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HomeMy WebLinkAboutMINUTES - 02112003 - SD.8 SD.8 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on February 11, 2003 by the following vote: AYES: Supervisors Gioia, Hilkema, Glover and DeSaulnier NOES: None ABSENT: Supervisor Gerber ABSTAIN: None The Board of Supervisors ACCEPTED the oral report from the Public Health Director on federal, state and local smallpox vaccination planning efforts. I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. Attested:February 11,2003 John Sweeten,Clerk of the Board of Supervisors and County Administrator By Deputy Clerk J*„N SEW'rter ti= DEPARTMENT OF HEALTH & HUMAN SERVICES Public Wealth Service Centers for Disease Control �dYYdttl and Prevention(CDC) Atlanta GA 30333 JAN 16 2003 Dear Colleague: We are at a crossroads in public health. In 1980, we eradicated smallpox as a naturally occurring disease. Now this contagious, deadly disease may be brought back as a biological weapon. The most effective tool we have against the disease is the smallpox vaccine, a vaccine not without its own risks. President Bush has initiated a national preparedness program to protect our citizens against smallpox as a biological weapon. Communities have been asked to form smallpox preparedness teams that are ready for a smallpox attack on this country. Some of you must now decide whether you will participate in this effort and receive the vaccination so that you might protect others. Your decision must be weighed carefully. As you consider your participation on a smallpox preparedness team,please read the materials in the enclosed Smallpox Pre-Vaccination Information Package before making your decision. The Vaccine Information Statement(VIS)and supplemental fact sheets and forms are included in this package. A list of materials follows: 1. Vaccine Information Statement 2. Smallpox Vaccine Information Statement Supplement A: Reactions after Vaccination 3. Smallpox Vaccine Information Statement Supplement B: Vaccination Site Appearance and Care 4. Smallpox Vaccine Information Statement Supplement C: Skin Conditions That Mean You Should NOT Get Smallpox Vaccine 5. Smallpox Vaccine Information Statement Supplement D: A Weakened Immune System Means You Should NOT Get Smallpox Vaccine 6. Smallpox Vaccine Information Statement Supplement E: Pregnancy and Breastfeeding Mean You Should NOT Get Smallpox Vaccine 7. Pre-Event Smallpox Vaccination Screening Worksheet If you have any doubts, you may discuss these issues with your healthcare provider prior to vaccination. Your safety is our highest priority. We recognize the decision about whether or not to participate in a smallpox preparedness team is difficult. We urge you to read, understand,and weigh all the information concerning your personal risks against your ability to help protect those in your community against a potential attack. We want you to err on the side of caution and not put you or your loved ones at risk of a serious adverse reaction. Page 2 - Dear Colleague On behalf of all of us in public health,we truly thank you for taking the time to make this important decision. Sincerely, rliu�eLouise Gerberdin M.P. or Enclosure SIR= s SMALLPDX FACT SHEET Smallpox Overview The Disease Smallpox Is a serious, contagious, and sometimes fatal Infectious disease. There is no specific treatment for smallpox disease, and the only prevention Is vaccination. The name smallpox is derived from the Latin word for"spotted" and refers to the raised bumps that appear on the face and body of an infected person. There are two clinical forms of smallpox. Varlola major Is the severe and most common form of smallpox, with a more extensive rash and higher fever. There are four types of variola major smallpox: ordinary (the most frequent type, accounting for 90% or more of cases); modified (mild and occurring in previously vaccinated persons); fiat; and hemorrhagic (both rare and very severe). Historically, variola major has an overall fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal. Variola minor is a less common presentation of smallpox, and a much less severe disease, with death rates historically of 1% or less. Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. The last naturally occurring case In the world was In Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because It was no longer necessary for prevention. Where Smallpox Comes From Smallpox Is caused by the varlola virus that emerged In human populations thousands of years ago. Except for laboratory stockpiles, the variola virus has been eliminated. However, In the aftermath of the events of September and October, 2001, there Is heightened concern that the varlola virus might be used as an agent of bioterrorlsm. For this reason, the U.S. government Is taking precautions for dealing with a smallpox outbreak. Transmission Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with Infected bodily fluids or contaminated objects such as bedding or clothing. