Did you get a smallpox packet from the CDC?

pickledpepperRN · Mar 9, 2003

Los Angeles; Infection Tied to Smallpox Vaccine; The eye problem is linked to contact with a member of the

military who was inoculated.

The Los Angeles Times; Los Angeles, Calif.; Mar 1, 2003; Lisa Richardson;

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/03/04/MN220873.DTL

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

patient safety.

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

1998.

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

workers,

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

weakened immunity.

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

immunosuppressive agents."

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

vaccinated.

"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

anonymous.

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

vaccination plan.

"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.

ACCIDENTAL INFECTION

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

California.

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 [email protected].