Small Pox Vaccine - weighing the risks

  1. lots of people are wondering whats the big deal with getting vaccinated? maybe it wasnt such a big deal when we were kids but because of the job we do, there are other things to consider this time:

    <<for immediate release

    Smallpox Vaccinations: Weighing the Risks
    New York State Nurses Association Urges Protections for Nurses Who Volunteer
    by Nancy Webber
    NYSNA Report

    On December 13, 2002, the Bush administration announced that healthcare workers would be among the first to participate in a voluntary smallpox vaccination program.

    By that time, county public health departments were already making plans to inoculate these volunteers, who would give vaccinations to other healthcare workers and to the general public in the event of a smallpox emergency. Acute-care facilities were designating smallpox response teams made up of a cross-section of hospital workers and specialties.

    These fast-moving events left nurses facing the difficult decision whether to be vaccinated. There are many factors to be considered. As healthcare professionals, nurses recognize the need to prepare for a smallpox outbreak possibly generated by a bioterrorism attack. The risks of the vaccine itself, however, raise concerns about severe side effects, the possibility of endangering the health of family members and patients, and issues related to potential liability and compensation for lost time at work.

    Responding to these concerns, the New York State Nurses Association (NYSNA) recently sent a letter to hospitals where the association represents RNs for collective bargaining, putting them on notice that they would have to negotiate certain aspects of the vaccination program.

    "Being vaccinated could have a serious impact on a nurse's health and livelihood," said Lorraine Seidel, director of NYSNA's Economic and General Welfare (E&GW) Program. "Before facilities implement their vaccination programs, we must be assured that RNs will be protected in every way possible."

    NYSNA outlined six major areas of concern, noting that more could arise as the program develops --

    * Nurses must be properly educated about smallpox and the vaccine. Before nurses volunteer to be vaccinated, employers must provide complete and accurate information about the relative risks of contracting smallpox and the possible side effects of the vaccine both for nurses and for unvaccinated people with whom they come in contact.

    * There must be no reprisal for refusing to volunteer. Nurses should not be harassed or experience discrimination if they refuse to be vaccinated. They should not have to divulge the reason for their refusal.

    Nurses should not be vaccinated, for example, if they have a history of eczema or atopic dermatitis, HIV infection, a compromised immune system, allergies to antibiotics used in development of the vaccine, and pregnancy. People with these conditions are more likely to experience severe reactions. Nurses also may be at risk if they have a history of dermatitis associated with latex allergy.

    In the vaccination plan it submitted to the state, the New York City Department of Health will require all volunteers in the city to receive confidential HIV testing before being vaccinated.

    * Specific pre-vaccination information must be provided for those who do volunteer. If nurses do decide to volunteer, they must be fully informed about their rights as workers, possible side effects, the treatment available in the event of a severe reaction, care of the inoculation site, and precautions to prevent accidental inoculation of patients and household members.

    * Nurses must be paid for lost time from work due to reaction to the vaccine. The smallpox vaccine contains a live vaccinia virus. Vaccinia, known as cowpox in earlier centuries, is a weaker relative of smallpox and provides immunity from the more deadly disease. In fact, it is the source of the word "vaccination" (the Latin word for "cow" is "vacca"). Typically, a person vaccinated against smallpox for the first time may experience flu-like symptoms: fever, malaise, and swollen lymph nodes. In clinical trials at the University of Iowa, about a quarter of those vaccinated missed at least one day of work or school.

    The smallpox vaccine can cause more severe side effects in a small percentage of cases, which were outlined in the December 2002 issue of Report. It is estimated that 15 people out of a million will experience life-threatening complications and one or two out of a million will die.

    * NYSNA is telling employers that if nurses volunteer to be vaccinated as part of a public health initiative, they should not have to use sick time or other personal time for missed workdays. In addition, treatment for severe side effects must be provided at no additional cost to the nurse volunteer.

    * Nurses must not be held liable for accidental inoculation of patients or others. Because the smallpox vaccine contains a live virus, the virus can be shed from the vaccination site for up to three weeks. There are measures that can be taken to minimize the risk of accidentally inoculating others. Special care must be taken to cover the sore that develops after vaccination. Frequent handwashing also will prevent the vaccinia virus from being passed on. But despite these precautions, potential liability remains.

    * Facility vaccination plans must address the risks of having recently vaccinated employees care for patients. Hospitals have already expressed concern about their liability if employees or patients are harmed by the vaccine. As Report went to press, many of these legal questions had not been resolved.

    * Plans must be provided for staffing support and coverage for staff who may be absent from work following vaccination. NYSNA proposes that vaccinations be administered on a staggered basis to minimize impact on staffing levels, with a group being vaccinated every three weeks. Most absences due to typical vaccine reactions will occur eight to ten days after inoculation.

    If you are represented by NYSNA for collective bargaining and have questions or concerns about how your facility is implementing its smallpox vaccination program, contact your NYSNA nursing representative. Information is also available at NYSNA's Web site, www.nysna.org, and at www.smallpox.gov.