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Humans are the only natural hosts of variola. Smallpox is not known to be transmitted by Insects or animals. A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person becomes most contagious with the onset of rash. At this stage the Infected person is usually very sick and not able to move around in the community. The Infected person Is contagious until the last smallpox scab falls off. DEPARTMENT of HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER-HKALTHIER• PEOPLE" Smallpox Disease Incubation Period Exposure to the virus is followed by an incubation period during which people (Duration:7 to 17 days) do not have any symptoms and may feel fine. This incubation period averages Not contagious about 12 to 14 days but can range from 7 to 17 days. During this time, people are not contagious. Initial Symptoms The first symptoms of smallpox include fever, malaise, head and body aches, (Prodrome) and sometimes vomiting. The fever Is usually high, in the range of 101 to 104 (duration: 2 to 4 days) degrees Fahrenheit. At this time, people are usually too sick to carry on their Sometimes normal activities. This is called the prodrome phase and may last for 2 to 4 contagious* days. Early Rash A rash emerges first as small red spots on the tongue and in the mouth. (Duration:about 4 days) Most contagious These spots develop into sores that break open and spread large amounts of Rash distribution: the virus Into the mouth and throat. At this time, the person becomes most contagious. £.; Around the time the sores in the mouth break down, a rash appears on the skin, starting on the face and spreading to the arms and legs and then to the hands and feet. Usually the rash spreads to all parts of the body within 24 hours. As the rash appears, the fever usually falls and the person may start to feel better. By the third day of the rash, the rash becomes raised bumps. By the fourth day, the bumps fill with a thick, opaque fluid and often have a depression In the center that looks like a bellybutton. (This is a major distinguishing characteristic of smallpox.) Fever often will rise again at this time and remain high until scabs form over the bumps. Pustular Rash The bumps become pustules—sharply raised, usually round and firm to the (Duration:about 5 days) touch as if there's a small round object under the skin. People often say the Contagious bumps feel like BBllets embedded In the skin. Pustules and Scabs The pustules begin to form a crust and then scab. (Duration: about 5 days) Contagious By the end of the second week after the rash appears, most of the sores have scabbed over. Resolving Scabs The scabs begin to fall off, leaving marks on the skin that eventually become (Duration:about 6 days) pitted scars. Most scabs will have fallen off three weeks after the rash Contagious appears. The person Is contagious to others until all of the scabs have fallen off. Scabs resolved Scabs have fallen off. Person is no longer contagious. Not contagious *Smallpox may be contagious during the prodrome phase, but Is most Infectious during the first 7 to 10 days following rash onset. For more information, visit www.cdc.govlsmalloox, or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Espahoi), or (866) 874-2546 (TTY) December 9, 2002 DEPARTMENT of HEALTH AWD HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER-HEALTHIER- PEOPLE" r SMALLPDX TM Pre-went Screening Worksheet for Smallpox Vaccine The smallpox vaccine contains a live virus that is closely related to the smallpox virus. Most people who receive this vaccine will not have any adverse reactions. However, some people should not receive the vaccine because they are at risk of having problems following vaccination. The smallpox vaccine is not like most other vaccines you may have received in the past. The vaccine virus can be spread from person to person, which means that problems following vaccination can occur both in the vaccinated person and his or her close contacts. Your close contacts Include everyone who lives in your household and anyone that you have close, physical contact with (such as a sex partner). Before being vaccinated, you should find out If you and your close contacts have any of the conditions listed below. Also write down the names and doses of all prescription medications that you and your close contacts take. Talk with your doctor or pharmacist If you are not sure. This worksheet contains questions designed to help you determine If you should not receive smallpox vaccine because of certain medical conditions that would place you or your close contacts at risk for a serious reaction from the vaccine, If you determine that you should not receive this vaccine, then you should not attend the vaccination clinic. Otherwise, you should bring the worksheet to the vaccination clinic after filling It out. If you are not sure about some responses, you should try to get the answers from your doctor before going to the vaccination clinic. Some of these questions are of a personal and sensitive nature. This worksheet will not be collected by those administering the smallpox vaccine Who should not receive smallpox vaccine? You should NOT receive the smallpox vaccine if you or a close contact has any of the conditions listed below. Close contacts include anyone living In your household and anyone you have close, physical contact with (such as a sex partner). Friends or people you work with are not considered close contacts. • Known or suspected HIVJAIDS infection. • A condition that impairs the immune system like leukemia, lymphoma, or a primary immune deficiency disorder. • Some severe autolmmune diseases such as systemic lupus erythematosus (SLE) that may significantly suppress the Immune system. • Use drugs that affect the immune system, like oral steroids (prednisone and related drugs), some drugs given for autoimmune diseases, or drugs taken In association with an organ or bone marrow transplant. • Are receiving or recently received chemotherapy or radiation therapy for cancer. • Currently