Smallpox Vaccines: CDC Guidance and Preparedness Tabletop Exercise

By Jennifer Alton, Vice President of Government Affairs, Bavarian Nordic

Smallpox_vaccineThe tragic Ebola outbreak in West Africa is a contemporary reminder that humans are vulnerable to infectious diseases and that preparedness must remain a top priority. But Ebola isn’t the only health threat facing the global community. Other biological airborne threats – including smallpox – continue to pose public health and national security risks for communities across the country. State and local health officials are the nation’s first line of defense and must be adequately informed and provided with up-to-date training opportunities. To that end, a new resource from the Centers for Disease Control and Prevention (CDC) and an interactive tabletop exercise at the upcoming Preparedness Summit will help health officials bolster their knowledge and preparedness strategies.

Attendees of the 2015 Preparedness Summit are invited to play the role of state public health adviser on Tuesday, April 14 at 10:30 AM in room International 7 for Real-time Decisions: Interactive Smallpox Outbreak Tabletop Exercise. Dr. Craig Vanderwagen from Martin, Blank, and Associates will conduct this interactive tabletop exercise using news clips and real-time, wireless survey responses from the audience to explore the implications of a smallpox outbreak in the United States.

The exercise comes on the heels of the newly released “Clinical Guidance for Smallpox Vaccine Use in a Postevent Vaccination Program.” The new guidance is a collaboration between NACCHO, CDC, and the American Academy of Pediatrics that provides recommendations for persons at risk of smallpox infection after an intentional or accidental release of the virus.

CDC’s guidance outlines recommendations for the clinical use of the three smallpox vaccines stored in the Strategic National Stockpile (SNS): ACAM2000 and Aventis Pasteur Smallpox Vaccine (APSV), both replicating vaccines, and IMVAMUNE, a non-replicating vaccine. The guidance states that all people who have been directly exposed to smallpox will be offered one of the replicating vaccines, ACAM2000 or APSV.

Under the new guidance, people who have not been exposed to the virus, but who are at risk of smallpox infection, will also be offered replicating vaccines, unless they have certain conditions that put them at higher risk of serious side effects. Because the virus that makes up these vaccines can reproduce in human cells, vaccine-associated infections can occur in immunocompromised individuals, such as those with HIV infections or skin disorders like eczema. These individuals are at a higher risk of experiencing adverse events from the replicating vaccines, and therefore will be offered the non-replicating vaccine, IMVAMUNE. IMVAMUNE is stockpiled under a pre-Emergency Use Authorization, and is undergoing the final phase of testing for full FDA licensure, at which point it can be considered for use in all indicated individuals, regardless of exposure status to smallpox.

People with severely compromised immune systems are not expected to benefit from vaccination at all, so they would not be offered any vaccine, unless they have been directly exposed to smallpox, in which case they may be offered IMVAMUNE if smallpox antivirals are not available.

Guidance that offers direction to state and local health officials on how to allocate the nation’s stockpiled vaccines is critical to a prepared response. Yet it is only a single tool for decision-making at the state and local level. What medical interventions are still necessary? Do the allocation recommendations in the guidance make sense operationally? What non-medical interventions—closure of transportation hubs, social isolation, quarantine— should be priority? Interested Preparedness Summit attendees are encouraged to play the role of a state public health adviser and decide for themselves.

For more information on smallpox vaccines and the Strategic National Stockpile:

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