Immunization Branch
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I. Scope of Response

Command structures for establishing the scope of a response must be established in advance. Contact lists should be distributed identifying technical staff responsible for surveillance and control measures during an outbreak. Standardized procedures for who should be informed must be created to ensure a coordinated response. Data from epidemiological investigations by state and local health officials, in collaboration with CDC epidemiologists will delineate the size of the outbreak. The amount of vaccine/prophylactic medication available, and the possibility that additional new and epidemiologically related cases will be identified in subsequent days will influence the response.

In addition to a contact list for technical staff the following lists should be created prior to a BT event:

• High-risk individuals
• Regional/Local Health Department Personnel
• Clinic personnel and volunteers
• Clinic location contacts
• Clinic support services (emergency services, law enforcement, sanitation, water, )
• Hospitals
• Clinical laboratories
• Pharmacies
• Translators/Language lines

II. Vaccination/Prophylactic Medication Estimates

For any level of response, there should be a plan for prioritizing selected groups to receive vaccine/prophylactic medication. Assess the potential number of clients based on the identified target population (high risk, geographic boundaries, etc…). Individuals classified as “high risk” are those workers deemed necessary to ensure a sustained response to a BT event.

High-risk workers include the following:

• Health-care workers and public health personnel involved in the distribution of vaccine/prophylactic medication
• Personnel involved with direct medical or public health evaluation, care, or transportation of confirmed, probable, or suspected patients
• Laboratory personnel collecting or processing clinical specimens from confirmed, probable, or suspected patients
• Persons responsible for community safety and security (e.g. police and firefighters)
• Groups likely to come into contact with infectious materials (e.g. laundry workers and medical waste handlers)
• Highly skilled persons who provide essential community services (e.g. nuclear power plant, telecommunications and electrical grid operators).

Local hospitals, clinics, public utilities, and other key agencies and businesses, should be directed to establish lists of high-risk employees. Information about immediate family size should also be collected. Vaccine/prophylactic medication estimates (high-risk + immediate family members) for key agencies and businesses should be given to the planning authority.

Figure 1. Example of form used to estimate vaccine/prophylactic medication needs for high-risk population

Figure 2. Example of clinic contact list with capacity and vaccine/prophylactic medication estimates

Comments (special needs or requirements for site):

Figure 3. Summary List of Clinics

XYZ County Clinics

Based on the estimates provided by key agencies and businesses, select sites for high-risk clinics. Estimate capacity and vaccine/prophylactic medications required by proposed clinic site.

Capacity (clients/hour)=Number of Clinicians (6 clients per hour)

Capacity may vary depending on the physical layout of each clinic, the speed of screeners and immunizers, and other factors. During an actual response to a BT event the vaccine/prophylactic medication estimates might be scaled back based on the epidemiologic investigation. It may not be necessary to vaccinate and/or treat all high-risk persons. Initial estimates reflect a "worst-case", community wide scenario. Local planning authorities may want to create high-risk lists for smaller, more manageable geographic areas within their jurisdiction.

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