pregnant or might become pregnant within 4 weeks after smallpox vaccination. Any woman who might be pregnant should perform a pregnancy test with a "'first morning„ urine sample on the day of vaccination. • Some skin diseases in childhood or adulthood, including atopic dermatitis or eczema. • A history (as a child or adult) of a RECURRING itchy, red rash that lasted more than 2 weeks and was located in the creases of the arms or legs (even If currently resolved). (Version 2) January 23, 2003 Page 1 of 7 DEPARTMENT OF HEALTH AND HUMAN 'SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER* HEALTHIER- PEOPLE' Pre-Event Screening Worksheet for Smallpox Vaccine (continued from previous page) • Darier's disease (keratosis follicularis), a skin disease that usually begins in childhood. • Had a serious, life-threatening reaction to smallpox vaccine in the past (does not apply to close contacts). Who should delay vaccination? You should delay receiving the smallpox vaccine if you meet any of the following criteria: • You are currently breastfeeding • You (or a close contact) currently have a skin problem that causes significant breaks in the skin surface, such as burns, severe acne, impetigo, chickenpox, shingles, poison ivy, or other rashes (including those caused by prescription medications). You are currently using steroid drops In your eyes. • You have a moderate or severe Illness (including an illness with a fever), You can receive the smallpox vaccine after the acute Illness or rash goes away, or after you stop using these medications, and your doctor approves the vaccination. What about HIV infection? Up to 300,000 people in the United States may be infected with the HIV virus and do not know it. You can have HTV infection and feel completely well. Although you may seem fine, if you have HIV infection you are at risk for serious, life-threatening reactions from this vaccine. If you do not know your HIV status, you should talk with your private doctor to decide if you should be tested before volunteering to get vaccinated. People with conditions such as HIV or AIDS that can suppress their Immune system are at higher risk for having severe adverse events after vaccination. Below is a list of factors that may place you at higher risk for having HIV infection. If any of these apply to you, you should strongly consider being tested for HIV before getting the smallpox vaccine. In addition, since some people with HIV do not have these risk factors, if you have any concerns please get tested. 1. Use of needles to inject anything nor prescribed by your doctor 2. Had an accidental needle-stick 3. Had sexual contact with someone who has HIV/AIDS or has had a positive test for HIV/AIDS virus 4. Had sexual contact with a prostitute or someone else who takes money or drugs or payment for sex 5. Had sexual contact with someone who has ever used needles to inject anything = prescribed by a doctor 6. For women: Had sexual contact with a man who has ever had sexual contact with another male 7. For men: Had sexual contact with another man Screening questions Please answer the questions on the following pages to help you determine if you should not get smallpox vaccine due to medical conditions or treatments that place you or your close contacts at greater risk for adverse reactions. Answer each question to the best of your knowledge. You may ask your health care provider or a clinic health care provider for assistance If you do not understand a question. If you need more information, visit www.cdc.Qov/smallpox, or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY). (Version 2) January 23, 2003 Paqe 2 of 7 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER• HEALTHIER• PEOPLE' Pre-Event Screening Worksheet for Smallpox Vaccine (continued from previous page) Conditions Do you have this condition? Does a close contact have this condition? I. Currently have cancer, or ® NO ❑ NO been treated for cancer within y the past 3 months Do not get vaccinated Do not get vaccinated 2. An organ or bone marrow ❑ NO ® NO transplant Do not get vaccinated Do not get vaccinated 3. A disease that affects the ❑ NO ❑ NO immune system like y lymphoma, leukemia, or a Do not get vaccinated Do not get vaccinated primary immune deficiency disorder 4. An autoimmune disease such © NO ❑ NO as systemic lupus erythematosus (SLE), that may Do not get vaccinated until Do not get vaccinated suppress the immune system you check with your doctor until you check with your - contact's doctor 5. Currently pregnant or might FEMALES ONLY: ❑ NO be pregnant. A pregnancy test is recommended if there is ANY ® NO chance you might be pregnant Do not get vaccinated (When did your last menstrual Do not get vaccinated period begin? /____j ) 6. Currently breastfeeding ❑ NO Not applicable Delay vaccination until you are no longer breastfeeding - 7. An allergy to polymyxin B, ❑] NO Not applicable streptomycin, chlortetracycline or neomycin Do not get vaccinated (Version 2) --___ -January 23, 2003 - -- - - -- Page 3 of 7 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREvENTION SAFER•HEALTHIER• PEOPLE" Pre-Event Screening Worksheet for Smallpox Vaccine (continued from previous page) Conditions Do you have this condition? Does a close contact have this condition? 