Pre-Event Smallpox Vaccination Program Plan

December 6, 2002
Updated on January 21, 2003



The purpose of this plan is to describe the critical actions that are being taken to quickly and safely vaccinate a core group of public health, health care and public safety professionals against smallpox. This plan outlines the strategies and approaches that will guide the public health implementation of the National Smallpox Vaccination Program (NSVP) Phase 1.

This plan will be regularly updated to reflect changes in federal guidelines and policies, as well as changes in national and local capacities and resources.

Description of Jurisdiction

Vermont is a small rural New England state, bordered on the south by Massachusetts,the east by New Hampshire, and the west by New York and Lake Champlain. On the north is the international border with the Canadian province of Quebec. Vermont is approximately 180 miles north to south and just over 90 miles east to west at its widest point, covering 9,250 square miles. The state is divided north to south by the Green Mountains, with few direct east-west transportation corridors.

Vermont’s population of 610,000 ranks 49th in the nation. The population of the largest city, Burlington, is 39,000. There is one Metropolitan Statistical Area centered in Burlington with a total population of 163,700. Seventy-two percent of the population resides in rural communities. Montreal, Quebec, is the closest large city, with 3.4 million population. Tourism brings in an estimated 3.5 million visitors each year. Peak tourism periods are summer and fall.

Vermont has a system of state and municipal government, but no county government. Vermont’s public health system is based on a centralized Department of Health and laboratory in Burlington, with 12 district health offices located throughout the state. In each district office are public health nurses trained in epidemiology and linked directly with the central office. The Vermont Department of Health has strong and long-standing ties with hospitals and primary care providers statewide. There are 14 community hospitals, including Fletcher Allen Health Care in Burlington, which is a tertiary care facility. There are also tertiary care hospitals nearby in Lebanon, NH and Albany, NY, and a Veterans Administration Hospital in White River Junction.

The Vermont Department of Public Safety, including the state’s Office of Emergency Management, Emergency Operations Center (EOC) and state police headquarters, are located in Waterbury. The state police force is organized into four Regional Terrorism Management Districts, each directed by a troop commander and containing one or more state police barracks.

Many fire and emergency medical services are provided through volunteer services, organized into 13 districts that roughly correspond to county lines. Health Department directors of district health offices represent public health on 11 Local Emergency Planning Committees (LEPCs).


The Vermont Department of Health (VDH) plans to vaccinate up to 2000 public health and health care workers in phase one of the NSVP. In Vermont, the executive director of public health preparedness and response for bioterrorism, the state epidemiologist, and the state immunization chief will oversee this specialized vaccination initiative, in accordance with the VDH incident command system structure.

The first steps to implement this plan are already being taken, as VDH public health nurses throughout the state are being screened for past history of vaccination and possible contraindications to the vaccine. Based on the preliminary screening, the state epidemiologist will meet with eligible public health staff to discuss in more detail the contraindications and possible side effects or adverse reactions to the vaccine, as well as any other questions or concerns.

The Vermont plan is approved and the vaccine is ready for release by CDC. The first group of eligible volunteer public health nurses will be vaccinated once all final CDC and VDH policies and procedures are in place. This group of public health nurses will become the first members of the smallpox response team, and will then begin vaccinating more. This plan envisions core smallpox response teams at each hospital, and four public health/ health care response teams who will be vaccinated and ready to respond quickly and effectively to a case of smallpox anywhere in the state. To accomplish this, a total of 2,000 doses of vaccine are requested.

Vaccination clinics will take place at four designated Health Department district offices around the state in Burlington, St. Johnsbury, Rutland and Springfield. These clinic sites will utilize the state’s existing vaccine distribution system, including vaccine storage facilities and secure sites. The four clinic sites provide for optimal control of vaccine quality and security, as well as the most efficient administration of the 100-dose vials. The VDH Immunization Program will upgrade the system used to transport vaccine to ensure security and vaccine quality.

VDH public health nurses will serve as the primary vaccinators in phase 1, to ensure optimum vaccine administration and handling, and care of the immunization site. Public health nurses will also be responsible for monitoring immunization sites and determining vaccine “take” status. They will have a primary role in training other nurses to monitor immunization sites. In phase two, this core of expert public health nurses would also be responsible for training other designated nurses in vaccine administration, handling and site monitoring. It will also be their responsibility to assure optimum quality of this specialized vaccination initiative through all phases.

The Vermont Association of Hospitals and Health Systems (VAHHS) and representatives of local hospitals have been active participants in the initial plans for smallpox preparedness and response in the state. VDH is now providing guidance to each hospital administrator to assist in identifying hospital workers who would be eligible to serve on health care response teams. During January and February 2003, the state’s hospitals will be identifying possible candidates for the vaccine and initial screening criteria. Also in January and February 2003, VDH district directors will conduct informational sessions for potential vaccine candidates at each hospital in their region. A limited number of state and local public safety officers and emergency medical services providers will also receive this same preliminary screening and information.