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  2. 14 Comments

  3. by   -jt
    Public Health Nurses on the Leading Edge
    NYSNA Report
    http://www.NYSNA.org

    Before smallpox was eradicated in the 20th century, public health nurses in counties across New York played a leading role in vaccinating millions against the disease. In 2003, they are once again in the spotlight.

    "We have a long way to go," said Joan Ellison, an RN who is director of public health for Livingston County. "But if something happened tomorrow, we'd be ready. We know our roles and responsibilities."

    Public health nurses will be the first to be vaccinated and the first to administer vaccinations to fellow healthcare workers as part of a national program to prepare for a possible bioterrorist attack. While most New York hospitals were just beginning to tackle the logistics of implementing a smallpox vaccination program, county health departments were preparing to put their plans into action.

    The preparation comes at a cost, however. According to the New York State Association of County Health Officials (NYSACHO), the smallpox vaccination program is forcing nurses and other public health professionals away from other essential tasks such as tuberculosis control, infectious disease surveillance, and home care.

    NYSACHO is urging more state and federal funding for counties to carry out the smallpox vaccination program outlined by the federal government.

    The Livingston County Public Health Department will soon present a comprehensive educational program to all nurses on staff. The workshop will cover the smallpox disease, the smallpox vaccine, and the countywide plan.

    "It's unfair to ask anyone to volunteer until they have the education," Ellison said. "The nurses need to know what the vaccine is all about in order to make an informed decision."

    In Onondaga County, consent forms are being distributed to the nursing staff. "It's clear that vaccination is voluntary and that if nurses refuse to be vaccinated, they don't have to explain why," said Pat Sullivan-Murphy, a public health staff nurse. She said the county is also making sure that insurance will cover any treatment related to the vaccination and that time off from work won't affect nurses' sick leave.

    Before any nurses are vaccinated, they will be screened for risk factors that may increase the chance of severe reactions to the smallpox vaccine.

    "A lot of nurses would volunteer if they could," said Sullivan-Murphy. "But they may have family at home on chemotherapy or a history of eczema, which prevents them from being vaccinated at this stage."

    She hopes that enough nurses will volunteer to allow the county to carry out the first phase of its plan. She plans to volunteer herself.

    Reports are starting to emerge across the country, however, that the volunteer response will be low. Two hospitals in Georgia and Virginia have decided not to have employees vaccinated. At Erie County Medical Center in Buffalo, only 20 employees out of more than 2,000 have volunteered, according to NYSNA staff.

    None of the volunteers were nurses or physicians.

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  4. by   -jt
    <<for immediate release

    American Nurses Association Raises Concerns About Smallpox Vaccination Plans
    Bush Administration has not answered key questions

    Washington, DC -- The American Nurses Association (ANA) continues to raise important questions about the Bush Administration's plans to begin vaccinating thousands of Americans against smallpox, beginning with registered nurses and other health care professionals who would be called upon to respond to an outbreak.

    "We are well aware that there is a pressing need to be prepared against the possibility of a bio-terrorist attack," said ANA President Barbara A. Blakeney, MS, APRN,BC, ANP. "Since 1998, the ANA has been involved in developing strategies for educating the nation's 2.7 million registered nurses to respond in the event of such an attack. ANA also is working closely with the U.S. Department of Health and Human Services (DHHS), to develop the National Nurse Response Teams for just such an event," she added. "However, we want people to be able to make an informed decision about whether or not they should get vaccinated against smallpox, and I do not believe we have the answers we need to make that informed decision," she said.

    In a November 7, 2002, letter to DHHS Secretary Tommy Thompson, Blakeney outlined a series of issues that need to be addressed before proceeding with widespread inoculations. Those issues include, but are not limited to:

    1. Assurances that the decision by a health care worker about whether to be vaccinated is voluntary and without fear of reprisal. ANA is pleased that the President has informally expressed his intention to make the vaccination program voluntary for all.

    2. Who would pay for the costs related to vaccination and possible treatment for any side-effects, including potential side-effects suffered by family members of those vaccinated.

    3. An additional concern is that, at the present time, the Vaccine Injury Compensation Program (VICP) does not cover voluntary immunizations.

    4. Who would bear the cost for lost work time related to the vaccinations. ANA believes any lost work days should be paid by the employer.

    5. Potential liability/malpractice concerns as a result of administering the vaccine.

    6. Needlestick safety concerns.

    7. Risk of complications associated with skin diseases or dermatitis. It is estimated that 8 percent to 12 percent of health care workers are sensitized to latex which often presents itself in the form of dermatitis. The potential for dermatologic reactions must be taken into account both in discussing the overall vaccination policy and when developing the screening questionnaire and interview process.

    Ms. Blakeney's letter to DHHS Secretary Tommy Thompson may be read, in its entirety, at http://www.nursingworld.org/news/dis...bbltrsmpx.htm.

