster research and 177. See also Training and education practice, 299�304 culturally appropriate, 115 examples of gaps in disaster research, testing for ease of comprehension, 116 301�303 18th World Health Assembly, 10 key lessons learned in disaster practice, Elements of smallpox preparedness, 210� 303 219 key research findings and recurring preparing key responders, 210�213 themes, 300�301 protecting the public, 211, 215 learning from disaster practice, 303�304 rapid public health response, 210�211, learning from disaster research, 300�303 214 nature of, 299 the role of public and media a resource for learning from past communication in, 218�219 experience, 303�304 the role of the health care community in, Evidence-Based Performance Goals for 215�218 Public Health Disaster Preparedness, 11th World Health Assembly, 10 99, 122, 288, 308, 318, 320, 326 Emergency and disaster preparedness and recommendations regarding use of, 288, response, the diverse field of, 291� 326 292 Evidence-based Practice Center, 313 Emergency Management Institute, 312 Evidence of increased preparedness, absence Emergency manager, defined, 328 of, 98�100 Emergency medical services (EMS) Read the entire page →
From page 355... ... See also Civilian smallpox 150�153 vaccination program Focus on preparedness, 165�169 communicating with, 171�174 Food and Drug Administration (FDA) , 15, legal information sheets for, 278 48, 142�143, 234, 265 policy options regarding vaccinating Food-borne disease, 220, 305 members of, 28 Forensic Epidemiology training program, 297 protecting, 211, 215 France, possible stocks of smallpox virus in, trust of, 7, 95, 154 26 Generalized vaccinia, 17, 132 Frist, Bill, 58, 91 Georgia, 11, 289 Fulginiti, Vince, 345 Gerberding, Julie, xvi, 29, 51, 57, 91, 93, Funding, 190�191 123, 162, 195, 203, 252, 285 recommendations regarding, 117 Goals. Read the entire page →
From page 356... ... See also Cooperative Agreement Hepatitis A virus, 306 on Public Health Preparedness and Herd immunity, 18 Response for Bioterrorism, History, of public health disaster response, Continuation Guidance for; National 288�289 Bioterrorism Hospital Preparedness HIV infection Program Cooperative Agreement impairment of immune systems due to, Guidance; Supplemental Guidance 18, 128, 235 for Planning and Implementing the testing for, 237 National Smallpox Vaccination Homeland Security Act, 43, 52, 132, 138 Program threat levels under, 91, 165 comments about, 200�201 Homeland Security Advisory Council to states, 158 (HSAC) , 298 Guillain-Barr� syndrome, 147 Homeland Security Council (HSC) Read the entire page →
From page 357... ... , xvi, 11, 24� Implementation of the smallpox vaccination 25, 86, 91, 93 program, 3, 39�80, 226�242 Committee on Emerging Microbial Congressional interest and involvement, Threats to Health in the 21st 3, 58 Century, 205 extraordinary rapidity of, 3�4, 45�46 Committee on Smallpox Vaccination facilitating partnerships among public Program Implementation, xvi, 2, 84, health agencies and the first 98�99, 123, 125, 195, 203, 252, responder communities, 64�65 255, 285 factors compromising, 5, 60�61 The Future of the Public's Health in the major milestones and relevant events, 21st Century, 86 xvii, 41�58 Tools for Evaluating the Metropolitan noteworthy features of the program, 58� Medical Response System Program: 60 Phase I Report, 267 opportunities for learning, 63�65 Institutions other favorable outcomes, 65 policy context of smallpox preparedness program challenges, 60�63 in, 217 relationship between the civilian and when to close, 261 military vaccination programs, 59�60 Integrating smallpox preparedness into smallpox vaccination program timeline, overall public health preparedness, 39, 66�71 204�222 success factors for, 7 challenges in defining and assessing Inadvertent inoculation, 231, 234, 250. See public health preparedness, 6, 204� also Transmission of vaccinia to 210 contacts elements of smallpox preparedness, 210� Incident Command System (ICS) Read the entire page →
From page 358... ... See Institute of Medicine Lessons learned from the public health Iraq response to proxy events, 100, 288, 304�308 possible stocks of smallpox virus in, 26 war in, 26, 39, 50�51, 90 Lessons learned from the smallpox Iraq Survey Group, 91 vaccination program, 4, 63�64, 81� 107 Isolation procedures, 261, 278, 280, 310 absence of explicit scientific and public health rationale for the program, 81� J 96 administrative, need to review, 6 JCAHO. See Joint Commission on need to develop measures and indicators Accreditation of Healthcare for smallpox preparedness, 6 Organizations opportunities for scientific research, 6, Jenner, Edward, 10, 14 225, 242 Johns Hopkins University, Center for push for rapid implementation without Civilian Biodefense Studies, 15 adequate preparation, challenges Joint Commission on Accreditation of posed by, 60�61 Healthcare Organizations (JCAHO) Read the entire page →
