Vaccination plans raise host of questions
In a letter to the Advisory Committee on Immuniza-tion Practices, several national infection control organizations raised concerns about how the vaccination and follow-up would occur, including these:
• Health care provider’s occupational health function should include documentation of history of smallpox vaccination, history of any contraindications for vaccine, as well as a history of varicella immunization or disease.
• Simple, effective screening tool for high-risk indicators is necessary, if mass vaccination programs are to occur.
• Will vaccine used be new stock or reserved stock that must be diluted? Who will be responsible for the dilution?
• What personal protective equipment is required for dilution and/or administration of smallpox vaccine?
• What is the plan/priority for vaccination? Will previously vaccinated people be vaccinated after never-vaccinated individuals?
• There should be guidelines/criteria developed regarding pregnant women, immunosuppressed individuals, or those with dermatological conditions that address risk vs. benefit following exposure. Consideration should be given to the conditions under which public health concerns and the need to protect all citizens from smallpox change the recommendation for not immunizing these groups.
• Current recommendations are to recheck six to eight days post-vaccination and record response as major or equivocal. How will this be done?
• Specific recommendations regarding revaccination of equivocal or nonresponders will be needed.
Source: Association for Professionals in Infection Control and Epidemiology, Letter to the Advisory Committee on Immunization Practice, June 13, 2002.
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