Avagene Moore: Welcome to the EIIP Virtual Forum! Avagene Moore: On behalf of my partner/associate, Amy Sebring and myself, we are pleased to see many familiar names with us today - it is also nice to see so many new "faces" present. Avagene Moore: For the benefit of newcomers to the Forum, you can click on any URL used today and the site will come up in your browser. For example, http://www.smallpox.gov . Since we will not be using slides in this session we suggest you visit any sites referenced after the dialogue today. Avagene Moore: If you have not reviewed today's background page, please take a few minutes later today and do so. There are some very valuable links included that will further add to your knowledge of today's topic. Avagene Moore: Because of the events of the past week, a lot of additional content is now available on these sites for the benefit of all US citizens. Avagene Moore: Please note that we are discussing planning for smallpox vaccination in terms of "pre-event" (before an outbreak of smallpox) and "post- event" (after an outbreak of smallpox.) Avagene Moore: After the formal part of our presentation, you will have an opportunity to ask questions of today's guest. I will give the protocol for doing that just prior to that segment of our hour. Avagene Moore: Our session is an interview format today. As the moderator, I will ask a few questions and my associate, Amy Sebring, will input the responses as provided by our speaker who is here and will be available for your real-time questions. Avagene Moore: And now it is my pleasure to introduce our speaker. ... Avagene Moore: After the attacks of September 11, 2001, Karen M. Becker, DVM, MPH, was called from her position at the U. S. Department of Human and Health Services' Office of International and Refugee Health to work in Secretary Tommy Thompson's Emergency Command Center. Avagene Moore: When the Office of Public Health Preparedness was created in October 2001, Dr. Becker came on board as a Senior Health Advisor to the Director, to develop programs that will strengthen state and local public health emergency preparedness. Avagene Moore: We are delighted to have you with us today, Dr. Becker. I am sure the members of our audience will have a number of good questions for you after the interview portion of our program. Karen Becker: It is a real pleasure to be here. Avagene Moore: Before we start, Dr. Becker - Karen - would you like to say hello to our audience? Avagene Moore: Thank you, Karen. We will now start - to our audience, may I suggest you jot down any questions you may have as we go along. That way you will be prepared when we are ready for the Q&A portion of the program. Karen Becker: Hello to all of my colleagues out in the field..... Avagene Moore: And now, for our first question ... Karen Becker: I hope to sometime have the chance to meet you all in person. Avagene Moore: What guidance has been given to the States for their pre-event vaccination planning? Amy Sebring: The CDC Draft Smallpox plan was developed and released to the states to assist them with their smallpox response plans. This plan identifies the public health and medical activities that must be undertaken to control an outbreak of smallpox and ... Amy Sebring: assists state planners with suggestions on how to accomplish these activities. In addition, guidance for developing a large-scale vaccination clinic plan has been released to state public health officials and emergency planners. Amy Sebring: Both of these plans as well as a template for hospital preparedness are accessible on the CDC website, along with many educational and training resources. Amy Sebring: Please also note that a number of new planning resources have also recently been posted to the CDC smallpox website at http://www.bt.cdc.gov/agent/smallpox/ including the guidance to the states. Amy Sebring: Specifically for pre-event vaccination, the goals of the National Smallpox Vaccination Program (NSVP) are to increase the nation's smallpox preparedness capacity by 1) offering vaccination safely to volunteer public health teams (smallpox response teams) and ... Amy Sebring: 2) offering vaccinations safely to key volunteer healthcare workers, (such as hospital staff) who would treat and manage any initial smallpox cases and suspect cases. Amy Sebring: Some of the highlights of the guidance to the states for pre-event vaccination are: Amy Sebring: * appointment of a state coordinator for the smallpox immunization program, description of the program operation and management and timeline for program implementation Amy Sebring: * identification of at least one public health smallpox response team, number of teams needed and their proposed composition, and timeline for their selection and vaccination Amy Sebring: * criteria for hospitals and healthcare workers expected to participate, estimated number of participants, and timeline for selection and vaccination Amy Sebring: * and other guidance pertaining to selection of clinic sites and vaccination teams, as well as other planning aspects for implementation. Avagene