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Last Updated

23 Jan 2003

Source: Associated Press, January 23, 2003

Smallpox Vaccine Choice Raises Questions

By The Associated Press

Across the country, doctors, nurses and public health officials are making some hard choices about whether to get the smallpox shot for the good of the country.

In the coming weeks, health care workers will be deciding whether to volunteer to be vaccinated so they can be ready to respond to a smallpox bioterrorist attack. The first shots will be given Friday in Connecticut, the first state ready with the vaccine.

Nebraska, Vermont and Los Angeles County also had received vaccine shipments by Wednesday but were waiting at least until next week to begin vaccinating.

Worries about the vaccine's fierce side effects and the threat that it may even sicken people near those vaccinated has prompted a number of nurses to refuse.

As an emergency-room nurse in Milwaukee, Lisa Hass-Peters knows she is a prime candidate for a smallpox response team.

But her husband, Jeff, has had two liver transplants, leaving his immune system weakened. That means the smallpox vaccine made from a live virus related to smallpox could make him sick. He could be infected from the scab on her arm caused by the vaccine.

"I didn't hesitate to decline,'' said Hass-Peters, who works at Milwaukee's Froedtert Memorial Lutheran Hospital. "If I truly was exposed, I guess I would be weighing my options again. But I don't feel a threat at this particular moment.''

In a recent survey, 63 percent of 2,600 nurses responding said they would get the smallpox shot, 13 percent said they wouldn't and 24 percent were undecided, according to the National Network for Immunization Information, a coalition of several health trade groups.

Ultimately, the government plans to vaccinate nearly 500,000 health workers. But even some major hospitals are refusing the vaccine, including Colorado's largest chain, Centura Health with 10 hospitals; and Grady Memorial Hospital in Atlanta, home of the Centers for Disease Control and Prevention, which is shipping vaccine to the states.

The risk of a smallpox attack is unknown, and the chance that any given person will be exposed is small, an advisory panel for the Institute of Medicine said recently in urging the government to go slower with the vaccinations.

But the risks of the vaccine are well-known. Some people may have sore arms and fever or feel sick enough to miss work. As many as 40 people out of every million vaccinated for the first time will face life-threatening reactions, and one or two will die.

The vaccine is not recommended for people with skin problems, such as eczema, or those with weak immune systems, such as HIV, transplant or cancer patients. The government says even people with close family members in those categories should be screened out.

But sometimes those guidelines aren't enough. Nurse Stephanie Woodrum was struggling with the vaccine decision when a sickly patient at her hospital in South Charleston, W.Va., told her she was worried about being infected by a vaccinated hospital worker.

"My heart just broke for her,'' said Woodrum, who works at Thomas Memorial Hospital. "She's scared, and she has every right to be. Honestly, have I made up my mind? No, I haven't. It's a real difficult decision for me.''

Health care unions have criticized the Bush administration, accusing it of cutting corners on screening and training. They also worry that people who have side effects or miss work may not be fully compensated; the government says it is working on a plan.

Dr. James Bowes, the chief health officer in Frederick County, Md., believes adequate precautions have been taken. He said he will get the shot and expects several dozen of his staff will as well.

"I think the adverse reactions will be minimal if they're well-screened,'' he said. "I have no problem with it.''

But Sharon Eolis, a nurse practitioner at Cabrini Medical Center in Manhattan, takes a more cynical view. She believes the Bush administration is urging the vaccine simply to "build up a little hysteria'' ahead of an attack on Iraq.

She does not want to put herself in danger in the absence of an actual smallpox attack.

And more important, she says, are the patients at her hospital who might be accidentally infected.

"The risk just outweighs the benefit here,'' she said. ``The most important thing in a nurse's pledge is first, do no harm.''