1. Smallpox Vaccinee Evaluation and Follow-Up
WVDHHR/BPH
US Department of Health and Human Services
Centers for Disease Control and Prevention
December 2002 / January 2003

2. Smallpox Vaccinee Evaluation and Follow-Up
Learning Objectives:
Describe the “take” that can be expected after vaccination
Describe the care of the vaccination site
Describe the management of vaccinees after vaccination
Describe the system for vaccinee follow-up in West Virginia

3. Progression of smallpox vaccination site in a non-immunized person

4. Normal Response to Vaccination – “Take”
First (primary) Vaccination
Vesicular or pustular lesion
Area of definite palpable induration surrounding a center crust or ulcer
Revaccination
Less pronounced and more rapid progression
Pustular lesion or induration surrounding a central crust or ulcer
Take MUST be documented

5. Normal Variants Local satellite lesions Lymphangitis Local edema
Viral cellulitis
Swelling and tenderness of axillary lymph nodes, usually during 2nd week
Fever and malaise common

6. Satellite Lesion

7. Lymphangitis

8. Edema

9. Viral Cellulitis

10. Equivocal Reaction All responses other than major reaction or ‘take’
Caused by partial immunity, insufficiently potent vaccine, vaccination technique failure
Vaccination should be repeated ASAP, if possible

11. Vaccination Site Care
Virus can be recovered at site from time of papule until scab separates
Site should be kept dry and covered
Normal bathing can occur if covered by a waterproof bandage
Healthcare workers should keep site covered
Use gauze or similar absorbent material
Change gauze daily

12. Vaccination Site Care Cover this with semi-permeable dressing
Hand hygiene immediately after handling dressing or contact with site CRITICAL to preventing spread
Other infection control precautions to prevent contact with site
Clothing over site

13. Vaccination Site Care
Do NOT use semi-permeable dressing alone; could cause:
maceration of vaccination site
prolonged irritation and itching
increases touching/scratching, thereby contaminating hands
Designate staff to assess dressings daily

14. Administrative Leave
Do not need to place healthcare workers on leave, unless:
physically unable to work due to systemic signs and symptoms
extensive skin lesions or vaccination site that cannot be covered
healthcare workers do not adhere to infection control precautions and recommendations

15. Follow-up in West Virginia
Vaccinee take-home information:
List the number of the local vaccine safety monitor
Vaccine safety monitor
Monitor the vaccination site daily
Refer to Hospital Assigned Physicians for serious adverse events / questions
Support for HAPS / Vax Safety Monitor
IDEP:
CDC: contractor 800-###-#TBA

16. Twenty-one Day Diary Surveillance for mild adverse events
Record PVN for vaccinee on the form
Give to vaccinee at clinic
Educate them to record symptoms daily until day 21
Collect when the scab falls off.
Send to: IDEP
ATTN: Neely Kaydos-Daniels, PhD

17. Telephone Survey Patient Medical History Form has check-off:
‘Will you participate in a survey?’
If checked ‘yes:’ notify Neely Kaydos-Daniels, PhD:
Photocopy all forms immediately after vaccination clinic, OR
List name, phone, PVN AND
Fax: , OR
Mail: Room 125, 350 Capitol St / Charleston, WV 25301

18. Severe Vaccine Adverse Events
If VIG / Cidofovir is needed
Contact IDEP to initiate request
IDEP / physician will contact CDC
IDEP will work with physician to assure reporting
Reporting
Urgent
IDEP will assist with filing the report

19. Before you start, you must have:
Vaccine Safety Monitor
Site care education plan
Follow up plan
Hospital Assigned Physicians:
Infectious disease
Allergy/immunology
Neurology
Dermatology
Ophthalmology
Primary care

20. For More Information Coming soon: IDEP: 800-423-1271
CDC satellite training
MMWR
IDEP conference calls
IDEP:
CDC Smallpox website
National Immunization Program website