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Vol.1 • No. 4 • January 2003

What's new this month

Smallpox Vaccination Program
NYC Department of Health and Mental Hygiene's Information Sheet
NYC Department of Health and Mental Hygiene FAQ's

Reading the Signs



FDNY has been meeting regularly with the Department of Health and other NYC response agencies to formulate a plan of response for smallpox vaccination. The program remains in the early stage of development but it is expected that phase one will begin sometime in February. This phase will target primarily hospital care workers and some of our first responder members. We remain committed to providing this program to interested members while protecting the safety of our members. The most recent information from the Department of Health is provided, along with frequently asked questions about this immunization. More information will follow as we develop our FDNY vaccination program.

New York City Department of Health and Mental Hygiene's Information Sheet for Hospital-Based Health Care Workers on The Smallpox Vaccination Program

The World Trade Center attacks and the intentional outbreak of anthrax in the fall of 2001 have demonstrated that the threat of terrorism in New York City is real. As health care and public health professionals, we need to ensure our preparedness against future terrorist threats, including the threat of smallpox.

The federal government has announced its plans for a voluntary smallpox vaccination program for hospital-based health care workers and public health and safety workers. The purpose of this program is to protect those who would be called upon to take care of the initial victims of a smallpox attack. By volunteering for vaccination, these health care, public health and public safety workers are volunteering to be on our front lines of defense in the event of a smallpox attack.

The risk of a smallpox attack is unknown at this time. The federal government has no definite information that the smallpox virus might be used as a terrorist weapon. However, there are concerns that certain countries or groups may have this virus and might use it as a terrorist weapon against the United States.

In New York City, we are planning to form teams of volunteer health care, public health and public safety workers who will receive the smallpox vaccine and be our strategic reserves in the event of smallpox attack. These vaccinated teams will provide care for the initial victims, establish emergency vaccine clinics, conduct public health investigations and implement the public health measures that would be needed to control a smallpox outbreak rapidly and effectively, if one were to occur.

The New York City Department of Health and Mental Hygiene will work closely with our partners in the hospital community to be sure that this smallpox vaccine program is done as safely as possible. A critical part of this program will be making certain that anyone who volunteers to be on a health care smallpox response team is fully educated about the smallpox vaccine, including the potential risks of vaccination. In the absence of a smallpox outbreak or a definite and credible threat that a smallpox attack is imminent (or likely), vaccine will not be offered to anyone who has a medical condition that puts them at higher risk for a severe reaction to the smallpox vaccine. Since the smallpox vaccine contains a live virus, vaccine will also not be offered to anyone who lives with or has close intimate contact with someone who has a medical condition that puts them at higher risk for a severe vaccine reaction.

The first phase of this program will target health care personnel who work in acute care hospitals and will start in February 2003. After this first phase is completed, smallpox vaccine may be offered to all other health care personnel, as well as public health and safety workers. There is no recommendation to vaccinate the general public at this time. The fact sheet that follows is to help answer any questions that potential volunteers may have about smallpox, the smallpox vaccine and the City's vaccination plans.

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New York City Department of Health and Mental Hygiene
Frequently Asked Questions about Smallpox Vaccine and the Voluntary Program for Vaccination of Health Care Smallpox Response Teams

1) What is smallpox?
Smallpox is a virus that causes an illness with high fevers and a severe rash. The rash spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar, which can leave permanent scars when healed. The smallpox virus is contagious, though less contagious than viruses such as influenza and chickenpox. Up to one-third of persons who are infected may die.

The smallpox virus no longer occurs naturally, due to the success of the vaccination program led by the World Health Organization to rid the world of this disease. The last natural case of smallpox in the world was in 1977.

2) Is there any treatment for smallpox?
No. There is currently no proven treatment for smallpox. But scientists are evaluating new anti-viral medications. Early results from laboratory studies suggest that the anti-viral drug, cidofovir, may work against the smallpox virus; currently, studies with animals are being done to better understand this drug's ability to treat smallpox disease. However, this medicine has never been used to treat patients with smallpox so we can not be sure that it will work in people.

Patients with smallpox can benefit from supportive therapy (for example, intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

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3) What is smallpox vaccine?
The smallpox vaccine is a live virus vaccine that helps the body develop immunity (antibodies) to smallpox virus. It contains vaccinia virus, which is closely related to, but a different virus than smallpox virus. The vaccine does not contain the smallpox virus, and can not give you smallpox disease.

The vaccine is the best way to prevent smallpox disease and death in someone who may be or has been exposed to the smallpox virus. The vaccine protects against smallpox even if given up to 3 days after exposure. In the United States, we stopped routine use of smallpox vaccine for all persons in 1972, except for certain laboratory workers and the military. The military stopped using the vaccine in the mid 1980s. In most parts of the world, smallpox vaccinations ended by 1980.

