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HomeMy WebLinkAboutAgenda - 02-17-2003-8kORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: February 17, 2003 Action Agenda Item No. ~- SUBJECT: Participation in the National Smallpox Immunization Plan and Protection for Participating Employees DEPARTMENT: Health PUBLIC HEARING: (Y/N) No ATTACHMENT(S): INFORMATION CONTACT: Rosemary Summers, ext. 2411 TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To consider participating in the smallpox immunization of essential County employees in response to the Centers for Disease Control and Prevention smallpox immunization program and to provide specific protection as noted in the recommendations for any employee who may experience illness as a result of the vaccine. BACKGROUND: North Carolina Public Health law places the responsibility for addressing communicable disease issues in a community with the public health entity in that county. In Orange County, the Health Department provides those services. These responsibilities include investigation, surveillance, prevention and treatment of specific communicable diseases, including smallpox. As part of emerging concerns regarding terrorism in the United States, the US Department of Health and Human Services through the Centers for Disease Control and Prevention (CDC) recommended a three stage plan to be implemented nationally. Stage I of the plan is designed to protect a small core of public health and hospital personnel who are most likely to encounter the disease if cases arose in a community. Stage II of the plan includes immunizing those needed for widespread vaccination efforts, all hospital staff, and other first responders such as emergency medical staff, fire and rescue and law enforcement staff. There are no specific plans to vaccinate more widely at this point in time. However, should an outbreak occur, implementation of Stage I and II would provide a protected population to respond appropriately. If the County does not have a core team protected, it would hamper a quick response to an identified outbreak. The likelihood of an outbreak being an isolated incident would be small and therefore response by surrounding counties that have protected teams would be difficult since they would be responding to their own communities' needs. The CDC has recently made smallpox vaccine available to states for Stage I of the immunization program. North Carolina received its first shipment at the end of January and 2 immunized State personnel, some Wake County Public Health employees, and the seven Public Health Regional Response Teams. The vaccine is expected to be distributed to local health departments sometime in February for implementation of each county's Stage I plan. There are a small number of health department employees identified to receive the vaccine in this stage (about 15). UNC Hospitals will also have personnel immunized in this first stage by health department staff. Orange County Public Health staff are responsible for immunizing the hospital personnel in Stage I, and it is a requirement that those who are vaccinating be vaccinated themselves to protect against inadvertent immunization. Hospital staff cannot move forward at this time until Health Department vaccinators have been vaccinated. Vaccination in the first two stages is strictly voluntary. The smallpox vaccine is a live vaccine, making it different from other vaccines that are commonly used today and there are some risks associated with taking the vaccine. Most people experience normal, usually mild, reactions that include a sore arm, fever, and body aches. People most likely to have serious side effects are those who would be excluded from vaccination based on present or past health conditions. In the past, about 1 person for every 100,000 people vaccinated for the first time experienced reactions that, while not life-threatening, were serious. Serious reactions would require medical attention. Based on past experience, it is estimated that 1 or 2 people in 1 million who receive the vaccine may die as a result. Careful screening of potential vaccine recipients is essential to ensure that those at increased risk do not receive the vaccine. Whenever possible, people that have had prior smallpox vaccinations will be revaccinated, lowering the risk. Health Department employees have already indicated their willingness to participate by being trained to conduct the vaccinations. Nationally, there has been much concern over liability issues for agencies and staff that participate in this effort. While Section 304B of the Homeland Security Act provides liability protection for agencies and staff that give the vaccine, there has not been as clear a guidance on protecting staff as employees from individual consequences in receiving the vaccine. Staff must be protected by the vaccine in order to administer the vaccine to others. However, the State is requiring all vaccine recipients to be volunteers. Careful screening of all persons receiving the vaccine should virtually eliminate the possibility of adverse reactions occurring from receiving the vaccine. Some staff may experience a few days of illness associated with receiving the vaccine. In addition, there may be adverse reactions to the vaccine that would require other health care intervention, although the likelihood of that is very small. It is the opinion of the Health Director that the health, safety and welfare of the citizens of the County require that essential volunteer County employees take the vaccine in order that there be sufficient immunized personnel to assist the public in the event of an outbreak. The recommendation below provides Orange County staff that volunteer to be immunized with protection in the event the employee becomes ill as a result of the smallpox immunization. Catawba County and Wake County have approved similar provisions and UNC Health Care System is considering a similar policy. There are several major hospitals in the state that have chosen not to participate in this vaccination effort; however, no health departments have to date refused participation. The County Attorney and the Personnel Director were extensively consulted in the development of the recommendations below and the County Attorney drafted the specific language included here. FINANCIAL IMPACT: The State is supplying the vaccine and all medical supplies for Stage I of the Smallpox Vaccination Plan. The County has trained five vaccinators from the health department that will provide all volunteers with vaccinations. In Stage II, the hospital will provide vaccinations for the remainder of its employees, while the Health Department staff will immunize the remaining volunteers. The cost at Stage I is minimal. Depending on the time frame required for the Stage II immunizations, there may be some cost associated with diverting staff from clinical or home visiting responsibilities while vaccinating others. It is expected that the State will provide the needed medical supplies in Stage II as well. In both Stage I and II, if 3% of the vaccine recipients are mildly ill (recent experience suggests 1-3% with mild symptoms), about 5 people would be taking sick leave from 1-5 days. In addition, the policy below would assist employees in bridging the gap between first becoming ill and when Workmen's Compensation begins. RECOMMENDATION(S): The Manager recommends that: 1. That the Health Director, or her designee, identify those County employees for whom immunization is recommended under Stage I of the Federal immunization program. The selection of such employees is in the sole discretion of the Director and is not subject to appeal by any employee. 2. If an employee who is so selected elects to take the vaccine, and, as a result of taking that vaccine, becomes ill and requires medical treatment, the County reimburse such employee any reasonable medical charges paid by such employee as a deductible or co-pay amount required by the County's health insurance plan, unless such deductible or co-pay amount is payable by workers compensation insurance or another health insurance policy. Subject to The North Carolina Worker's Compensation Act, N.C. Gen. Stat. § 97-1 et seq., determination of whether an illness is the result of taking the vaccine is in the sole discretion of the Health Director or her designee and is not subject to appeal by any employee. 3. If an employee who is so selected elects to take the vaccine, and, as a result of taking that vaccine, becomes ill such that absence from work is required, the employee shall be granted additional sick leave days for such absence, up to seven days (which coordinates with The North Carolina Worker's Compensation Act benefit waiting period). Subject to The North Carolina Worker's Compensation Act, determination of whether an absence is the result of taking the vaccine is in the sole discretion of the Health Director or her designee and is not subject to appeal by any employee.