Objective: Vaccine is a means of control of a Foot and Mouth Disease (FMD) outbreak in the United States. A clear national policy regarding vaccination is lacking. Our goal was to better understand what potential incident commanders see as important "triggers" for vaccinating as an outbreak control strategy. Design: An FMD outbreak scenario was developed. The outbreak started in Northwestern Illinois (four Illinois premises affected at the end of week one; thirteen by the end of week two) and spreadacross state lines into Minnesota by the end of the fifth week (sixty premises affected). This scenario was used to query potential incident commanders regarding the factors that would most determine their likelihood to recommend vaccination in the givensituation. Sample Population: Seven potential incident commanders participated in individual phone discussions regarding FMD vaccination given the outbreak scenario. Results: Two individuals favored vaccination the first week of the outbreak, with six wanting vaccination before the end of week five; one did not want to vaccinate during the scenario. Respondents ranked nine specific determinates for deciding to vaccinate. Ranked from most important to least important were: 1) the capability to manage the outbreak by stamping out; 2) rate of spread; 3) size of outbreak; 4) density of animal populations; 5) munber/type of affected industries; 6) national security/economic impact; 7) outbreak duration; 8) type of index case; 9) infection in wildlife. Conclusions: Most (4/7) incident commanders wanted to vaccinate on or before the end of week two of the outbreak scenario.
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