Moore: What is the review process for State plans for pre-event vaccination planning? Amy Sebring: States are just now turning in their response and large-scale clinic plans to CDC for review. Guidance for preparedness measures will be utilized for staff to review plans and help states identify areas where further planning may be needed. Amy Sebring: With respect to the pre-event vaccination plans, a system is in place to review the plans within 48 hours of their arrival by primary reviewers at the National Immunization Program, and ... Amy Sebring: then to subject matter experts in various centers for review of the more technical sections. The primary reviewers will make recommendations for overall approval/disapproval, based on the minimum requirements set forth in the guidance. Amy Sebring: CDC project officers will coordinate conference calls with the state program officials, primary reviewers and the subject matter experts to address any identified deficiencies in the most expeditious manner possible. Avagene Moore: Emergency Managers work closely with elected officials and first responders. What are the pre-event vaccination recommendations with respect to continuity of government functions? Amy Sebring: Public health planners and other community response planners and emergency managers are encouraged to work together to develop comprehensive and coordinated plans that ... Amy Sebring: integrate all necessary emergency response functions, including continuity of essential government functions. Vaccinations can and will be scheduled to prevent or minimize affect on essential government functions Avagene Moore: Assuming smallpox vaccinations will be voluntary, what information will be shared upon which individuals will base their decision and how will they get it? Amy Sebring: Yes, all vaccinations of smallpox response teams and healthcare workers will be strictly voluntary. Individuals will be provided with information about the vaccine, who should and shouldn't get the vaccine based on certain medical conditions,... Amy Sebring: what the expected normal reaction to vaccination would be, and what some of the more serious reactions are to the vaccine so that they can make up their own mind regarding the risks and benefits of smallpox vaccination. ... Amy Sebring: Vaccination will be provided in state based immunization programs that are currently being established by state public health officials. Avagene Moore: When it comes to post-event vaccination planning, that is an immunization program after an outbreak of smallpox has occurred, what resources are State and Local governments expected to provide? Amy Sebring: They are expected to provide the majority of the vaccination clinic manpower, including security, vaccination personnel, transportation modes, vaccine distribution, etc. Amy Sebring: In addition, pre-selection of clinic sites and setup protocols should be done as a part of state and local planning. Amy Sebring: Post-event vaccination activities include 2 areas: Amy Sebring: 1) Preparedness - Development of plans and pre-event vaccinations as we have just been discussing. In most cases, planning is being done by existing public health personnel, and ... Amy Sebring: 2) Response - Implementing smallpox control activities (case investigation and monitoring, disease surveillance, and vaccination programs). Amy Sebring: The occurrence of a smallpox outbreak would be considered a national emergency that would require diversion of all available state/local resources. Avagene Moore: What resources will the federal government provide? Amy Sebring: The federal government will provide vaccine through the national pharmaceutical stockpile in a smallpox outbreak. In addition, the government will provide manpower assistance to the extent that it can but ... Amy Sebring: in a nationwide response, state and local governments will most likely have to rely on local manpower resources to carry out the bulk of the vaccination activities. Amy Sebring: The Federal government has recently provided over $1 billion to assist state public health planners to enhance overall preparedness for bio terrorism. However these funds will not be available or sufficient to cover smallpox response activities. Amy Sebring: CDC is currently working to estimate the cost of conducting mass smallpox vaccinations. Avagene Moore: What is the current policy/strategy with respect to post-event smallpox (e.g. "ring" vs. mass immunization) and what are the priorities? Amy Sebring: The priority for vaccination in a smallpox outbreak is first identifying and vaccinating those that were exposed and their close contacts ... Amy Sebring: second, vaccinating those that have a high risk of exposure (responders that will be evaluating or caring for smallpox patients)... Amy Sebring: and then other responders that have a lower risk of contacting smallpox patients. In addition, local, state, and Federal planners are developing plans to expand to large-scale voluntary vaccination also if needed in a smallpox emergency. Amy Sebring: Ring vaccination (identifying, vaccinating