Reasonable Rascal
06-23-01, 17:27
Vaccinia (Smallpox) Vaccine: Recommendations of the ACIP, 2001 [excerpts]
---------------------------------------------These revised recommendations regarding vaccinia (smallpox) vaccine update the previous [US] Advisory Committee on Immunization Practices (ACIP) recommendations (MMWR 1991;40; No. RR-14:1-10) and include current information regarding the non-emergency use of vaccinia vaccine among laboratory and health-care workers occupationally exposed to vaccinia virus, recombinant vaccinia viruses, and other orthopoxviruses that can infect humans.
In addition, this report contains ACIP's recommendations for the use of vaccinia vaccine if smallpox (variola) virus were used as an agent of biological terrorism or if a smallpox outbreak were to occur for another unforeseen reason.
Variola virus is the etiological agent of smallpox. During the smallpox era, the only known reservoir for the virus was humans; no known animal or insect reservoirs or vectors existed. The most frequent mode of transmission was person-to-person, spread through direct deposit of infective droplets onto the nasal, oral, or pharyngeal mucosal membranes, or the alveoli of the lungs from close, face-to-face contact with an infectious person. Indirect spread (i.e., not requiring face-to-face contact with an infectious person) through fine-particle aerosols or a fomite [object] containing the virus was less common.
Vaccinia vaccine is a highly effective immunizing agent that enabled the global eradication of smallpox... As a result, recommendations for routine smallpox vaccination were rescinded in 1971. In 1976, the recommendation for routine smallpox vaccination of health-care workers was also discontinued. In 1982, the only active licensed producer of vaccinia vaccine in the United States discontinued production for general use, and in 1983, distribution to the civilian population was discontinued. All military personnel continued to be vaccinated, but that practice ceased in 1990. Since January 1982, smallpox vaccination has not been required for international travelers, and International Certificates of Vaccination forms no longer include a space to record smallpox vaccination.
Currently, international concern is heightened regarding the potential use of smallpox (variola) virus as a bioterrorism agent. Because of these concerns, ACIP has developed recommendations for vaccinia (smallpox) vaccine regarding the potential use of smallpox virus as a biological weapon. Additionally, recommendations regarding vaccination of persons working with highly attenuated strains or recombinant vaccines derived from highly attenuated strains of vaccinia virus have been revised.
VACCINIA VACCINE
Dryvax,® the vaccinia (smallpox) vaccine currently licensed in the United States, is a lyophilized, live-virus preparation of infectious vaccinia virus (Wyeth Laboratories, Inc., Marietta, Pennsylvania).
***** Vaccinia vaccine does not contain smallpox (variola) virus. *****
Previously, the vaccine had been prepared from calf lymph with a seed virus derived from the New York City Board of Health (NYCBOH) strain of vaccinia virus and has a minimum concentration of 108 pock-forming units (PFU)/ml. Vaccine was administered by using the multiple-puncture technique with a bifurcated needle. A reformulated vaccine, produced by using cell-culture techniques, is now being developed.
SMALLPOX VACCINE FOR BIOTERRORISM PREPAREDNESS
Although use of biological agents is an increasing threat, use of conventional weapons (e.g., explosives) is still considered more likely in terrorism scenarios. Moreover, use of smallpox virus as a biological weapon might be less likely than other biological agents because of its restricted availability; however, its use would have substantial public health consequences. Therefore, in support of
current public health bioterrorism preparedness efforts, ACIP has developed the following recommendations if this unlikely event occurs.
Surveillance
A suspected case of smallpox is a public health emergency... A suspected smallpox case should be reported immediately by telephone to state or local health officials and advice obtained regarding isolation and laboratory specimen collection. State or local health officials should notify CDC immediately if a suspected case of smallpox is reported...
Because of ... healthcare-associated smallpox transmission from imported cases present in a hospital setting, health officials should be diligent regarding use of adequate isolation facilities and precautions.
Currently, specific therapies with proven treatment effectiveness for clinical smallpox are unavailable. Medical care of more seriously ill smallpox patients would include supportive measures only...
Pre-release Vaccination
The risk for smallpox occurring as a result of a deliberate release by terrorists is considered low, and the population at risk for such an exposure cannot be determined. Therefore, pre-exposure vaccination is not recommended for any group other than laboratory or medical personnel working with non-highly attenuated Orthopoxviruses (see Routine Nonemergency Vaccine Use)...
Post-release Vaccination
If an intentional release of smallpox (variola) virus does occur, vaccinia vaccine will be recommended for certain directly exposed groups and other persons who have an increased likelihood of contact with infectious materials from a smallpox patient (e.g., personnel responsible for medical waste disposal, linen disposal or disinfection, and room disinfection in a facility where smallpox patients are present)...
Persons who have received a previous vaccination (i.e., childhood vaccination or vaccination more than 3 years before) against smallpox might demonstrate a more accelerated immune response after revaccination than those receiving a primary vaccination. If possible, these persons should be revaccinated and assigned to patient care activities in the early stages of a smallpox outbreak until additional personnel can be successfully vaccinated...
--
[The remainder of the report gives detailed and illustrated recommendations (with comprehensive referencing) on the following:
Symptoms
Vaccine Efficacy
Side Effects and Adverse Reactions
Precautions and Contraindications
Treatment for Vaccinia Vaccine Complications
Recombinant Vaccinia Viruses
Routine Non-emergency Vaccine Use
Routine Non-emergency Revaccination
Prevention Of Contact Transmission Of Vaccinia Virus
Vaccination Method
Evidence Of Immunity And Vaccination-response Interpretation
Vaccinia Vaccine Availability
Contraindications to Vaccination During a Smallpox Emergency
Infection Control Measures
VIG for Prophylaxis and Treatment of Adverse Reactions During a
Smallpox Emergency
URL to original source document and pics:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm
---------------------------------------------These revised recommendations regarding vaccinia (smallpox) vaccine update the previous [US] Advisory Committee on Immunization Practices (ACIP) recommendations (MMWR 1991;40; No. RR-14:1-10) and include current information regarding the non-emergency use of vaccinia vaccine among laboratory and health-care workers occupationally exposed to vaccinia virus, recombinant vaccinia viruses, and other orthopoxviruses that can infect humans.
