So what is the deal with this small pox vaccination thing?

sjoe · Dec 14, 2002

Good questions. There is a lot of information, and more questions, about the smallpox vaccine, need for it, risks, etc. at the present discussion of this topic on the "general nursing polls" forum.

azgirl · Dec 14, 2002

Isn't the one we had as children still effective?

Lots of questions with this coming up again.

karenG · Dec 15, 2002

smallpox vaccine only lasts 10yrs. over here they are talking about vaccinating 700 key workers to look after the rest of us!! should be fun!

Karen

rebelwaclause, ASN, RN · Dec 15, 2002

I just got this email today:

Make the Smallpox Vaccine Plan Safe!

As President Bush moves forward with his controversial smallpox vaccine plan, SEIU nurses and hospital workers are calling for more safeguards to protect the public's health.

As front line health care workers, we want to be able to care for patients if a smallpox outbreak occurs. That's why we're taking steps to protect our patients and our families from unnecessary risks.

From coast to coast, we're publicizing the need for better screening, education, and monitoring to protect those for whom the vaccine poses serious health risks. And we're spreading the word that we need to guarantee adequate compensation for those who suffer injuries and even death as a result of the vaccine.

Get the Facts!

The SEIU Nurse Alliance wants you to know these facts:

Vaccine manufacturers and those who administer it

have been offered immunity from liability in a proposal

tucked into the Homeland Security Bill.

The Centers for Disease Control and Prevention (CDC)

says that many people, including pregnant women, people

with weakened immune systems (ie: people being treated

for cancer, those who are HIV positive or transplant

patients) and people with eczema or other skin conditions

should not receive the smallpox vaccine.

The CDC estimates that approximately 30% of those

who are vaccinated will feel too sick to work and provide

proper patient care for one or more days. Roughly 10%

could have a serious reaction.

The smallpox vaccine is "probably the least safe

human vaccine" today. -- Dr. Anthony S. Fauci, director

of the National Institute of Allergy and Infectious

Diseases.

Stay Informed and Spread the Word!

To get more information about the risks associated with the vaccine and what it will take to make the vaccine plan safe, visit www.seiusmallpox.org . You'll find fact sheets you can share with other health caregivers and learn more about what we're doing to minimize the risk to the public.

Please pass this information on to your co-workers. Use our easy Tell-a-Friend feature below.

emily_mom · Dec 15, 2002

I read in the WSJ that effectiveness starts to decrease and is not therapeutic after 20 years. I don't think it will be mandatory, do you???

Kristy

-jt · Dec 15, 2002

Looks like it may be voluntary at first because it does have risks.

Received a notice from my union:

Small Pox Vaccinations Are Coming!

New York State Nurses Association

REPORT: December 2002

Smallpox Vaccinations Are Coming!

Federal Agency Recommends Inoculations for Healthcare Workers

by Nancy Webber

NYSNA

It looks as if at least some nurses in New York state will have to decide whether to be vaccinated for smallpox within the next year, as the state prepares for a possible bioterrorism attack.

Thanks to aggressive immunization efforts in the 20th century, the world's last documented case of smallpox was in 1977. Routine smallpox vaccinations in the U.S. were halted in 1972. But samples of the virus were kept in research facilities in the U.S. and the Soviet Union, and there is some evidence that some of this stockpile has been obtained by terrorist organizations. If the smallpox virus was spread through a population with no immunity to the disease, up to 30% would die, as estimated by the Centers for Disease Control and Prevention (CDC).

The CDC's Advisory Committee on Immunization Practices (ACIP) recommended in October that about a half million hospital workers in the U.S. be immunized. These workers would be equipped to respond to any outbreak of smallpox. As Report went to press, a final decision was yet to be announced. But some kind of vaccination program is probably inevitable, perhaps as early as January 2003.

"It's going to happen," said Karen Ballard, director of NYSNA's Practice and Governmental Affairs Program. "As soon as there is enough vaccine immune globulin (VIG) to treat severe reactions, we will see healthcare workers vaccinated in New York. It makes public health sense to be prepared for an outbreak."