and monitoring contacts to smallpox cases) is critical and will occur regardless of the extent to which broader population-based vaccinations occur. Avagene Moore: What is the status with respect to post-event vaccination planning by the States? Amy Sebring: States are in the process of finalizing their post-event plans and submitting them to CDC for review and comment. Amy Sebring: Pre-event plans are currently being reviewed by CDC. CDC is working with states to ensure that critical elements are being covered in the plans and will provide on-site assistance, if necessary, although ... Amy Sebring: so far no states have requested this. We expect that actual vaccinations of hospital and public health response teams will begin in late January. Avagene Moore: What local planning remains to be done? Amy Sebring: As local plans are completed, practicing and evaluating these plans is the most important next step. This will help familiarize responders and systems to their roles, identify gaps and weaknesses, and solidify coordination. Amy Sebring: In some cases, identification of specific clinic sites, and individual job assignments still need to be done. In most cases state and local public health agencies are still working with individual hospitals to identify the individual volunteers who will comprise the response teams. Avagene Moore: How will State and Local emergency managers provide input into these and future recommendations, plans, and policies? Amy Sebring: State and local emergency managers should work directly with public health, medical, and other response planners in their community in the refinement of these plans as they are being developed. Amy Sebring: Their input is important from the very beginning to assure comprehensive and coordinated plans. Avagene Moore: Thank you, Amy who spoke for Karen. We will now open up the session for Q&A. If you wish to ask Karen a question or make a comment, please input a question mark ( ? ) to the screen. There is no need to input your name - it will show up automatically. ... Avagene Moore: Start composing your question or comment but hold it until I call upon you by name. You will be called upon in the order your question mark was submitted. We appreciate everyone by honoring this protocol so we can keep order and make our time meaningful. Rick Tobin: ? Avagene Moore: Please input your ? now if you have a question for Dr. Becker. Amy Sebring: ? Rae Varian: ? Sunnie Baldwin: ? Avagene Moore: Rick, please input your question when it is ready. Others, please input your questions (?) too. Rick Tobin: I sat through the CDC class two weeks ago. Why isn't gamma globulin being included in the Nat. Pharmaceutical push packages? Santosh Kumar: What input in planning is needed for public health planners, from the emergency management officials Milford NH: ? Chris Waters: ? Rae Varian: A smallpox outbreak will immediately become a nationally declared disaster? K. Clark: ? Avagene Moore: Just a minute, Santosh. Request to speak and wait your turn. Everyone please abide by the rules. Karen Becker: VIG is going to kept in strategic sites within the stockpile, but at present there are limited supplies...... Sunnie Baldwin: Will NGO's be participating, if so, do we plan with our local EM's or will all direction be via National directives? Karen Becker: because we cannot afford to waste any, there will need to be a thoughtful process of making sure that VIG is indeed indicated.... Karen Becker: By September, we should have enough VIG from collecting plasma from vaccinees and harvesting antibodies to vaccinate the entire US population. Avagene Moore: Amy, you are next, please. Amy Sebring: I just wanted to comment Ava that I am sure Dr. Becker will also be interested in hearing about what our participants experiences with planning are so far also, so just a reminder that you can also enter comments with your question mark. Amy Sebring: When you are called on! Karen Becker: I am very interested to hear your experiences. Avagene Moore: Thank you, Amy. Rae, your question please. Santosh Kumar: May I ask my question Karen Becker: Rae--no.... Avagene Moore: For those who put in your questions early, you will have to redo them when I call upon you. When it is your turn, Santosh. Isabel McCurdy: ? Rae Varian: A smallpox outbreak will immediately result in a nationally declared disaster? Karen Becker: the response to a smallpox outbreak will depend opn the extent of the outbreak, its geographical distribution..... Karen Becker: the primary strategy is to vaccinate thoe contacts of cases, suspected contacts, and contacts of contacts.... Karen Becker: and of course make sure those investigating the outbreak and vaccinating, etc are protected.... Valerie Quigley: ? Karen Becker: the plan is not to panic and expand into a mass vaccinaiton unless it is indicated.... Karen Becker: a slow expansion of the ring dictated by the epidemiologic evidence is what we plan to do.... Karen Becker: but of course there will also be the political pressures that we need to deal with as well and what the public is