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Last Updated

13 Jan 2003

Source: Newsday, January 13, 2003

Smallpox Shot Worries

Vaccinated workers' risk to patients among the issues

By Margaret Ramirez, STAFF WRITER

Hospital officials in the city have begun wrestling with some of the serious health issues related to the planned smallpox vaccination program, including whether vaccinated employees should receive time off to avoid harming patients.

"We are addressing some of the thorny issues," said Dr. Robert C. Rothberg, site director for the emergency room at New York University Medical Center in Manhattan. "Do you furlough staff that have agreed to be vaccinated? And is it safe for someone who just received the vaccine to work in a neo-natal or oncology unit? It's a big debate raging in the medical community."

President George W. Bush outlined a national plan last month to offer smallpox vaccinations to thousands of health workers to prepare for a possible bioterror attack. The federal government is expected to ship about 15,000 doses of smallpox vaccine to New York City, most likely after Jan. 24 when the Homeland Security Act goes into effect.

Last week, city health officials offered a tentative time line for the smallpox plan saying health department staff would be the first to receive vaccinations in mid-February. That staff would then vaccinate a group of workers at each hospital in March and train them to be vaccinators, following a model known as "train the trainer."

But, health department spokeswoman Sandra Mullin said the proposed time line depends on release of the vaccine, as well as completion of educational materials and consent forms by the national Centers for Disease for Control and Prevention. So far, no date was set for distribution of either the vaccine or the federal forms.

Even so, city health officials set today as the deadline for hospitals to notify them on whether they plan to participate in the smallpox program.

Most of the city's 74 acute-care hospitals are expected to participate, according to Susan Waltman, senior vice president of the Greater New York Hospital Association. But, some hospitals last week said they were trying to determine how the vaccination program would affect patient care. A spokesman at Beth Israel Medical Center in Manhattan, for example, said the hospital was still unsure of its position.

At St. Vincent's Hospital Manhattan, however, Dr. Ruth Smith said the decision was simple.

"We already experienced the bombing of the World Trade Center in 1993 and then Sept. 11. So we feel this is the best way to have our staff protected," said Smith, director of personnel health services at St. Vincent's.

The smallpox vaccination is effective against the disease, but about 1 in 1,000 people may have serious side effects ranging from severe skin rash to encephalitis. One in a million people may die.

Aside from the illnesses that might affect vaccinated medical staff, some hospital officials are worried about the virus within the vaccine being accidentally transmitted to a patient or family member. After a person is vaccinated, the site is bandaged for at least two weeks to prevent transmission to other people.

The federal government has said health care workers do not need to be placed on leave or "furlough" after they receive smallpox vaccinations because transmission is unlikely in a health care setting.

But, Rothberg of NYU Medical Center, said some hospitals are considering administrative leave as a safety precaution.

"As physicians, you have to assume every patient has a compromised immune system, so they are all at risk of secondary transmission," Rothberg said. "The chances of transmission are low. But, still, it's not zero."

Another concern is the issue of who will cover lost work time and expenses if a hospital employee gets sick as a result of getting a smallpox shot. The American Hospital Association and the American Nurses Association have called on the Bush administration to create a federal compensation fund.

To deal with those compensation questions, Waltman of the Greater New York Hospital Association, said a meeting with hospital union officials is being planned for later this month.

"We are encouraging all hospitals to take part in the vaccination program," she said. "We have to make sure we have a work force that is able to care for smallpox patients. It's a very important role."

Applying the Vaccine

A look at the multiple-puncture vaccination method for smallpox

Preferred vaccination area is the deltoid area of the upper arm.

1. Bifurcated needle is dipped into vaccine vial.

2. Fifteen rapid insertions are made in an area roughly 5 mm in diameter.

3. Excess vaccine is absorbed by sterile gauze and the vaccinated site is dressed.

SOURCE: Center for Disease Control and Prevention.