From page 359... ... INDEX 359 clarity issues, 131 integrating smallpox preparedness into communication, 154�158 overall public health preparedness, communication planning, 2, 154�158 204�222 compensation for adverse reactions to pregnancy screening, 146, 231�233 the smallpox vaccine, 2, 61, 131�134 recommendations, 118�120 consistency in screening materials, 139� selected aspects of smallpox vaccination 142 program implementation, 226�242 general considerations, 127�136 vaccination of members of the general guidance to states, 158 public who insist on receiving informed consent process, 136�139 smallpox vaccine, 222�226 issues of timing, 129�130 Letter Report #5, 252�284 key messages, 127 applicability of scenarios to decision national security concerns and the making and management structure of unknown balance of risks and a smallpox response, 260�262 benefits, 127�129 applicability of scenarios to specific local opportunity costs, 136 circumstances, 259�260 overall progress at achieving the goals of caveats to consider in proposed the program, 158 "scenarios," 258�259 recommendations from, 111�114 comments about the draft readiness screening potential vaccinees, 139 indicators, 262�274 specific considerations, 136�159 committee tasks, 255 training and education, 150�153 description of the Public Health treatment of vaccine complications, 149 Preparedness Project, 253�255 workforce issues resulting from draft smallpox indicators and suggested vaccination, 134�135 criteria, 277�283 Letter Report #2, 162�194 essential capabilities needed for current program context, 163�164 preparedness, 284 focusing on preparedness, 165�169 general parameters of four scenarios to key messages, 164 assess smallpox readiness indicators, need for evaluation, 169�170 255�262 overarching issues of preparedness and learning from real-life experiences and evaluation, 164�170 hypothetical scenarios, 255�256 programmatic issues, 170�191 little variability in types of planning recommendations, 115�117 activities across scenarios, 260 Letter Report #3, 195 purpose, development, and use of four comments about the guidance, 200�201 smallpox "scenarios," 256�258 considerations for next steps in the recommendations, 120�121, 283�284 vaccination program, 197�199 utility of smallpox scenarios, 255�256 general comments, 196�197 Letter Report #6, 285�328 recommendations, 117�118 challenges and opportunities inherent in Letter Report #4, 203�251 integrating public health into a Advisory Committee on Immunization broader field, 292�299 Practices Smallpox Vaccine Safety charge to the committee, 4, 286�287 Working Group, 234�236 common definitions and terminology communicating about and coordinating needed, 297�299 the response to adverse events, 226� coordination issues, 292�297, 299 227 the evidence base from disaster research compensation available for smallpox and practice, 299�304 vaccine injuries, 2, 61, 240�242 integrating public health into disaster data systems used in smallpox preparedness and response, 288�292 vaccination program, 227�231 learning from the public health response evaluation and safety studies, 236�240 to proxy events, 100, 288, 304�308 Read the entire page →
From page 360... ... June 2003 ACIP recommendation to end Local and State Public Health Preparedness the smallpox vaccination program, 3, and Response Capacity Inventories, 57�58 320 the monkeypox outbreak, 55�56 Local circumstances, specific, applicability selected adverse events associated with of scenarios to, 259�260 smallpox vaccination among Local health departments, 88 civilians, 3, 50 local plans to respond to smallpox and supplementary funding for the smallpox other threats, 2, 192 vaccination program, 54�55 Logistics, for vaccination of members of the timeline of smallpox vaccination general public who insist on receiving program with number of weekly smallpox vaccine, 223 vaccinations and key events, 40 "Low-likelihood, high-consequence" events, vaccination program safety profile, 48�50 1, 7 the war in Iraq, 26, 39, 50�51, 90 Military smallpox vaccination program, 3, 9, 40�41 M in Finland, 47 pregnancy screening in, 231 Mass mailings, 157 size of cohort (much larger than Mass media references, 4, 41, 45, 172 civilian) , 170, 212 Mass vaccination, 211, 215, 310 Millennium Cohort Study, 60, 239 coordinated, 10 MIPT. Read the entire page →
