OVERVIEW OF MEDICAL SCREENING AND

COUNSELING

Job Description For Staff

• Review medical history for clients with contraindications to vaccination and answer questions about informed consent

• Examine all forms for completeness of information for those clients discharged to the Vaccination Area

• Assist clients in completion of forms if necessary

DISCHARGE OF CLIENTS

• To the Vaccination Area for administration of the vaccine if it is determined there are no contraindications and the client is willing to be vaccinated.

• Exit the vaccination clinic if it is determined that the client has contraindications that make vaccination unwise or the client declines vaccination.

Smallpox Vaccine Contraindications and

Screening

Department of Health and Human ServicesCenters for Disease Control and Prevention

December 2002

Note: this graphic file matches the content of William Atkinson’s on-air presentation. A separate graphic file includes this information as well as information on contraindications and precautions to vaccination included on the smallpox vaccine administration videotape.

SMALLPOX VACCINE

• Vaccine contains live vaccinia virus which is administered into the superficial layers of the skin

• A successful vaccination produces a lesion on the skin that contains vaccine virus for up to 3 weeks.

• Vaccinia virus can be transmitted to household and other close contacts

• Candidates for vaccination must be screened for contraindications

• Certain medical conditions in the person’s household contacts must also be considered as contraindications for vaccination

• Serious allergic reaction to a prior dose of vaccine or vaccine component

• Children <12 months of age

• Moderate or severe acute illness

• Pregnancy or pregnant household contact

• Breastfeeding (because of close physical contact)

Smallpox VaccineContraindications and Precautions

(Non-exposure situations)

• Eczema or atopic dermatitis (current or past history) in the recipient or household contact• Acute, chronic, or exfoliative skin

conditions (until improved or resolved)• Immunosuppression in the recipient

or household contact

Smallpox VaccineContraindications and Precautions

(Nonexposure Situations)

SEVERE ALLERGIC REACTION TO VACCINE COMPONENT

• Urticaria, wheezing, anaphylaxis, difficulty breathing

• Reaction is to one of antibiotic components of vaccine, or to phenol

• New vaccines won’t have antibiotics

Screening for Pregnancy• In pre-event setting or post-event

without exposure, should NOT be given to:–pregnant women–women trying to become pregnant

• Educate women of child-bearing age about fetal vaccinia• Advise avoidance of pregnancy for 4

weeks following vaccination

Fetal Vaccinia

• Rare complication (<50 cases reported)• Usually following primary vaccination

of the mother in the second or third trimester• Fetal infection following vaccination in

the first trimester may result in spontaneous abortion• No known pattern of congenital

malformations

Fetal vaccinia

Examples of Immunosupressive Diseases• Leukemia

• Lymphoma

• Generalized malignancy (active)

• Solid organ or stem cell transplant

• Humoral or cellular immunity disorders

• Autoimmune diseases

• HIV infection

Examples of Immunosuppressive Therapy• Alkylating agents

• Antimetabolites

• Radiation

• High dose corticosteroid therapy:

–> 2 mg/kg/day, OR

–> 20 mg/day for > 14 days

Screening for HIV Infection

• Vaccine should NOT be administered to those with HIV infection or AIDS unless directly exposed to smallpox• Protective T-cell count unknown• HIV testing will not be readily available

in the post event setting, so educate regarding risk:–Risk of vaccine for those with

HIV/AIDS–Risk factors for HIV

Progressive Vaccinia• Occurs almost exclusively among

persons with cellular immunodeficiency• Can occur in persons with humoral

immunodeficiency• Can occur following revaccination of

people who have become immunosuppressed since their primary vaccination• Occurred 0.9-1.5 cases per million

primary vaccinations (rare but potentially fatal)

Progressive Vaccinia

• Primary vaccination lesion does not heal• Progresses to ulcerative lesion,

often with central necrosis• Little or no inflammation at the

site and generally little pain• Virus continues to spread locally

and through viremia

Progressive vaccinia

Screening for Eczema and Atopic Dermatitis

• Risk factor for eczema vaccinatum

• Do not administer if history of eczema OR atopic dermatitis

• Do not administer if household members have history of eczema OR atopic dermatitis

• Other acute, chronic, exfoliative conditions – wait until resolved or under good control

Questions and Information:• Have you or member of your household

been diagnosed with eczema or atopic dermatitis?

• Eczema/atopic dermatitis usually is itchy, red, scaly rash that lasts more than 2 weeks and comes and goes. If you or household member EVER had a rash like this, you should NOT receive smallpox vaccine, unless you are directly exposed to smallpox.

Screening for Eczema and Atopic Dermatitis

Examples of Acute/Chronic/Exfoliative Skin

Conditions• Varicella infection (Shingles or

Chickenpox)• Contact dermatitis• Active psoriasis• Burns• Impetigo• Herpes• Severe Acne• Darier’s Disease

Eczema Vaccinatum

• Generalized spread of vaccinia on the skin of a person with eczema or true atopic dermatitis, or a history of eczema or atopic dermatitis• Severity independent of the activity of

the underlying eczema• Severe cases among contacts of

recently vaccinated person• Occurred 10 to 39 cases per million

primary vaccinations (rare but potentially fatal)

Eczema Vaccinatum• Skin lesions may be papular,

vesicular, or pustular• May occur anywhere on the body• Predilection for areas of previous

atopic dermatitis or other abnormal skin, then spreads (non-centrifugal)• Patients often severely ill• Occurs 5 – 19 days post vaccination

Eczema vaccinatum

CONTRAINDICATIONS TO VACCINE IF EXPOSED TO

SMALLPOX:

• None.

• Benefits now outweigh risks.

For More Information

• CDC Smallpox websitewww.cdc.gov/smallpox

• National Immunization Program website

www.cdc.gov/nip