# Presentation: 005222

**Nancy Ridley, M.S.**
**	**Assistant Commissioner
- 	Massachusetts Department of Public Health

***SMALLPOX:******State Planning and Implementation***

## Massachusetts Demographics

- Small geography and high density...
- 6.5 million residents
- 351 cities and towns (essentially no counties)
- 76 acute care hospitals (with ERs)
- 7 Emergency Response Planning Regions

## Hospitals by Region

**Region 1 West**
- 1 Baystate Health Systems – Springfield
- 2 Berkshire Medical Center – Pittsfield
- 3 Cooley Dickinson Hospital – Northampton
- 4 Fairview Hospital – Great Barrington
- 5 Franklin Medical Center – Greenfield
- 6 Holyoke Hospital – Holyoke
- 7 Mary Lane Hospital – Ware
- 8 Mercy Medical Center – Springfield
- 9 Noble Hospital – Westfield
- 10 North Adams Regional – North Adams
- 11 Wing Memorial - Palmer

**Region 3 Northeast**
- 23 Addison Gilbert Hospital - Gloucester
- 24 Anna Jaques Hospital - Newburyport
- 25 Beverly Hospital - Beverly
- 26 Cable Emergency Center - Ipswich
- 27 Merrimack Valley Hospital - Haverhill
- 28 Holy Family Hospital - Methuen
- 29 Lahey Clinic North - Peabody
- 30 Lawrence General - Lawrence
- 31 Lawrence Memorial - Medford
- 32 Lowell General - Lowell
- 33 Melrose Wakefield - Melrose
- 34 Saints Memorial - Lowell
- 35 Salem/North Shore Children’s Hospital - Salem
- 36 Union Hospital - Lynn
- 37 Whidden Memorial Hospital - Everett

**Region 2 Central**
- 12 Athol Memorial Hospital - Athol
- 13 Clinton Hospital - Clinton
- 14 Deaconess-Nashoba Hospital - Ayer
- 15 Harrington Memorial Hospital - Southbridge
- 16 Health Alliance Hospital - Leominster
- 17 Heywood Hospital - Gardner
- 18 Hubbard Regional Hospital -
- 19 Milford-Whitinsville Hospital - Milford
- 20 St. Vincent Hospital - Worcester
- 21 UMass Memorial Medical Center - Worcester
- 22 UMass University Medical Center - Worcester

**Region 4a Metro North**
- 52 Deaconess Waltham Hospital - Waltham
- 53 Emerson Hospital - Concord
- 54 Lahey Clinic - Burlington
- 55 MetroWest Medical Center - Framingham
- 56 MetroWest Medical Center - Natick
- 62 Winchester Hospital - Winchester
- 63 UMass Memorial Marlborough Hospital
-      Marlborough

**Region 4b Metro South**
- 48 Caritas Norwood Hospital - Norwood
- 49 The Cambridge Hospital - Cambridge
- 50 Mount Auburn Hospital - Cambridge
- 51 Deaconess Glover Hospital - Needham
- 57 Milton Hospital - Milton
- 58 Newton-Wellesley - Newton
- 59 Quincy Medical Center - Quincy
- 60 Somerville Hospital - Somerville
- 61 South Shore Hospital – Weymouth

**Region 4c - Boston**
- 38 Beth Israel Deaconess Medical Center
- 39 Boston Medical Center
- 40 Brigham and Women’s Hospital
- 41 Carney Hospital
- 42 Children’s Hospital
- 43 Faulkner Hospital
- 44 Massachusetts General Hospital
- 45 New England Medical Center
- 46 St. Elizabeth’s Medical Center
- 47 West Roxbury VA Hospital

**Region 5 Southeast**
- 64 Brockton Hospital - Brockton
- 65 Cape Cod Hospital - Barnstable
- 66 Charlton Memorial Hospital - Fall River
- 67 Falmouth Hospital - Falmouth
- 68 Caritas Good Samaritan - Brockton
- 69 Jordan Hospital - Plymouth
- 70 Martha’s Vineyard – Oak Bluffs
- 71 Morton Hospital - Taunton

- 72 Nantucket Cottage - Nantucket
- 73 St. Anne’s Hospital - Fall River
- 74 St. Luke’s Hospital - New Bedford
- 75 Sturdy Memorial - Attleborough
- 76 Tobey Hospital - Wareham

**Region 1**

**Region 2**

**Region 4a**

**Region 3**

**Region 4c**

**Region 4b**

**Region 5**

**www.state.ma.us/dph/bioterrorism/advisorygrps/pdfs/hospitals_by_region_6_02_2.pdf**

## Smallpox PlanningMassachusetts

- Statewide Smallpox Workgroup
- Pre-event plan
- Phase 1A – 7,600 hospital staff
- 100 staff X 76 hospitals
- Phase 1B – 2,400 community response team personnel
- 16 member teams... Medical, EMS, 1st responders
- 150 members X 7 regions to be vaccinated to ensure 24/7 coverage
- Phase 2 (maybe)...

## Smallpox: Pre-Event PlanningMassachusetts

- Phase 1A and 1B:
- Immunization of 10,000 volunteer health care workers, public health workers and first responders
- Previously vaccinated
- Careful screening of volunteers and household contacts for contraindications
- Extensive follow-up for adverse events
- No furloughs...

## Phase 1A and 1B:

State public health response team (DPH staff)
Multidisciplinary teams at 76 hospitals 
7 regional response teams
Capacity building
Public Health nurses
School nurses
Visiting Nurse Associations

- State public health response team (DPH staff)
- Multidisciplinary teams at 76 hospitals
- 7 regional response teams
- Capacity building
- Public Health nurses
- School nurses
- Visiting Nurse Associations

*Smallpox: Pre-Event Planning**Massachusetts **(cont.)*

## Smallpox: Pre-Event PlanningMassachusetts (cont.)

- Vaccination of DPH staff began February 12th
- Phase 1A vaccination (hospitals)
- 10-12 weeks
- Phase 1B vaccination (response teams)
- 12 weeks – completion (<6 months)

## Vaccination Process

- Hospital Response Teams:
- DPH vaccinates 10 core state public health staff
- 50 additional DPH staff, plus Boston and Cambridge health department staff vaccinated
- Once vaccine “takes” confirmed (~ March 1), these 60 vaccinees will begin vaccinating the “vaccinators” in each of the 76 hospitals
- Community Response Teams:
- Vendor operated vaccination clinics

## Smallpox: Phase 2

- Eventual vaccination of *all *health care workers and first responders
- Massachusetts estimate = approximately 120,000 individuals
- No official announcement from Federal government
- Will be based on lessons learned from Phase 1

## Smallpox: Controversial Issues

- Liability
- Worker compensation (vaccinee, secondary contacts)
- Malpractice coverage
- Health insurance coverage for side effects
- Furloughs
- Unions (police, fire, nurses, etc.)

## Controversial Issues, cont.

- Vaccine safety (Lister v. New York Board of Health strains)
- Safety of needles
- Municipal v. private first responders
- Dissemination of training materials
- Sustainability of state bioterrorism initiatives

## Pre-Event v. Post-Event Planning

- Pre-Event:
- Plan to deal with one suspected case of smallpox in Massachusetts
- Post-Event:
- Plan to vaccinate the entire population within 4 days regardless of an actual smallpox case in Massachusetts