Who will be vaccinated? -

ACIP proposes that all acute care facilities establish smallpox healthcare teams made up of physicians, nurses, and support personnel from the emergency department, intensive care, and other subspecialties. Each team might include up to 45 people, depending on the size of the facility, and each hospital would need at least two teams.

Everyone on the team would be vaccinated against smallpox and trained to provide care to smallpox patients. Even nurses who were vaccinated prior to 1972 would probably need to be re-vaccinated because the effectiveness of the vaccine drops after ten years. The proposal specifies, however, that vaccinations will be voluntary.

Reactions can be severe -

The smallpox vaccine carries a higher risk of serious side effects than other vaccinations. Unlike flu shots, smallpox vaccinations use a live cowpox virus (vaccinia) that is similar to the smallpox virus (variola) and thus provides immunity to smallpox. If the vaccination "takes," a skin eruption occurs at the site of the inoculation. Over the course of three weeks, the so-called "Jennerian vesicle" eventually forms a scab and heals over. The person will also typically experience itching at the vaccination site, swelling and tenderness of the axillary lymph nodes, fever, and malaise.

In a small number of cases, reactions can be much more severe. A national survey done in 1968 found that 63 out of every million people who received primary vaccinations had such reactions. A survey of physicians in 10 states during the same period found a much higher adverse event rate of 823 per million patients. Researchers say the lower rate should be considered minimal. These reactions do not include cases of smallpox. The vaccine does not use the smallpox virus and an individual cannot get smallpox from a vaccination.

The most common types of major complications are accidental infection, generalized vaccinia, and progressive vaccinia.

Accidental infection occurs when the vaccinia virus is introduced into other parts of the body, such as the eyes or mouth, usually caused by failure to wash the hands after touching the vaccination site.

Generalized vaccinia occurs when widespread lesions appear apart from the vaccination site, usually accompanied by fever. Extreme cases can be fatal, especially in children or those with suppressed immune systems.

Progressive vaccinia is characterized by a spreading necrosis at the vaccination site, with metastatic lesions in later stages.

Severe reactions may be treated with vaccine immune globulin (VIG). According to the CDC, there is enough VIG available to treat 600-800 patients. More is being produced.

Patients who contract vaccinia may also develop encephalitis, with children under a year old at a higher risk. In the 1968 national survey, there were 2.3 cases of encephalitis per million.

People with histories of eczema, atopic dermatitis, or other skin conditions are more prone to severe reactions. Those with HIV/AIDS are also at increased risk, as are any individuals whose immune systems are suppressed.

Vaccinia can be spread by contact -

The national survey done in 1968 found that 20% of those who developed vaccinia didn't acquire it from their own vaccination. They got the disease from someone else's vaccination.

For three weeks following a smallpox vaccination, the vaccinia virus is shed from the inoculation site and may be spread to others through contact. This fact is significant, because healthcare workers daily come in contact with patients who are most susceptible to infection.

"There are issues for nurses to consider, both personally and professionally," said NYSNA's Karen Ballard. "During that three-week period, they must carefully follow procedures to prevent contact transmission of vaccina, not only to their patients, but also to members of their families who are not vaccinated. Handwashing will be critical."

Citing the 1968 data, health experts say the chance of infection from someone else's vaccination is low, and that close contact is necessary for transmission. ACIP is recommending that healthcare workers keep the vaccination site covered with two layers of dressings (absorbent gauze covered by a semi-permeable bandage) until the scab falls off. The vaccination site must be checked daily and individuals must wash their hands after touching the vaccination site.

Forty-year-old data may not accurately predict what would happen in 2003, however. The population is vastly different. Almost everyone under the age of 30 has no immunity to smallpox. Atopic dermatitis, a significant risk factor for severe reactions, has become more prevalent in children over the past 30 years. There are more people with suppressed immune systems due to HIV/AIDS or various medical treatments. And, an estimated 8-12% of healthcare workers are sensitized to latex and are likely to have dermatitis.

A likely vaccination scenario:

ACIP did not recommend that nurses and other workers be placed on leave after being vaccinated, stating that the close contact required for transmitting the vaccinia virus is unlikely in a healthcare setting. Nurses may need to take some sick leave, however, because of the discomfort and fever commonly associated with the vaccine.

