TRANSCRIPT

Decision Point for the Smallpox Vaccine Candidate

### 11 minutes 15 seconds

#### 

**NARRATOR:**

#### Now an important message regarding receiving the smallpox vaccination by the Director of the Centers for Disease Control and Prevention, Dr. Julie Gerberding.

**DR. GERBERDING:**

Hello. Today we are taking another step forward in our nation\'s
preparedness for terrorism. Although the threat of smallpox is not
imminent, there is a possibility of intentional release by
bio-terrorists. You are being offered the chance to receive smallpox
vaccine now so that you will be better prepared to assist in the
response to a smallpox outbreak.

We thank you for considering this call to service. You may be on the
frontlines should the

unthinkable happen - a smallpox attack. If you receive the smallpox
vaccination today, you will be accepting risk to yourself and your
family in order to protect our country. For this, you have our deepest
gratitude. I want to again review the key considerations.

You must be very aware of your own medical conditions that could
increase your risk of vaccine side effects. If you live closely with
others, you must consider their health status as well. We want you to
err on the side of caution and not put yourself or your loved ones at
risk of an adverse reaction if you have any doubts. Once in a great
while, someone who is otherwise completely healthy may have an adverse
reaction.

People who are vaccinated will need to follow the instructions on caring
for the smallpox vaccination site to avoid transmission of the vaccine
virus to themselves or others, especially family or household members.
Your safety is our highest priority. Vaccination is voluntary.

This video is designed to talk you through the major risks,
contraindications, and screening considerations to ensure you can make
an informed decision about vaccination. More information can be found in
your patient advice package. Please review all the materials prior to
vaccination.

Now, let\'s talk a little bit more about the vaccine itself. The
smallpox vaccine contains a virus called vaccinia virus. This virus is
related to the smallpox virus, but does not cause smallpox.

Since vaccinia virus is a live virus, it is possible for you to spread
the virus from the vaccination site to another part of your body, or to
someone close to you by touching the site and then touching someone
else. This can be prevented by proper care of the vaccine site. The
smallpox vaccine does pose a risk of some serious side effects. With
careful screening, we can identify those who might have problems,
discourage vaccination, and therefore avoid many of these complications.

# Some of the groups we know are at risk for these include: 

-   Those with HIV infection or AIDS

-   Those with a weakened immune system, which can be caused by certain
    medical conditions or drug treatments.

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-   Those who have eczema or atopic dermatitis now or at any time in the
    past

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-   Those who currently have an active acute or chronic skin condition
    like burns, severe acne or psoriasis. (If you have one of these
    conditions, you should wait until it resolves prior to receiving
    vaccine) and,

-   Those who are pregnant or breastfeeding should not receive the
    vaccine.

If you fall into ANY of these groups, you should not get the smallpox
vaccine at this time.

Also, if you have a close contact or a household member with any of
these conditions, you should not get the vaccine because of the risks it
poses to them if accidentally transmitted in your home. In addition, if
you have a serious allergy to one of the vaccine components, you should
not receive the vaccine. If you have a temporary condition, you can be
reconsidered for vaccination after it has resolved. If you\'re not sure
whether or not you have these conditions, you should contact your
personal healthcare provider.

Now, let\'s talk in more detail about important screening: first, HIV
infection. About 300,000 people in the United States are infected with
the HIV virus and do not know it. You can have HIV infection and feel
perfectly fine. People with HIV infection can have suppressed immune
systems that increase the risk of having a severe skin rash or blood
infection from the live virus in the vaccine. If you have not had a
recent HIV test and any of the following conditions hold true for you,
you should be tested for HIV infection prior to getting a smallpox
vaccination.