demanding. Avagene Moore: Sunnie, please. Sunnie Baldwin: Sorry about the mishit. Someday I will get this computer down! Restate-Will NGO's be participating, if so, do we plan with our local EM's or will all direction be via National Directives from the respective NGO's? Amy Sebring: NGO=non governmental organization Karen Becker: All public health emergencies are local, and local participation is essential to a successful response.... Sunnie Baldwin: Thanks, we are currently participating at the advisory level Sunnie Baldwin: In our area of Texas Karen Becker: However, so that prpearedness and response efforts are coordinated, the State or Municipal Health Departments who are grantees of the BT funding...., who is th Karen Becker: funding...should bewho emergency managers and other responders should be working with.... Karen Becker: much of the smallpox planning and response efforts are linked to the critical capacities that have been included in the general state and municipal workplans which have all been approved... Sunnie Baldwin: We are networking through our Regional Planning Commissions and LEPC's. Is this the correct way? Sunnie Baldwin: Thanks. question answered. Karen Becker: In the guidance, we require that local involvement be demonstrated and we encourage emergency respondersto work closely with the state health departments and cities who are grantees. Avagene Moore: Santosh, now it is your turn, please. Karen Becker: Yes I think you are doing this correctly .... Karen Becker: but most importantly are you satisfied with the process so far? Santosh Kumar: Santosh - is there a criteria or indicator or any guidelines when we may have to switch from ring vaccination to mass vaccination Karen Becker: Tricky question and one that is often thought through when we practice scenarios..... Karen Becker: The knee jerk reaction will be to bow to political pressures from those who do not understand that smallpox does not spread like wildfire..... Milford NH: Is there a quarantine period for vaccinated , Santosh Kumar: Because I heard the mass vaccination is completely ruled out and ring vaccination will enhance to mass Karen Becker: This disease is less contagious than others such as influenza and measles..... Karen Becker: and public health experts believe strongly based on experience that we can control outbreaks with expanded and intensified surveillance... Santosh Kumar: What planning issues are required from EMA to the state planning Karen Becker: rigorous contact tracing... Karen Becker: and a good vacicnaiton strategy that reaches those who are vaccinating as well, incvluding first responders who are responding to community needs... Rick Tobin: ? Karen Becker: however, if smallpox begins to pop up in different places and public panic because of the unpredictability occurs.... Karen Becker: the President might be advised to begin mass b\vaccination... Karen Becker: however this is not a black and white issue... Bill Shoaf: ? Karen Becker: we might expand the ring strategy in some reigons without having to jump into a Naitonal mass vaccinaiton program.. Rae Varian: ? James Flach: ? Karen Becker: we can always expand the program but once we decide to mass vaccinate we cannot reverse this decision so we need to be very careful when making these decisions. Avagene Moore: Milford, please. (One question at a time please so everyone gets a chance to talk to Dr.Becker.) Karen Becker: ON quarantine.... Milford NH: Is there a quaratine period for vaccinated individuals? Karen Becker: I cannot recall from my history books or during my experience that quarantine has ever resulted in helping control an infecitous disease outbreak...... Karen Becker: The economic, ethical, and social implicaitons are enormous.... Karen Becker: both for the US and other ocuntries.... Karen Becker: While isolation of confirmed or suspected cases is important to disease control.... Karen Becker: quarantine often results in enormous economic losses.... Don Hartley: ? Marla Hoyos: ? Karen Becker: people rebelling.... Milford NH: If I receive a prophalactyc vaccination will I have to be quaranteened for a period of time? Karen Becker: and enormous other problems because we are obligated to make th\sure the quarantined people are taken care of..... Karen Becker: instead, a strong communication strategy to the public is essential.... Karen Becker: and we should be telling people to stay in their homes ansd not go out if at all possibile... Theresa Wigley: ? Karen Becker: sometimes when there is a quarantine one cannot even be sure if uninfected people are being kept confined with infected individuals. Avagene Moore: Chris Waters, please. One question at a time, please. Input another ? if you have something more to ask about. Thanks.