It is likely that healthcare facilities will vaccinate the smallpox teams in phases to minimize the effect on staffing levels. ACIP also recommends that nurses who have previously been vaccinated should be included in the first phase, because they are less likely to have severe reactions.

Anyone who is considering being vaccinated for smallpox should be screened for:

* history of atopic dermatitis, eczema, Darier's disease or household members with these conditions

* current skin conditions such as burns, impetigo, varicella zoster, herpes, severe acne, or psoriasis

* pregnancy-pregnant women (or those trying to become pregnant) should not be vaccinated because of a potential risk of fetal vaccinia

* HIV/AIDS infection-available on a voluntary and confidential basis.

"Nurses should be informed about the risk factors and evaluate the risks both for themselves and their families," said Ballard. "It is clear, however, that all workers on a smallpox response team must be vaccinated."

NYSNA staff working on issues -

NYSNA staff are working closely with the state Department of Health and other agencies involved in establishing a possible vaccination program. The association also has received an emergency preparedness grant from the state to provide education and training to nurses who may be administering vaccinations to healthcare workers or the general public.

NYSNA is preparing an online continuing education course on smallpox that will soon be available at http://www.nysna.org.

Detailed information can also be found at the CDC Web site, http://www.bt.cdc.gov/agent/smallpox/index.asp.

>>>>

-jt · Jan 3, 2003

notice from the ANA website http://www.ANA.org

Two Large Hospitals REFUSE Smallpox Shots

12/30/02

Two prominent teaching hospitals are refusing to vaccinate their employees against smallpox, rejecting President Bush's call for mass inoculation of front-line medical workers who would be the first to confront a biological attack.

Officials at Grady Memorial Hospital, Atlanta, and Virginia Commonwealth University, Richmond, said that the risk of dangerous side effects of the vaccine and inadvertent transmission to patients outweighs the remote threat of an attack with a virus that has not been seen since the 1970s.

Officials at three other large medical centers -- Children's Hospital of Philadelphia, Emory Dunwoody Medical Center, Atlanta, and the University of Iowa Hospitals and Clinics, Iowa City -- are also leaning against inoculating their staffs.

Read full story at http://www.washingtonpost.com/wp-dyn/articles/A4253-2002Dec17.html.

brianpribis · Jan 3, 2003

I don't have the refs right now but apparently one can be inoculated shortly after exposure and still be o.k. (unless you have a reaction and die or something like that). Also, small pox is not easy to spread. Really the only effective way to do it is to expose yourself and then spread it via close contact with others. Even at that you may never get it. In other words if terrorists are going to attack small pox wouldn't be the easiest or most efficient way to do it. Either way, there is a chance (higher then most other vaccinations) that someone will die. Who wants to be the one? There is also the chance of spreading the virus with inoculation due to the fact that it is a live virus. Although the chance for cross infection is small, who wants to be around their children or wife/husband and take that chance?

Charity, RN, APRN · Jan 3, 2003

They are asking for 300 volunteers at my hospital this month.

C

suenurse54 · Jan 4, 2003

:confused:

I can't believe people are making such a big deal out of this!!

I had 4 of them in my life; the last one at age 17 in 1971. Yes, they do cause a sore arm much like a typhoid shot, but the people who have problems are usually the people who would have problems with ANY vaccine. Yes, there are people out there who may have an adverse reaction to it without any history of such, but the chances are very small. People are equating this to the anthrax shots for which there is no long term data. Smallpox vaccines have been around for 200 years and are very safe.

Sue

RNFROG3, BSN, RN · Jan 4, 2003

Innoculated twice and still alive but I do remember one very sore arm. I was in the army in 1982 going thru basic training. The drill instructors told us not to touch the scab and if the scab was dislodged we could die! Mind games galore!! I of course being the klutz I am scraped against the door frame as I was headed out--- I bled like a stuck pig! This being before the big aids scare and still no one wanted to help me-I now understand why and i guess the instructors had to quit telling folks that cuz I made it all the way thru and I'm still kicking!