Nursing News:
Washington state health workers get smallpox vaccination

By CAROL SMITH
Washington stateıs first smallpox vaccinations of health workers began under tight security in the National Guard armory here. About 70 public health employees threaded their way solemnly through white-draped privacy stations to receive the vaccinations.
³As a nurse, I want to be in a good position to take care of people if faced with a possible case,² said Janice Boase, assistant chief of communicable diseases for Public Health-Seattle and King County. She was the second volunteer to roll up her sleeve for the 15 pinpricks that delivered the vaccine. ³In my job,² she said, ³Iım likely to be one of the first people to respond to investigate an outbreak.² Yesterdayıs operation, coordinated by the state Health Department, was also a test of a prototype clinic that health officials expect to be replicated in nine emergency-response regions as part of the stateıs Stage 1 Smallpox Vaccination Plan.
The pilot clinic was set up to move volunteers efficiently from station to station to be screened, educated about the vaccine and its potential side effects, vaccinated, bandaged and finally advised about care of the vaccine site. Many of those getting the shots yesterday will be helping set up those clinics in the coming weeks. ³This was to vaccinate the vaccinators,² said Health Department spokesman Donn Moyer. The state has received 4,000 doses of smallpox vaccine from the federal government for use in its emergency response program and expects to use about half of those to vaccinate hospital workers next month. The stateıs efforts are part of a national push to prepare for a bioterrorism emergency.
So far, more than 4,000 civilians around the country have received the vaccines with no serious reactions, according to the U.S. Centers for Disease Control and Prevention, which is coordinating and monitoring the vaccination effort. About 100,000 military personnel have also received the vaccine, with five reports of serious reactions. Two men got encephalitis. One had a heart infection, another developed a ³generalized vaccinia² rash and in another case, the virus apparently migrated to the patientıs eye.
All five men have since recovered and are in good condition, the CDC says. Most reactions to the vaccine are mild, and could include fever, itching or a rash, health officials said. About 2 out of a million people die from the vaccination.
Because of the risk, eight hospitals around the state, including the Providence Health System in Washington, which operates five hospitals, have said they will not vaccinate employees. ³Weıve determined that the risk of adversely affecting our patients and employees by participating in Stage 1 of the voluntary smallpox vaccination program is greater than the risk of facing an outbreak of smallpox,² said Providence Chief Executive Officer Greg Van Pelt.
The hospital noted that the vaccine is effective within four days of exposure to smallpox, giving health care workers a window of time to respond. However, Providence officials said they are tracking information about smallpox and would reconsider their position if new information warranted it.
The vaccine is currently not recommended for the general public because the risks of complications outweigh the public benefit in the absence of any smallpox cases, said state health officer Dr. Maxine Hayes. The vaccination of health workers is a precaution. Although the natural disease was wiped out worldwide decades ago, experts are worried that terrorists may have gained access to laboratory samples that could be used to reintroduce the disease.
³It is prudent to have a limited number of people vaccinated against smallpox to ensure rapid response in the event of an attack,² said state Secretary of Health Mary Selecky, who was on hand yesterday to observe the clinic in action. ³That is one of the important roles of public health in homeland security.²
The smallpox pilot clinics have also given the state a blueprint for dealing with any number of public health emergencies that would require getting medication or vaccinations to large numbers of people, she said. The state expects to vaccinate another 25 to 30 public health workers at the National Guard Armory in Moses Lake next week.
Most of those who volunteered yesterday had been vaccinated previously, some during stints with the military, and others during the period before 1970 when smallpox vaccinations were given routinely to children. Those who have previously been vaccinated have a weaker immune response to the new vaccine, so they get pricked 15 times to ensure the vaccination takes, Hayes said. People who have not had a smallpox vaccination are pricked only three times.
The pinpricks, made with a needle with two points, didnıt hurt, participants said. ³Itıs less painful than a flu shot,² Boase said. Smallpox isnıt actually used in the vaccine, which is based on a related virus, called vaccinia. But the antibodies made against vaccinia also protect a person from smallpox. Because of possible serious side effects, there are some people who should not get the vaccine. Pregnant women, or those with eczema and certain other skin conditions shouldnıt receive it. Anyone with an immune system weakened by HIV or cancer also should not be vaccinated.
People in households with other family members who have such risk factors, or who live with children under age one should also not be vaccinated, according to health officials. (For more information, see www.doh.wa.gov/ BioTerr/faqsmallpoxvaccine. htm.)
Because the vaccine uses a live virus, those who got it yesterday must be extremely careful to keep the inoculation site covered and wash their hands to avoid infecting others.
Copyright 2003, Seattle Post-Intelligencer. Reprinted with permission.