From page 361... ... See Office of Domestic Preparedness Standards, 206, 220, 267 Office of Domestic Preparedness (ODP) , 121, National security concerns and the 287, 294, 304, 314�315, 325�326 unknown balance of risks and Homeland Security Grant Program, benefits, 127�129 294�295 National security program Urban Area Security Initiative Grant health component of, 5 Program, 294 imperatives of, 6, 210 Office of Public Health Emergency National Smallpox Vaccination Program, Preparedness, 236n xv, 96, 184 Office of Terrorism Preparedness and National Smallpox Vaccine in Pregnancy Emergency Response (OTPER) Read the entire page →
From page 362... ... See 42, 49, 93, 111�113, 126, 140, 145, also National Smallpox Vaccine in 182 Pregnancy Registry Pilot program, 119 recommendations regarding, 120, 146 "Placebo-controlled" trials, 316 Preparedness, 165�169. See also Planning activities, training-related, 153 Biopreparedness; Chemical Stockpile Planning assumptions, 302 Emergency Preparedness Program; Policy context of smallpox preparedness, 1, Cooperative Agreement on Public 3, 22�38 Health Preparedness and Response CDC's draft policy options, 28 for Bioterrorism; Council on Public CDC's efforts to inform government Health Preparedness; Evidence-Based policy, 30 Performance Goals for Public Health CDC's smallpox vaccination and Disaster Preparedness; National preparedness activities, 24�25 Bioterrorism Hospital Preparedness early news of the DHHS plan, 30�31 Program Cooperative Agreement evolution of the smallpox vaccination Guidance; Office of Public Health policy, 25�26 Emergency Preparedness; Policy funding for bioterrorism and smallpox, context of smallpox preparedness; 33�34 Public Health Competencies for institutional policy, 217 Bioterrorism and Emergency June 2002 ACIP meeting, 3, 27�29 Preparedness and Response October 2002 ACIP meeting, 32�33 Read the entire page →
From page 363... ... See General public Public Health Security and Bioterrorism Public Access and Records Office, 126 Preparedness and Response Act of Public accountability, democratic principle 2002, 23 of, 87 Public Health Service Act, 43 Read the entire page →
From page 364... ... Smallpox Indicators Real-life experiences, learning from, 255� Q 256 Recommendations, xvi, 3, 115�122, 283� Quality improvement, continuous, 263�264 284, 287�288, 325�326 Quarantine procedures, 261, 278 CDC safety system guidance to states, Questioning the enhancement of smallpox 114 preparedness, 5, 96�100 communicating about and coordinating absence of evidence of increased the response to adverse events, 115, preparedness, 98�100 119 focus on numbers instead of communication planning, 2, 114, 207 preparedness, 96�98 compensation for adverse reactions to the smallpox vaccine, 2, 61, 111� R 112, 117 comprehension of screening materials, Radiological Emergency Preparedness 112�113 Program (REP) , 315�316 data to assess vaccine and program Rapid public health response, 210�211, 214 safety, 116�117 Rapidity, of the implementation of the educating household contacts, 113 smallpox vaccination program, 3�4, to end the smallpox vaccination 45�46 program, 3, 57�58 Rare adverse reactions, monitoring for, establishment of a Data Safety and 145�146 Monitoring Board, 114 Rash, distinctive, a stage of smallpox, 13 evaluation and safety studies, 120 Rationale for the smallpox preparedness evaluation of risk factors for known policy, 5, 26�27. Read the entire page →
From page 365... ... reasons for declining vaccine, 113 Ring vaccination, 10�11 a standard for smallpox preparedness, Risk-benefit, of vaccination of members of 118 the general public who insist on strengthening preparedness by applying receiving smallpox vaccine, 224�225 research findings and experience in Risk factors, for known adverse reactions, bioterrorism preparedness, 287�288, evaluation of, 145 326 Risks training and education, 115�116 communicating, 268 using scenarios to test preparedness, 118 factors screened for, 47, 139 using the Evidence-Based Performance ratio to benefits, 1, 27, 84, 165, 223 Goals for Public Health Disaster Rosen, Peter, 347�348 Preparedness, 288, 326 Russia, possible stocks of smallpox virus in, using the pre-event vaccination system to 26 collect data on adverse reactions, 113 utility of the Active Surveillance System, 116, 119 S vaccination of members of the general public who insist on receiving Safety, 198 smallpox vaccine, 29, 118�119 collecting data on adverse reactions