(For those who are waiting, compose your question and hold until called upon by name.) Chris Waters: Since may first respnders will be police officers who have the least knowledge of the outward signs of small pox why aren't first responders vacinated at the same time as health workers, considering this also takes in large numbers of volunteer responders. Also has the question on product liability been addressed Johannes van Dam: You may already have addressed this, but for people who have been vaccinated in the past, what is the consensus on the duration of protection? Karen Becker: Police officers are not as likely to have direct and prolonged contact with peopleshowing symptoms i.e.rash and fever... Karen Becker: however, they will be part of the next phase of vacinnees... Karen Becker: we need to approach this carefully and slowly to justify the serious side effects of this vaccine.... Karen Becker: On liability.... Chris Waters: many rural areas a first responder will be onnscene for a period of time Karen Becker: this is being sorted and and is a very difficult issue.... Karen Becker: currently all vaccinators will be Federalized and the facilities will aslo be protected by the Federal Government... Karen Becker: However what is a more difficult issue and is not yet resolved is how to compensate those with adverse reactions that require medical attention... Karen Becker: However lawyers at HHS are working closely with us to try to figure out how to best deal with this complex issue. Avagene Moore: K Clark, please. If you came in late, there is a protocol for questions - put in a ? if you wish to speak. Thanks. Chris Waters: Thank you K. Clark: Are you saying that all vaccination sites will be protected by federal agents? Johannes van Dam: ? Karen Becker: NO I am sorry..... Karen Becker: what I meant to say that the places where vaccinations will be held will be government sites and will be protected under Federal Government liability regulations.... Jeff McClaran: ? Karen Becker: private doctors will not be vaccinating in their offices. Avagene Moore: Isabel, please. Isabel McCurdy: As a Canadian, are these vaccinations mandatory for American first responders? Karen Becker: No... Rick Tobin: One serious consideration for local planning is the double impact effect of innoculating hospital staff. Many hold jobs in two (or more!!) healthcare facilities. Simultaneous innoculations of staff could cripple a community's healthcare system. I hope they are considering the phased approach in their proposals. Karen Becker: this will be a voluntary vaccination program... K. Clark: So, you will be extending liability coverage to all participating non- public health agents, e.g. NGOs, hospitals, etc.? Rick Tobin: Sorry, hit wrong button. Karen Becker: while the military vaccinations are mandatory. Avagene Moore: Valerie, please. Valerie Quigley: What is the latest consensus on those of us who were vaccinated when we were kids? Are we still protected? Karen Becker: Unfortunately immunity only lastes about 10 years... Karen Becker: However, there is reasonable to assume that those who were vaccinated twice.... Karen Becker: have higher levels of immunity than those vaccinated once.... Valerie Quigley: I was told that those who were previously vaccinnated had few side effects with the second vaccination. True? Karen Becker: and it is thought that those who have been vaccinatated, while not completely immune against smallpox anymore.... Karen Becker: would be much less likely to suffer from an adverse vaccine reaciton...... Karen Becker: than someone who has never been vaccinated. Karen Becker: Rick.... Amy Sebring: ? Rick Tobin: We need to consider the impact of innoculating a complete community's healthcare workers at once. Many hold down jobs in two or more healthcare facilitieis. Peggy Peirson: ? Avagene Moore: Go ahead, Karen. Karen Becker: ZThe States have been asked to include in their plans the logistical issues of exactly how many people wioll be needed and how this can be done without devastating the continuity of operations for other health care needs. Steve Davis: ? Avagene Moore: Bill Shoaf, please. Bill Shoaf: At one point in time, small pox vaccinations were given to the public at large with the intent of eradicating the disease. The vaccinations were stopped when we believed we had obtained our goal. Now that we know this isn't the case, are there plans to eventually return to nation-wide vaccinations further down the road - when time and resources allow? Karen Becker: I would encourage you to look at your State's plan to see how this is being considered and dealt with. Karen Becker: Bill.... Karen Becker: This is a thought provoking question..... Karen Becker: if we have eradicated smallpox, and now we are thinking about vaccinating against this again..... Karen Becker: what does this mean for polio andothe rdiseases that we want to get rid of for good?..... Karen Becker: The Presdident announced last week that smallpox vaccine will be offered on a voluntary basis to Americans who want it.... Karen Becker: but without any disease I am not sure we can justify making it part of the National IMmunizaiton Program.... Karen Becker: but if we develop a safer vaccine this might become an option. Avagene Moore: Rae, you have another question for Dr Becker? Rae Varian: What would be a likely scenario for a smallpox outbreak? I'm developing an exercise