8. Had a serious, life- ❑ NO Not applicable threatening reaction to smallpox vaccine at any time in Do not get vaccinated your life 9. Have Darier's disease, a skin ❑ NO ❑ NO problem that usually begins in childhood Do not get vaccinated Do not get vaccinated 10. Ever given a diagnosis of ❑ NO ❑ NO atopic dermatitis or eczema by a doctor, including as a baby or child Do not get vaccinated Do not get vaccinated 11. Currently have a skin ❑ NO ❑ NO problem that causes significant breaks In the skin surface These problems include burns, Delay vaccination until Delay vaccination until severe acne, poison Ivy our skin is healed chickenpox, shingles, or other y your contact's skin is healed rashes (including those caused by prescription medications) Please answer `yes' or`no' to indicate if you or a close contact is currently receiving any of the following treatments or drugs. Talk to a health care provider if you are not sure. I t Treatments Are you receiving this Is a close contact receiving medication or treatment? this medication or treatment? 12. Intravenous steroids or oral ❑ NO ❑ NO steroid pills or capsules (Prednisone or related drugs) Do not get vaccinated Do not get vaccinated taken for 2 weeks or longer Name and dose of medication: Dame and dose of medication: within the past month (Version 2) January 23, 2003 Page 4 of 7 DEPARTMENT OF 14EALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER•HEALTHIER• PEOPLE' Pre-Event Screening Worksheet for Smallpox Vaccine (continued from previous page) Treatments Are you receiving this Is a close contact receiving medication or treatment? this medication or treatment? 13. Drugs that affect the ❑ NO ❑ NO immune system like y methotrexate, Do not get vaccinated Do not get vaccinated cyclophosphamide, and Name and dose of medication: Name and dose of medication: cyclosporine, among others, within the last 3 months 14. Radiation therapy In the ❑ NO ® NO past 3 months Do not get vaccinated Do not get vaccinated 15. Chemotherapy for cancer in ❑ NO ❑ NO the past 3 months Do not get vaccinated Do not get vaccinated 16. Currently use steroid drops ❑ NO Not applicable in your eyes Do not get vaccinated 17. Do you currently have a moderate or severe illness? YES -* You must wait until this illness goes away before you get vaccinated © NO Some Individuals may not be sure If they have had eczema or atopic dermatitis. The following questions are designed to help you determine if you should not get vaccinated because you or a close contact may have a history of atopic dermatitis or eczema. 18. Do you currently have an Itchy red rash that comes and goes but usually lasts more than 2 weeks, or did you have such a rash as a baby or child? YES You may have eczema or atopic dermatitis. You should discuss this possibility with your doctor. Please answer questions 19 and 20. ❑ NO KIP Tt9 q iestlon 21 ❑ Don't know -+ You should discuss any rashes you have with your doctor. If you can, please write down any information given to you by a doctor regarding this rash: (Version 2) January 23, 2003 Page 5 of 7 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER+HEALTHIER• PEOPLE"" Pre-Event Screening Worksheet for Smallpox Vaccine (continued from previous page) 19. Did the Itchy rash affect the creases of your elbows or knees? i YES ­).You likely have eczema or atopic dermatitis and should NOT get vaccinated at this time ❑ NO Don't know 20. Did you have food allergies as a baby or child? ❑ YES ❑ NO -4 SKIP TO question 21 ❑ Don't know IF YES Do you also have asthma or hay fever? YES You likely have eczema or atopic dermatitis and should NOT get vaccinated at this time ❑ NO 21. Does a close contact currently have an Itchy red rash that comes and goes but usually lasts more than 2 weeks, or did a close contact have this condition as a baby or child? ❑ YES -).Your close contact may have eczema or atopic dermatitis. Discuss this possibility with a doctor. ❑ NO ❑ Don't know --- You need to find out more about your contact's rash before getting vaccinated. If you answered "YES' or `Don't know'to question 21, more Information is needed about your close contact before you get the smallpox vaccine. If you do not know the answers to the questions below, please ask the appropriate person to help you answer them. A parent should answer these questions If they apply to a child. 22. Ask your close contact if he or she has an Itchy red rash that comes and goes but usually lasts more than 2 weeks, or if this person had such a rash as a baby or child? ❑ YES -i Your close contact may have eczema or atopic dermatitis. Please gather information so that questions 23 and 24 can be answered. Check with the contact's doctor about the rash. ❑ NO If you can, please write down any Information given by a doctor regarding this rash: 23. Did the itchy rash affect the creases of the elbows or knees? YES -* Your close contact likely has eczema or atopic dermatitis and you should NOT get vaccinated at this time ❑ NO ❑ Don't know (Version 2) January 23, 2003 Page 6 of 7 - DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER• HEALTHIER• PEOPLE" Pyre-Event Screening Worksheet for Smallpox Vaccine (continued from previous page) 24. Did the person with the rash have food allergies as a baby or child? YES ❑ NO ❑ Don't know IF YES-+ Does the person with rash and food allergies also have asthma or hay fever? -� Your close contact likely has eczema or atopic dermatitis and you should NOT get vaccinated at this time ❑ NO Don't know For more information, visit www.cdc.govlsmallaox, or call the CDC public response hotline at (888) 246-2575 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY) (Version 2) ___ -- -Ja_nuary 23, 2003 Page 7 of 7 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER- HEALTHIER- PEOPLE'