Sorry if you saw this info on another post. I put it on the wrong one.
Los Angeles; Infection Tied to Smallpox Vaccine; The eye problem is linked to contact with a member of
military who was inoculated.
The Los Angeles Times; Los Angeles, Calif.; Mar 1, 2003; Lisa Richardson;
S.F. General balks on vaccine
Hospital bars staff from smallpox
shots due to public safety
Sabin Russell, Chronicle Staff Writer
Tuesday, March 4, 2003
In one of the strongest challenges anywhere to the
Bush administration's smallpox vaccination plan, San
Francisco General Hospital is virtually barring staffers
from getting immunized because of concerns about
The move is part of a widening revolt in medical
circles against the White House vaccine program.
Coincidentally, that program is led by Centers for
Disease Control and Prevention Director Dr. Julie
Gerberding, who ran the infection control programs at
San Francisco General before joining the CDC in
Initially, federal planners hoped to vaccinate 500,000
doctors and nurses who would be the first line of
defense against a bioterrorism attack.
But because the vaccine itself is an infectious agent
-- a virus that causes vaccinia -- it is potentially
dangerous to those sensitive to that disease. There
is also a risk that newly immunized health care
for two to four weeks after vaccination, can
accidentally transmit vaccinia to patients.
Vaccinia typically stirs up a strong antibody
response that protects against smallpox. But
vaccinia can sometimes cause a life-threatening,
runaway infection, particularly in people with
Dr. Susan Fernyak, director of communicable
disease prevention and smallpox planning for the San
Francisco Department of Public Health, said the
purpose of the policy restricting vaccinations is to
protect those patients.
"We didn't want anyone who is vaccinated, and still
infectious, to be working with patients directly," she
said. "We have a high number of patients with HIV,
with certain skin conditions, with cancer, with
transplanted organs or who are taking
Under the policy, city health care workers who have
"direct contact" with patients are forbidden to receive
the vaccine unless they can find a way to avoid
patients. They must do so until the blister from the
vaccine on their arm is no longer infectious -- at least
two to four weeks.
NO TIME TO SPARE
But Fernyak acknowledged that, due to the chronic
shortage of nurses and tight budgets, almost no one
in the hospital can be relieved from patient care duty
for that length of time.
Throughout the health department, about 15 doctors
and administrators have juggled schedules so they
can be vaccinated, she said. Nurses are unlikely to
be able to do the same.
Gerberding declined to comment on San Francisco's
smallpox vaccine policy, but CDC spokesman Tom
Skinner said cities should not gloss over the risk of
bioterrorism. Gerberding, he said, "has been
participating in meetings where a certain level of
intelligence has been shared, and she's saying that,
without a doubt, we're doing the right thing."
Skinner said the reluctance of many hospital workers
to be vaccinated could be shortsighted. "Here's the
problem: I don't think anyone knows what an attack
will look like," he said. "Would it be one case in
Middletown, USA? Or a thousand cases at different
locations? Or a thousand cases in one location? You
must have people in place to vaccinate people."
While most nurses at San Francisco General appear
to support the city's stance -- and are firmly backed
by their union -- there are some who want to be
"We're all health care professionals. We can make
decisions for ourselves. You don't get to be an ER
nurse without having some brains," said one
emergency department nurse, who asked to remain
RISK VERSUS BENEFITS
"There are two chances in a million of dying from a
vaccine," the nurse added. "What are the chances of
a terrorist attack?"
A study by Rand, a Santa Monica think tank,
estimated that the nation's 10 million health care
workers, who make up 3 percent of the population,
could account for as many as half of the nation's
smallpox cases in the event of an attack.
But across the nation, only about 7,354 civilians have
been vaccinated under the program to date. Labor
unions are actively urging their members not to
volunteer for the vaccine.
Nurse union activists say the overwhelming majority
of nurses at San Francisco General support the
policy -- in fact, the Service Employees International
Union Local 790 was among the first to criticize the
"My feeling is, we don't ask the health department,
which is scarce on resources, to pay for other
people's paranoia," said Lorraine Thiebaud, vice
president of Local 790. "If you want to get the
vaccine, and you've got vacation time on the books,
go out and use it."
For every 1 million people vaccinated, according to
the CDC, between 14 and 52 will experience a severe
reaction, and one or two will die of it. Among that
same group of people, there will be 20 to 60 cases of
accidental transmission to someone who comes in
contact with them.
Last week in Los Angeles, an unidentified patient
was hospitalized with an accidental eye infection,
apparently contracted from someone recently
vaccinated in the military.
Across the country, the issue of compensating
health care workers for time lost if they are made ill
by the vaccine looms as the largest threat to the
federal program. CDC spokesman Tom Skinner said
the agency "is getting closer and closer" to releasing
a plan to address those concerns.
But federal disease control experts do not believe the
vaccine program poses a significant threat to
immune-compromised patients. Last week, the
Advisory Committee on Immunization Practices
published revised recommendations,
reiterating that proper bandaging and other infection
control procedures should "essentially eliminate" the
risk of infecting a patient.
With union hospital workers reluctant to be
vaccinated, medical giant Kaiser Permanente has put
on hold its plans to give the vaccine to its first-
response staffers. Under a "labor-management
partnership" pact, Kaiser is negotiating with its
unions over issues such as compensation for lost
time due to vaccine-related illness.
"There are some details that still need to be
negotiated," said Dr. David Witt, chairman of the
infectious disease program for Kaiser in Northern
Witt said Kaiser doctors may be more willing to be
vaccinated than unionized workers, because
physicians have "a better disability package than the
average union worker." Nevertheless, he said some
staffers at his South San Francisco hospital are
eager to be vaccinated. "Some of them are quite
angry, but I told them we can't go."
E-mail Sabin Russell at firstname.lastname@example.org