and want to set the stage realistically.. Karen Becker: I would be happy to share with you some of the smallpox scenarios we have worked with.... Karen Becker: the most important thing to keep in mind is to keep it simple.... Karen Becker: and not creat an out-of -this workd scenario that we cannot even begin to know where to begin to deal with..... Sheena Vivian: ? Rae Varian: That would be great! Maybe offline. rae.varian@fema.gov Karen Becker: begin by practicing the basic infrastructure needs, such as how our communicaiton systems work. Avagene Moore: James Flach, next. We have 8 questions waiting and time is running short. James Flach: What plans are in effect to educate the general public now to avert panic in the event of a ring? Karen Becker: James, I am coming with an answer... Karen Becker: - Detailed information will be needed on an ongoing, real-time basis to inform policy makers, health officials, clinic managers, and the public about the status of smallpox response activities. Data must be analyzed and shared continuously to enable managers at all levels to identify and resolve problems, evaluate progress toward program objectives and redirect the activities, as necessary..... James Flach: But I worry about the unknowing public Karen Becker: There are existing CDC materials on hand but state and local planners... James Flach: making a ring containment impossible Karen Becker: are also being asked to develop specific communicaiton plans.... Karen Becker: so that public panic is averted and we are speaking with a credible and consistent voice. Avagene Moore: Don Hartley, your turn. Don Hartley: An issue that concerns me is once an outbreak occurs, no matter how contained or small, there will be a media feeding fenzy that will serve to create a more panicky public and increase political pressure for mass vacinations. Media competition and the show business aspect of today's journalism will only serve to exacerbate the problem. Avagene Moore: Do you wish to comment, Karen? Karen Becker: Our public affairs people are currently working on strategies to help minimize the damage done by some media mongers.... Karen Becker: There do exist good journalists who print accurate and useful informaiton..... Karen Becker: and we are working tostrengthen relationships with them and include them in our communicaiton plans at Federal and State levels ....... Karen Becker: these partnerships need to be developed ands strengthened now, not during the crisis... Karen Becker: and we need to come out frequently with public messages on the status of the situaiton to reassure the public we are keepoing them involved and updated on the status of the outbreak. Avagene Moore: Marla, your question or comment, please. Dr Becker will give us an additional 5 minutes. We may not get to all the questions unless we are very brief. Marla Hoyos: How long should a healthcare worker be out of work after receiving the prophylactic vaccine? It would be the 3rd time vaccination for me and it wasn't fun the 2nd time around. Karen Becker: We estimate that about 30% of vaccinees will take a day or two off of work.... Karen Becker: however we are not recommending that people stop working unless they feel that need to do so. Avagene Moore: Theresa, please. Theresa Wigley: Because of extreme cost of vaccination program , will any financial assistance be available for rural areas with one person in the health dept? Karen Becker: Last February the States recieved over 1 billion dollars to strengthen their ability to plan for and respond to public health emergencies.... Karen Becker: additional funds (about the same amount) will be made available for 2003... Theresa Wigley: post outbreak Karen Becker: additionally, there will be Federal assistance (vaccines from the stockpile, VIG if needed)... Theresa Wigley: thanks Karen Becker: CDC is also currently working to estimate the true cost of conducting more extensive vaccinaiton programs if necessary to make sure that your needs are met. Avagene Moore: Johannes, do you have another question? I believe your first one was answered earlier. Comment? Johannes van Dam: My question was the same as Valerie (duration of protection). Thanks for addressing this. Nice initiative, this chat room. Avagene Moore: Jeff, please. Karen Becker: I do not think I addessed his quesiton... Amy Sebring: (Jeff is gone.) Avagene Moore: Additional comment about duration of protection from vaccination, Karen? Karen Becker: Yes... Karen Becker: we are learning form the vaccine program which is going on in Israel at present and past studies... Karen Becker: there is waning immunity over time but no one currentl who was vacicnated with the old program can be considered protected from smallpox..... Karen Becker: we will certainly learn more as we begin to vaccinate so that we do not have to rely so heavliy on experiences over 30 years ago! Avagene Moore: Peggy, next, please. K. Clark: ? Johannes van Dam: You mentioned a consensus on duration of protection of 10 years after previous immunization. Karen Becker: about that plusd or minus. Karen