Smallpox Vaccination Plan

Department of Health Formulating
Post-Smallpox Vaccination Plan

Nashville, November 7, 2002

The Tennessee Department of Health is formulating a comprehensive plan that would enable the entire population of the state to be voluntarily immunized against smallpox in a ten-day period if necessary. The most efficient method of preventing smallpox is to immediately identify and vaccinate close contacts of cases, but in the event of one or more confirmed cases of smallpox in this country, a decision may be made to also offer vaccine to all persons in a city, state, or the entire nation.

"Although there has not been a case of smallpox anywhere in the world since 1977, we are concerned about the possibility of a smallpox outbreak in this country as a result of a bioterrorist event. The Tennessee Department of Health is in the process of putting into place a system capable of delivering whatever vaccine or treatment is needed to all residents of this state in a matter of days," said Health Commissioner Fredia Wadley, M.D. "The federal government currently has a large enough stockpile of smallpox vaccine to vaccinate every American in an emergency."

The Department of Health is developing a post-event smallpox preparedness plan, and last week met with regional health officials to initiate local planning activities for large-scale administration of vaccine. Health department staff will be working with community leaders to identify sites for vaccination clinics, to recruit and train volunteer groups to staff clinics, to prepare plans to move and store vaccine, to devise strategies to transport persons who need transportation, and to make plans for vaccinating people in prisons, hospitals and nursing homes. In addition, the Department will be identifying and training public health investigation teams across the state who could quickly and effectively respond to possible or confirmed cases of smallpox.

"This planning process will position us to make vaccinations available to the entire population over a 10-day period. To successfully accomplish that goal, we will need 117 clinics statewide which can serve 5,000 patients each per day. More than 25,000 people will be needed to staff those clinics for 16 hours per day," said Commissioner Wadley. "Vaccinating people for smallpox is not as simple as just giving the shot. It would also be important to identify those who are ill or who may have been contacts to someone with smallpox, and also to screen out individuals at highest risk of developing complications. People must be informed of possible risks so they can make an informed decision about whether to be vaccinated, and those who are vaccinated must be taught how to take care of the vaccination site to prevent the virus from spreading."

The smallpox vaccine is the only way to prevent smallpox infection and has been effective in preventing smallpox infection in 95 percent of those vaccinated. The vaccine is made from a virus called vaccinia which is another "pox"-type virus related to smallpox. It cannot give you smallpox, but it does carry some risks. Historically rates of complication for people receiving the vaccine for the first time are such that for every million people who receive the vaccine, about 15 will have life threatening side effects. The death rate is about one or two persons per one million people vaccinated. Past experience indicates that the first dose of the vaccine offers protection from smallpox for three to five years, and sometimes as long as ten years or more. If a person is vaccinated again later, immunity lasts even longer. Routine vaccination of the American public against smallpox stopped in 1972.

The U.S. government policy for voluntary smallpox pre-event vaccination is under consideration, but no decisions have yet been made and the Department of Health has not yet received planning guidance.