BACKGROUND:
In October 2002, the ACIP/HICPAC recommended that hospitals vaccinate teams of healthcare workers to care for patients with suspected smallpox.

OBJECTIVE:
To document actions taken by hospitals following the recommendation to form smallpox response teams and to identify key factors in the decision-making process.

METHOD:
Standardized semi-structured interviews were conducted with hospital decision-makers in nine states between June-November 2003. Overall, 148 hospitals were selected for study recruitment.

RESULT:
Officials at 123 (88%) hospitals participated in interviews. Of these hospitals, 88 (72%) chose to form response teams; however, 22 (25%) did not vaccinate anyone because of staff concern about vaccine safety and contraindications. Key factors in the decision to form response teams were being prepared for an outbreak (50%), being a resource for the community (23%), and the feeling that it was the “right thing to do” (15%). Among hospitals that did not form response teams, key factors included lack of interested or eligible staff (28%), concern about vaccine side effects (18%), and hospital liability (19%). Many indicated that an increase in smallpox outbreak risk would compel them to become more active in formation of a response team. Several mentioned that the process had enhanced the hospital's preparedness for other potential public health emergencies, such as an influenza pandemic, and enhanced cooperation with local public health officials.

CONCLUSION:
The perceived risk of outbreak was a major determinant for hospital decisions regarding the formation of smallpox response teams. Interactions between public health agencies and hospitals during the decision-making process, even among hospitals that did not form teams, improved the relationship between these entities and may help with future public health or biopreparedness activities.

LEARNING OBJECTIVES:
To understand factors related to the formation of smallpox response teams by hospitals.