    ANA encourages DHHS to respond to these issues prior to implementing any program.

    "Whenever and wherever disasters have struck, registered nurses have responded selflessly by lending their skills, time and expertise to help victims and their families," Blakeney said.
    "Nurses are the backbone of the American health care system, and I expect they will respond to this call as well," she added.

    "However, it is our duty to protect, as much as possible, those persons who would step forward to protect us all," she said.

    # # #
    http://www.ANA.org
  5. by   NurseGirlKaren
    Alot of these are concerns that I have had and are why I have decided at this point not to volunteer for vaccination.
  6. by   Anagray
    I have been vaccinated against small pox as a child. I was born in Moscow and s.p. vac was something everyone did and I believe it is still done without any problems.
    However, If I had to do it again and do it here in US, I am not sure that I would feel secure about it, because the composition of the vaccine is different.
    I haven't decided what I'll do. I have about 2 years to think about it, because i am expecting and planning to bf.
  7. by   stressedlpn
    my question is this i am 8 wks pregnate, and have two small children at home, IF i go ahead and get this vaccine what effect am i looking at and risks am i taking towards infecting those i love
  8. by   -jt
    I dont think they will give it to you if youre pregnant
  9. by   dawngloves
    My facility has disscussed not vaccinated those who care for the immunocompromised, (heme/onco, transplant, neonatology) for fear of shedding the virus.
    If I could get it and then be off for a few weeks, sure! But I can't afford that.
  10. by   rncountry
    Pregnant women are not eligible to receive the vaccine.
  11. by   rncountry
    from the cdc

    Some people are at greater risk for serious side effects from the smallpox vaccine. Individuals who have any of the following conditions, or live with someone who does, should NOT get the smallpox vaccine unless they have been exposed to the smallpox virus:

    Eczema or atopic dermatitis. (This is true even if the condition is not currently active, mild or experienced as a child.)
    Skin conditions such as burns, chickenpox, shingles, impetigo, herpes, severe acne, or psoriasis. (People with any of these conditions should not get the vaccine until they have completely healed.)
    Weakened immune system. (Cancer treatment, an organ transplant, HIV, or medications to treat autoimmune disorders and other illnesses can weaken the immune system.)
    Pregnancy or plans to become pregnant within one month of vaccination.
    In addition, individuals should not get the smallpox vaccine if they:

    Are allergic to the vaccine or any of its ingredients.
    Are younger than 12 months of age. However, the Advisory Committee on Immunization Practices (ACIP) advises against non-emergency use of smallpox vaccine in children younger than 18 years of age.
    Have a moderate or severe short-term illness. (These people should wait until they are completely recovered to get the vaccine.)
    Are currently breastfeeding.
    Again, people who have been directly exposed to the smallpox virus should get the vaccine, regardless of their health status.

    Don't Hesitate!
    If offered the smallpox vaccine, individuals should tell their immunization provider if they have any of the above conditions, or even if they suspect they might.

    virus is spread from the site of innoculation, an occulsive dressing at the site should protect patients.
    again from the cdc

    Facts about vaccinia

    The vaccinia virus, the virus in the smallpox vaccine, is another "pox"-type virus.
    Vaccinia is related to smallpox, but milder.
    The vaccinia virus may cause rash, fever, and head and body aches. In certain groups of people, complications from the vaccinia virus can be severe.
    Vaccinia is spread by touching a vaccination site before it has healed or by touching bandages or clothing that have been contaminated with live virus from the smallpox vaccination site.
    This way, vaccinia can spread to other parts of the body or to other individuals. This is called inadvertent inoculation.
    In the past, spreading to other parts of the vaccine recipients' body was the more common form of inadvertent inoculation.
    Careful care must be taken of the site of the vaccine to prevent spreading of the vaccinia virus.
  12. by   dawngloves
    Originally posted by rncountry
    from the cdc

    virus is spread from the site of innoculation, an occulsive dressing at the site should protect patients.
    again from the cdc

    What is the most occlusive dsg? Tegaderm?
  13. by   dawngloves
    Jeez! Ya know this makes me wonder how did we all survive getting this as infants??? I mean, how is it different now? Honestly, I'd get it in a minute if I didn't worry about my little patients.
  14. by   rncountry
    Yes, dawn. Tegederm, opsite etc... the same as is used on a CVL.
    The risks need to be weighed, that makes only common sense. The screening process is to be heavy, you would not be eligible as you would be working with those under a year of age.
    At my hospital we are in the midst of the education process as we will be asking for volunteers next month. The ID doc wants only those that have already been vaccinated to get it again, at this time anyway.
    I just want those that have questions, myself among them, to go to the CDC website and read. There is a great deal of material, and as an infection control nurse I haven't gotten through all of it yet. I expect that there are going to be many questions and I need to be prepared to answer them.
    But I also think it is important to not get everyone riled up about this without the education to go with it. I don't mean this particular thread as much as I do some others. The best place to get questions answered is not here, but at the CDC site.

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