Becker: a few years on either side Avagene Moore: Peggy, please. Do you have a question? Peggy Peirson: I was told that someone who had minimal scarring from an earlier vaccination could be concluded to have had a lesser immune response, and would therefore be less "immune" from the first innoculation. I.e., if you can't find your scar or it's very faint, you never got much benefit from the vaccination, and would be higher risk to receive it now again. (This from a physician.) Any truth to that? Karen Becker: Studies have shown.... Karen Becker: that it is difficult to draw a correlation between the visible scarring and the actual immune response elicited... Karen Becker: what really matters is the actual "vaccine "take" during the first week or so... Karen Becker: the best way to predict reacitons is to review the contraindicaitons for vaccinaiton(immunesuppressed, pregnant, eczema,etc).... Karen Becker: and to make sure you do not fall into the high risk category for adverse vaccine reactions. Avagene Moore: Steve Davis, please. We have two more questions after this one and cannot take anymore. Steve Davis: Is each state developing their own CONOPS for this or is their a standard approach being recommended/required (like the FRP, using ICS, etc.) so that the state-national interface works smoothly? I am hearing differing info on the use of ICS for managing an outbreak. Amy Sebring: ICS=Incident Command System Steve Davis: CONOPS= Concept of Operations Amy Sebring: FRP=Federal Response Plan Avagene Moore: Thanks, acronym police. Karen Becker: The CDC has guidance which should serve and has served as a template for the States so that there is some level of standardization to this process while also allowing flexibility. You can find these on the CDC webiste provided earlier. Avagene Moore: Sheena, please. Sheena Vivian: From the Canadian side: given that our countries have a tremendous amount of reciprocal travel, are smallpox vaccination plans being coordinated with Health Canada? Karen Becker: Yess....... Chris Waters: Hope this goes to you Amy and nt the board. ICS is required in az mat by fed regs. Terrorism is haz mat with an attitude Karen Becker: we are working closely with Canada on coordination of plans and in fact.... Karen Becker: I am working closely with Canadian colleagues at Health Canada in the planning for a smallpox Command Post Exercise... Sunnie Baldwin: Thanks for the excellent answers. Have a safe, good, RESTFUL holiday. bye, y'all !!! Karen Becker: we are also working closely with countries wihtin a group called the Global Health Security Action Group.. Sunnie Baldwin: sorry! Karen Becker: Just returned form a meeting in Mexico where our Health Ministers agreed that we should work together to share and coordinate plans. Avagene Moore: Last question - K Clark, please. K. Clark: Is INS making any provisions not to penalize the undocumented population in light of the vaccination registration requirements? Karen Becker: Yes..... Karen Becker: if there is a smallpox outbreak it is sound public health practice.... Karen Becker: to follow the strategy of vaccinating those exposed, contacts, and contacts of contacts.... Karen Becker: regardless of citizen status. Avagene Moore: We are out of time for this Virtual Forum. Karen, we are most appreciative of your time with us and for helping us better understand the smallpox vaccination program. ... Avagene Moore: Audience, you were great too! And we mustn't forget Amy who always does a great job. Thanks, Amy! Thank you all! ... Sunnie Baldwin: This laptop is going home to California (to the ASUS factory) for a tune-up over the holidays-the touchpad is very ill Avagene Moore: To take care of a little business - the transcript will be posted later today and can be accessed from the EIIP Virtual Forum homepage. ... Avagene Moore: If interested in subscribing to the EIIP Mail List go to our homepage http://www.emforum.org and click on Subscribe. ... Avagene Moore: If interested in being an EIIP Partner, click on Partnership on our homepage. From there, you can see who is partnering with us, the criteria for partnership and find the agreement form. Very simple. ... Karen Becker: I really enjoyed this forum and hope you all have a wonderful holiday and look forward to working with you in 2003!! Theresa Wigley: Thank you Dr. Becker, great forum. Isabel McCurdy: //rose //flagcan Sunnie Baldwin: Again, have a good holiday. Rick Tobin: Wow, this was very, very very helpful. I'd like a return visit in January, if possible. Avagene Moore: We recently welcomed the following new Partners - The ComCARE Alliance; Applied Info Institute of Argentina; Erie County (PA) Emergency Management Agency; ASPA; and SYTEX Group, Inc. ... Jennifer Suter: Clap, Clap, Clap !!! Avagene Moore: And finally - Happy Holidays to all!! Linda Underwood: Thank you very much! An excellent chat. Happy and safe holidays! Amy Sebring: Fabulous job! //tree Avagene Moore: The EIIP Virtual Forum is now adjourned. No rules or protocol now - please help me express our thanks to Dr. Karen Becker for a great job!