4) What is this new smallpox vaccination program being started by the United States government?
The United States government has decided to offer smallpox vaccine to a small group of hospital, public health and public safety workers, as well as to some military troops overseas. About 500,000 civilian health care, public health and public safety workers in the United States will be offered smallpox vaccine during the next several months.

5) Since there is no longer any smallpox in the world, why is the United States government starting a new vaccine program?
The smallpox virus is still kept in government research laboratories in the United States and Russia. However, there are concerns that countries or terrorist groups hostile to the United States may have stockpiles of the smallpox virus. The risk of a deliberate release of smallpox as a biologic weapon is unknown, but if it did occur, there could be a large outbreak with many people becoming seriously ill, and up to one third dying. Therefore, the United States government has decided to prepare for a smallpox outbreak by vaccinating teams of volunteer hospital staff, public health and public safety workers before such an attack occurs. These persons would then be able to care for the first few patients until other hospital staff who are not yet vaccinated get the vaccine.

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6) What might we expect if an outbreak of smallpox occurred today?
If an outbreak of smallpox were to occur, several factors could contribute to a more rapid spread of smallpox than was usually seen before this disease was eradicated in 1977.

These factors include:

a) There are almost no persons who are immune (have protective antibodies) to smallpox due to the absence of naturally occurring disease worldwide and the end of routine vaccinations in the United States in 1972,

b) It may take longer for doctors to recognize the first cases of smallpox, as many doctors today are not familiar with smallpox disease, and

c) Smallpox virus may spread faster today due to the ease of travel and crowding of population compared to 30 years ago, when routine vaccination stopped.

Though outbreaks in the past have been controlled by rapidly vaccinating close contacts of smallpox patients (ring vaccination strategy), the success of this control was based on rapidly recognizing and isolating the first smallpox patients. The concern is that many doctors today have not seen smallpox and might not be able to recognize it in a timely manner before the outbreak spreads.

For these reasons, just one case of smallpox would require an immediate and coordinated public health and medical response to control the outbreak and to prevent further infection of susceptible individuals (people without immunity {antibodies} to smallpox). We would need vaccinated health care workers to care for the first victims. We would also need public health staff to work at emergency smallpox vaccine clinics as well as to find the close contacts of the initial smallpox cases who would be most at risk for smallpox infection.

We need to protect these health care, public health and public safety teams who will be essential to our response in the event of a smallpox outbreak. It is best if these first responder teams receive smallpox vaccine ahead of time, so they are ready to respond immediately as soon as the first smallpox cases are identified.

If there were a outbreak of smallpox, the federal government has enough smallpox vaccine for the entire country, if needed. By vaccinating health care and public health response teams ahead of time, we also would have emergency workers ready and able to give vaccine to all others who needed to be vaccinated after a smallpox outbreak had been confirmed.

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Reading the Signs

It is no secret that parenting is a confusing job in the best of times. The child who acts so lovingly towards his younger siblings may well be the terror of the schoolyard. Your teenagers who love to laugh can start crying their eyes out at the smallest disappointment.

In the wake of 9/11 determining whether or not your child is having real trouble or simply going through the normal rollercoaster of growing up is especially difficult. Nightmares and falling back on past misbehavior might be common. Children well aware of the pain caused by the tragedy may have trouble deciphering their feelings, let alone expressing them.

Though gauging your child's wellbeing is a difficult task, it is by no means an impossible one. School behavior and performance have proven to be good barometers of how your child feels. Children's anxiety may be acted out in an avoidance and irritability towards their classmates. A child who feels sad or hopeless may suddenly lose interest in extracurricular activities or lack motivation to study. Teenage children may show changes in appetite or sleep patterns, increased self-medication through drugs or alcohol, or a depressive indifference.

Volatility in children and teens is to be expected and for children of professional rescuers, it is doubly understandable in these uncertain times. So keep a close eye: note any drastic drop in grades and ask your child’s teacher to alert you to any problems with schoolwork, behavior, or mood. Show concern - not anger - about behavioral difficulties. Try to listen and love unconditionally and know when to seek help.

Don't hesitate to seek the advice of a child-behavior specialist if problems persist or worsen. The CSU has printed materials to help increase communication between parents and children of all ages. CSU staff also work closely with three well-respected children's programs that provide assessment and support to children and their families. To take advantage of these options, call Jason Leahey or Liza Frank at 212-570-1693 for more information.

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Dr. Kerry Kelly
Chief Medical Officer

Dr. David Prezant
Deputy Chief Medical Officer

Malachy Corrigan
Director, FDNY CSU

Mary T. McLaughlin
Director, FDNY BHS

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