# You may be at risk for HIV if you:

-   Used needles to take drugs or steroids not prescribed by a doctor

-   Had a blood transfusion prior to 1987

-   Had a organ, tissue or bone marrow transplant

-   Had a bone or skin graft from someone other than yourself

-   Came into contact with someone else\'s blood

-   Had an accidental needle stick

-   Had sexual contact with someone who has HIV infection or AIDS

-   Had sexual contact with a prostitute, or someone who takes money or
    drugs or payment for sex

-   Had sexual contact with someone who uses needles to take drugs

-   Had sexual contact with a man who has had sex with another man.

If you are not sure about your HIV risk, make sure. Get an HIV test. The
vaccine clinic personnel or your healthcare provider can help you find a
testing site. In the meantime, you do not have to state why you are
deferring vaccination today.

Another important screening consideration is pregnancy. Live viral
vaccines like the smallpox vaccine are not recommended during pregnancy.
Women who get the smallpox vaccine while they are pregnant have a higher
risk of a miscarriage or stillbirth. So for non-emergency indications,
smallpox vaccine should not be administered to pregnant women or to
persons who have household contacts who are pregnant. If there is a
chance you could be pregnant, you should not be vaccinated today. Make
sure. Get a pregnancy test. You can return for vaccination later. Also
pregnancy should be avoided for at least one month after vaccination.
Another consideration for women is breastfeeding. Women who are
breastfeeding should not be vaccinated because of the increased chance
of transmission to the breastfeeding infant.

Now I\'d like to talk about how to take care of the vaccine site. Proper
hand hygiene and care of the vaccine site will prevent spread to close
household contacts including infants. If you are not confident that you
can adhere or follow the instructions you should not vaccinated. You
will develop a lesion at the vaccine site that contains the vaccinia
virus. If you touch your vaccination site or bandage and touch other
parts of your body or touch other people, you can transfer the virus.
Careful hand hygiene, either washing with soap and water or applying an
alcohol-based hand sanitizing agent, will decrease the chance of
transfer after contact with the vaccine site or bandages. Hand hygiene
is especially important prior to touching your eyes. If you wear contact
lenses or your eyes are irritated, please be especially careful to avoid
infecting your eyes.

# Now, what should you expect after vaccination? 

You may experience swelling and tenderness of underarm lymph nodes
beginning 3 to 10 days after vaccination. In recent studies, 17 percent
of adults had a fever greater than 100 degrees in the 2 weeks after
vaccination.

# Other normal local reactions can include:

-   Local satellite lesions, (small lesions around the main site),

-   Considerable local swelling or edema and

-   Intense inflammation and redness

Up to one third of adults may be ill enough to miss work, school, or
recreational activities, or have trouble sleeping. On occasion, more
serious reactions and even life threatening reactions can occur.

Please read the information about these reactions that is included in
your advice package. Remember, if you experience ANY unusual or alarming
reactions following vaccination, you should see a clinician.

You have been asked to review a lot of information, and have been given
a lot of things to think about. The decision to get the smallpox vaccine
is yours to make. We want you to be honest with yourself about your
risk. If you have any doubt, don\'t get vaccinated today.

The patient advice packet you have been provided contains information we
just covered and much more. The VIS, or vaccination information
statement, summarizes the critical facts about the smallpox vaccine.
Please read the materials carefully and talk to someone from the vaccine
clinic team, or your own clinician, about any uncertainties you have.
Just prior to receiving the vaccine, you will be asked a series of
medical questions to be sure that the vaccine is safe for you and the
people you live with. You will be required to sign the medical history
form that states you have reviewed the information provided.

For additional information or for questions you may have later, please
see the CDC website, at
[www.cdc.gov/smallpox](http://www.cdc.gov/smallpox).

This is a challenging time in our nation\'s history. We have asked you
to volunteer for a smallpox vaccine so that we can protect our country
should an attack occur. This is a difficult decision. Please take your
time and review all the information before you decide. I thank you for
all you are doing to help us.

END

For more information, visit
[www.cdc.gov/smallpox](http://www.cdc.gov/smallpox), or call the CDC
public response hotline\
at (888) 246-2675 (English), (888) 246-2857 (Español), or (866) 874-2646
(TTY)\
March 11, 2003