In addition, this report contains ACIP's recommendations for the use of vaccinia vaccine if smallpox (variola) virus were used as an agent of biological terrorism or if a smallpox outbreak were to occur for another unforeseen reason.
Variola virus is the etiological agent of smallpox. During the smallpox era, the only known reservoir for the virus was humans; no known animal or insect reservoirs or vectors existed. The most frequent mode of transmission was person-to-person, spread through direct deposit of infective droplets onto the nasal, oral, or pharyngeal mucosal membranes, or the alveoli of the lungs from close, face-to-face contact with an infectious person. Indirect spread (i.e., not requiring face-to-face contact with an infectious person) through fine-particle aerosols or a fomite [object] containing the virus was less common.
Vaccinia vaccine is a highly effective immunizing agent that enabled the global eradication of smallpox... As a result, recommendations for routine smallpox vaccination were rescinded in 1971. In 1976, the recommendation for routine smallpox vaccination of health-care workers was also discontinued. In 1982, the only active licensed producer of vaccinia vaccine in the United States discontinued production for general use, and in 1983, distribution to the civilian population was discontinued. All military personnel continued to be vaccinated, but that practice ceased in 1990. Since January 1982, smallpox vaccination has not been required for international travelers, and International Certificates of Vaccination forms no longer include a space to record smallpox vaccination.
Currently, international concern is heightened regarding the potential use of smallpox (variola) virus as a bioterrorism agent. Because of these concerns, ACIP has developed recommendations for vaccinia (smallpox) vaccine regarding the potential use of smallpox virus as a biological weapon. Additionally, recommendations regarding vaccination of persons working with highly attenuated strains or recombinant vaccines derived from highly attenuated strains of vaccinia virus have been revised.
VACCINIA VACCINE
Dryvax,® the vaccinia (smallpox) vaccine currently licensed in the United States, is a lyophilized, live-virus preparation of infectious vaccinia virus (Wyeth Laboratories, Inc., Marietta, Pennsylvania).
***** Vaccinia vaccine does not contain smallpox (variola) virus. *****
Previously, the vaccine had been prepared from calf lymph with a seed virus derived from the New York City Board of Health (NYCBOH) strain of vaccinia virus and has a minimum concentration of 108 pock-forming units (PFU)/ml. Vaccine was administered by using the multiple-puncture technique with a bifurcated needle. A reformulated vaccine, produced by using cell-culture techniques, is now being developed.
SMALLPOX VACCINE FOR BIOTERRORISM PREPAREDNESS
Although use of biological agents is an increasing threat, use of conventional weapons (e.g., explosives) is still considered more likely in terrorism scenarios. Moreover, use of smallpox virus as a biological weapon might be less likely than other biological agents because of its restricted availability; however, its use would have substantial public health consequences. Therefore, in support of
current public health bioterrorism preparedness efforts, ACIP has developed the following recommendations if this unlikely event occurs.
Surveillance
A suspected case of smallpox is a public health emergency... A suspected smallpox case should be reported immediately by telephone to state or local health officials and advice obtained regarding isolation and laboratory specimen collection. State or local health officials should notify CDC immediately if a suspected case of smallpox is reported...
Because of ... healthcare-associated smallpox transmission from imported cases present in a hospital setting, health officials should be diligent regarding use of adequate isolation facilities and precautions.
Currently, specific therapies with proven treatment effectiveness for clinical smallpox are unavailable. Medical care of more seriously ill smallpox patients would include supportive measures only...
Pre-release Vaccination
The risk for smallpox occurring as a result of a deliberate release by terrorists is considered low, and the population at risk for such an exposure cannot be determined. Therefore, pre-exposure vaccination is not recommended for any group other than laboratory or medical personnel working with non-highly attenuated Orthopoxviruses (see Routine Nonemergency Vaccine Use)...
Post-release Vaccination
If an intentional release of smallpox (variola) virus does occur, vaccinia vaccine will be recommended for certain directly exposed groups and other persons who have an increased likelihood of contact with infectious materials from a smallpox patient (e.g., personnel responsible for medical waste disposal, linen disposal or disinfection, and room disinfection in a facility where smallpox patients are present)...
Persons who have received a previous vaccination (i.e., childhood vaccination or vaccination more than 3 years before) against smallpox might demonstrate a more accelerated immune response after revaccination than those receiving a primary vaccination. If possible, these persons should be revaccinated and assigned to patient care activities in the early stages of a smallpox outbreak until additional personnel can be successfully vaccinated...
--
[The remainder of the report gives detailed and illustrated recommendations (with comprehensive referencing) on the following:
Symptoms
Vaccine Efficacy
Side Effects and Adverse Reactions
Precautions and Contraindications
Treatment for Vaccinia Vaccine Complications
Recombinant Vaccinia Viruses
Routine Non-emergency Vaccine Use
Routine Non-emergency Revaccination
Prevention Of Contact Transmission Of Vaccinia Virus
Vaccination Method
Evidence Of Immunity And Vaccination-response Interpretation
Vaccinia Vaccine Availability
Contraindications to Vaccination During a Smallpox Emergency
Infection Control Measures
VIG for Prophylaxis and Treatment of Adverse Reactions During a
Smallpox Emergency
URL to original source document and pics:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm