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Addressing the Smallpox Threat

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Slide Presentation by Nathaniel Hupert, M.D.

On March 3, 2003, Nathaniel Hupert, M.D., made a presentation in the Web-Assisted Audioconference entitled Addressing the Smallpox Threat: Issues, Strategies, and Tools.

The is the text version of Dr. Hupert's slide presentation. Select to access the PowerPoint® slides (1.1 MB).

Computer-Aided Design

Nathaniel Hupert, M.D., M.P.H.
Assistant Professor of Public Health and Medicine
Department of Public Health
Division of Outcomes and Effectiveness Research
Weill Medical College, Cornell University

Slide 1

Guiding Questions

  • What are the critical components of a mass vaccination campaign?
  • What role can spreadsheet models play in forecasting resources requirements for mass vaccination campaigns?
  • What are the limitations of computer modeling in developing mass vaccination plans?

Slide 2

Components of Mass Prophylaxis Plan

Slide contains the "who," "what," "where," "when," and "how" as components of a mass prophylaxis plan. Each component is listed with examples of sub-components in each category. "Who" includes: population, public health, emergency management, health care professionals, law enforcement/legal, community relations, health care system, media, and liaison (interagency/interregional). "What" includes: transportation, support services, floor/flow plan, protocols, staff and stockpile. "Where" includes: location, size, security, access, storage, support services, and communication. "When" includes: Regional/Federal activation and local triggers. "How" includes: planning, operations, logistics, safety, public information, and administration.

Slide 3

Sample Patient Flow Diagram for Mass Antibiotic Dispensing

Slide contains a sample patient flow diagram for mass antibiotic dispensing. It shows the point of entry of a patient, who will pass through the triage area, through medical evaluation and drug dispensing, and then exit to go home or to the hospital, depending on the diagnosis. Also included on this chart is the transport of drugs from the airport to the drug-dispensing center.

Slide 4

Schematic Flow Through Simple Dispensing Model

Slide shows the paths that a patient can take through a simple dispensing center. Beginning at a triage station, infected and non-infected patients can go through evaluation stations and then to the hospital or to dispensing and then be sent home.

Slide 5

Steady-state assumption

  • Steady state develops if p = R/ST < 1, where

    R = patient arrival rate?
    S = # staff
    T = mean service time

  • When p = 1, then S = RT, or

    Staff required at a station is equal to the rate of patient arrival at that station times the mean station processing time per patient.

Slide 6

Schematic Flow Through Weill/Cornell Smallpox Vaccination Model

Slide depicts a detailed schematic flow chart through the model of a Weill/Cornell Smallpox Vaccination area. It includes various pathways that non-infected and possibly infected/infected patients may take. A person who is not infected will pass through the greeting area, form distribution, briefing/consent, triage, testing, witnessed consent and vaccination, form collecting and finally exit counseling before leaving for home. They can also be routed to crisis counseling anywhere throughout the process. A person who feels ill, or who believes they were in contact with someone who has smallpox will be led to the "Post-Event Contact Precaution Area." Here three paths can be taken. All patients begin at medical/contact evaluation station. Those not exposed will go through the same steps that non-infected patients go through. Suspected cases of smallpox or exposure to the disease will be vaccinated and sent home. Those refusing vaccination will be sent through counseling and then to a quarantine facility. Those who are afflicted with critical cases of smallpox at the time of entry will be directly sent to a medical care facility.

Slide 7

Weill/Cornell Smallpox Vaccination Staffing Model: Pre-Event

The slide contains the flow chart that was presented in Slide #6. This flow chart has arrows through the pathways that non-infected persons would take through the model, indicating staffing priorities for pre-event vaccination plans.

Slide 8

Weill Cornell Smallpox Vaccination Staffing Model: Post-Event

This slide includes the flow chart that was presented in Slide #6. Arrows on this flow chart through all pathways, with the exception of the path that a critical patient would take, highlight the fact that in a post-event situation, areas for both exposed and non-exposed persons would need to be sufficiently staffed.

Slide 9

Sample Output of Weill/Cornell Smallpox Vaccination Pre-Event Model

This slide provides information on three types of pre-event smallpox vaccination models: Slow, Baseline, and Fast. For each model, the maximum total core staff available, targetable population, and estimated length of campaign are listed. Each scenario assumes a maximum total core staff of 500 available to vaccinate a targeted population of 1,000,000 people in 14 days. A slow campaign would have a targetable population of 793,181 and an 18-day estimated length of campaign. A baseline model would have a targetable population of 1,140,000 people and a 12-day estimated length of campaign. A fast campaign would have a targetable population of 1,871,308 people and a 7-day estimated length of campaign.

Slide 10

Sample Output of Weill/Cornell Smallpox Vaccination Large-Scale Event Model

This slide provides information on three types of large-scale event smallpox vaccination models: Slow, Baseline, and Fast. For each model, maximum total core staff available, targetable population, and estimated length of campaign are listed. Each scenario assumes a maximum total core staff of 6669 available to vaccinate a targeted population of 5,000,000 people in 5 days. A slow campaign would have a targetable population of 3,503,294 and a 7 day estimated length of campaign. A Baseline model would have a targetable population of 5,000,555 people and a 5 day estimated length of campaign. A fast campaign would have a targetable population of 8,103,224 people and an estimated length of campaign of 3 days.

Slide 11

Predicted Length of Vaccination Campaign as a Function of Available Core Staff and Population Size

Slide shows a line graph that represents the direct relationship between the number of core staff available and the corresponding campaign duration. There are six different relationships represented here for populations of 100K, 500K, 1MM, 2.5MM, 5MM, and 8MM.

Slide 12

Trend in Number of Patients Served by POD per Day of Vaccination Campaign

Slide contains a three dimensional graph that represents the trend in number of patients served by a point of delivery (POD) per day of a vaccination campaign as a function of POD flow rate (patients per minute per point of delivery) and the number of hours of operation. This graph is assuming a campaign targeting 8MM people over 4 days.

Slide 13


  • Accuracy of any model depends on the quality of the underlying data.
    • Processing times are critical variable.
  • Output is design-specific.
    • A differently designed vaccination center may give a different result.
  • Multiple scalable centers with externally controlled patient flow.
    • Feasible but requires law enforcement input.
  • These numbers reflect only critical dispensing staff and do not include support staff for the centers or distribution and logistics staff.

Slide 14


  • Spreadsheet modeling allows planners to "think with numbers" when designing mass prophylaxis response strategies
  • Modeling forces critical examination of:
    • Assumptions about vaccination center layout and processes
    • Availability of resources
  • Model estimates are useful data to guide planning but do not replace the real thing: LIVE, REALISTIC EXERCISES

Slide 15


  • Jason Cuomo, MPH
  • Mark A. Callahan, MD
  • Alvin I. Mushlin, MD, ScM
NYC Office of Emergency Management
  • Edward Gabriel, MPA, AEMT-P
  • Sam Benson, AEMT-P
  • Anita Sher, MIA
U.S. DHHS, Office of the Asst. Sec'y for Public Health Preparedness
  • Capt. Ann Knebel, RN, DNSc
NYC Dept. of Health, Communicable Disease Unit
  • Marci Layton, MD
  • Sue Blank, MD, MPH
NY Presbyterian Healthcare System
  • Eliot Lazar, MD
  • Arthur Klein, MD
  • Neal Flomenbaum, MD

Current as of July 2003

Internet Citation:

Preparedness Issues for the Local Level. Text Version of a Slide Presentation at a Web-assisted Audioconference. Agency for Healthcare Research and Quality, Rockville, MD.

Return to Audioconference


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