for, 152 workforce issues resulting from vaccination, 112 recommendations regarding further Red Cross, 290 studies, 114, 120 of vaccination of members of the general Remains, disposal of, 280 REP. See Radiological Emergency public who insist on receiving Preparedness Program smallpox vaccine, 224, 243 Safety profile Reporting adverse events, 185�187, 216 web page for, 186 assessment of, 142�149 Research findings establishment of a data and safety monitoring board, 147�149 on exercises, 313�314 and recurring themes, 300�301 evaluation of risk factors for known Resources (e.g., human, equipment and adverse reactions, 145 gathering data on background rates of supplies, communication) Read the entire page →
From page 366... ... See Smallpox Immunization Safety 220 System recommendations regarding, 118 Skepticism, among key constituencies, 5�6, Scientific and Policy Considerations in 83 Developing Smallpox Vaccination Skin conditions, confused with smallpox, 12 Options, 30 Skin reactions, a surrogate measure of Scientific and public health rationale for the immunity, 14 smallpox vaccination program, 81� Smallpox, 11�19. See also Indicators; 96 Variola virus CDC's role in providing scientific and conditions confused with, 12 public health reasoning for policy, contemporary circumstances of, 18�19 93�96 controlling and eradicating, 13 confusing and contradictory information a disease that does not exist, 1, 11 about the policy and the program, funding for, 33�34 89�90 in the historical context, 3, 9�21 input of key constituencies, 85�88 identifying, 12, 217 Read the entire page →
From page 367... ... " scenario approach, outbreak, 280 306�308 possible additional indicators, 282�283 Smallpox vaccination program. See also surge capacity at mass distribution sites Lessons learned from the smallpox for medical countermeasures, 278� vaccination program 279 considerations for next steps in, 197� Smallpox Modeling Working Group, 311� 199 312 milestones in implementing, xvii, 41�58 Smallpox outbreak Smallpox vaccination program challenges, defining, 281 60�63 medical care and monitoring for the data system, 62 potential victims of, 280 the informed consent process, 2, 61 notification of, 281 mechanisms for communication, 62 possibility of, 7, 11, 24, 26, 89, 208, a push for rapid implementation without 218, 261, 280 adequate preparation, 60�61 responding to, 283 strain the health care system is under, 63 Smallpox preparedness, 2, 210�219 Smallpox Vaccination Program Safety assessing, 204 Summary, 60 funding, 260 Read the entire page →
From page 368... ... See also Public interest Somalia, smallpox in, 11 to assess common adverse reactions, Soviet Union, fall of, 84 178�179 Special needs, panelist comments about Swine influenza campaign, 26, 86, 130, 261 populations with, 274 Specific considerations, 136�159 Stakeholders. See also Key constituencies T gaps and needs of public health Task Force on Community Preventive preparedness identified by, 272�274 Standard for smallpox preparedness, Services, 299 recommendations regarding, 118 TB. Read the entire page →
From page 369... ... See Patient Tuberculosis (TB) , resurgence of, 221 Vaccination Number Vaccination of members of the general Turning Point Public Health Statute Modernization Collaborative, 214 public who insist on receiving smallpox vaccine, 222�226 communication, 224 U logistics, 223 recommendations regarding, 29, 118�119 University of Pittsburgh Medical Center, resources, 223�224 Center for Biosecurity, 15 risk-benefit, 224�225 Urban Area Security Initiative Grant safety of, 224, 243 Program, 294 Vaccination program safety profile, 48�50 U.S. Read the entire page →
From page 370... ... See Weapons of Mass Destruction Vaccinia keratitis, 132 Vaccinia-specific antibody, 14 Woolson, Robert, 348 Vaccinia-virus, 126 Workers' compensation, 187�188 Workforce issues resulting from New York City Board of Health strain of, 15 vaccination, 134�135 transmission of, 9, 12, 48 recommendations regarding, 112 Working Group on Civilian Biodefense, 15 VAERS. See Vaccine Adverse Event Reporting System Working Group on Smallpox Vaccination, Variola virus, 9 47 World Health Assemblies, 10 identifying, 12 live, official repositories for, 11 World Health Organization (WHO) Read the entire page →

From page 349...

... See also Group, 47, 59�60, 183�185, 234, 241 Inadvertent inoculation; Transmission Advisory Committee on Immunization of vaccinia to contacts Practices Smallpox Vaccine Safety Accountability. See also Responsibility Working Group (ACIP SVS WG)

Index Pages 349-370

Index
Pages 349-370