Smallpox Executive Summary

Department of Health and Mental Hygiene
Arlene Stephenson, Acting Secretary

Community Health Administration
Diane Matuszak, M.D., M.P.H., Director

January 6, 2003

Smallpox last naturally occurred in 1977, however, there is a potential for the use of smallpox as an agent of bioterrorism or biological warfare. CDC has requested smallpox response plans from each state and territory.

DHMH has primary responsibility for the health of the residents of Maryland. Emergency Preparedness activities are coordinated through the Office of the Deputy Secretary of Health for Public Health Services in concert with the 24 local Health Departments. Additionally, planning activities are coordinated with other response agencies such as Maryland Emergency Management Agency, Maryland Institute for Emergency Medical Services Systems (MIEMSS), Maryland State Police and local public safety agencies. DHMH’s Smallpox Interim Response Plan includes the following activities:

Pre-event phase:

• Training the health community to recognize the renewed potential for smallpox occurrence, to be knowledgeable of the clinical aspects of the disease and to be aware of the treatment potentials and outbreak control methods to be instituted.
• Developing of a robust communication system to enable consultation and notification of suspect cases. This system includes links from the health care provider and provider center through local Health Departments to DHMH. The information transmitted includes individual case information, Syndromic surveillance data for rash illness, and collective data. The links occur through telephones, faxes, electronic data transfers, etc.
• Developing of a core of response providers who would be capable of treating the first smallpox patients, providing epidemiological investigation of contacts of the initial cases, implementing vaccine strategies as outbreak containment measures, etc
  

  These teams take on two forms:

  • Public Health Response Teams: Responds to sites (hospital, clinic sites, residences) and provides clinical guidance, epidemiological investigation, initial vaccination and further vaccination guidance, isolation and quarantine guidance and support. In Maryland there will be 2 state-sponsored teams and approximately 78 local Health Department teams of 6-8 people each for a total of approximately 500 people. These teams will be trained, equipped and pre-vaccinated.
  • Hospital Health Care Teams: Provides care to the first smallpox patients and consist of health care providers, nursing staff, allied health care providers, ancillary service providers. In Maryland, all acute care hospitals are preparing teams of 50-250 people (dependent on size and vulnerability) for a total of approximately 5500 people.
• Developing a plan for expanding the ready force in a second phase of vaccinations to the remaining response communities including the remaining health care providers, traditional first responders (Fire/Rescue/EMS and law enforcement).
• Assuring appropriate legal and regulatory authority to activate a response and provide outbreak containment measures by analysis of current regulations and preparation of Gubernatorial and Secretarial Declarations and Authorization.
• Assuring adequate communications with the general public by preparing press releases and statements that can be readily utilized during an event, by providing education opportunities prior to the event and providing for those in whom English is not their first language.
• Assuring Laboratory capacity for safe handling of laboratory specimens used to rule out other vesicular rash illnesses and rule in smallpox.
• Assuring implementation of the plan, exercising the plan and review and update of the plan on a regular basis to maintain preparedness.

Event:

Developing a system to provide mass vaccinations that

• Provides adequate locations, monitoring, safety, storage and security. At least 30 sites have been identified. Software provided by CDC will be utilized for data management
• Providing adequate staff to vaccinate the entire population of Maryland in 10 days if necessary. This will enlist over 6000 people.
• Providing a coordinated epidemiological plan for investigation and follow-up of contacts of suspect cases, provide surveillance systems that can identify cases and track outbreak to monitor containment measure outcomes, provide adequate vaccination strategies for outbreak containment, provide policies for quarantine and isolation of cases and contacts.
• Providing communications to health care providers and the general public.

For security, safety and confidentiality reasons, DHMH will not release specific vaccination logistics, vaccine distribution information, county-specific data, or information specific to individual or hospital participation or non-participation.

Maryland Department of Health & Mental Hygiene -
Epidemiology & Disease Control Program
May, 2002