1ST IN STATE TAKE THEIR MEDICINE



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Last Updated

27 Feb 2003

Source: San Francisco Chronicle, February 27, 2003

1st in state take their medicine

Health workers vaccinated for smallpox

Sabin Russell, Chronicle Medical Writer

Surrounded by television cameras, state health Director Diana Bonta took 15 quick pokes in the upper arm from a needle dipped in smallpox vaccine in San Mateo Wednesday, launching a statewide program to vaccinate public health employees against the unlikely but horrifying threat of a bioterrorist attack.

"I am a nurse and director of a large department, and I thought it important, in terms of leadership, that I get this vaccination," said Bonta, who nevertheless wants changes made in the federal government's smallpox vaccine program.

About 20 health care workers, including Bonta, San Mateo County health Director Margaret Taylor, private physicians and hospital technicians, lined up for the smallpox inoculations -- making them the first of what could be thousands of health workers in the Bay Area to get the vaccine.

California has received 10,000 doses of vaccine destined for health care workers who would be the first to encounter victims of a smallpox attack.

Although San Mateo County is the first in the Bay Area to begin inoculating health care workers, vaccine has also been delivered to Alameda, Contra Costa, Napa and Santa Clara counties. Marin, San Francisco, Solano and Sonoma counties are expected to receive deliveries within weeks.

With inoculations starting, Bonta said the federal government needs to make changes in the program. The needles used to deliver the vaccine, for example, do not meet modern standards for safety. Designed for a program that ended 30 years ago, they cannot be retracted, and pose a risk of accidentally jabbing the doctor or nurse administering the vaccine.

Bonta also wants a federal law passed that would guarantee compensation to health care workers who are made ill or lose work if they react badly to the vaccine.

Smallpox was declared eradicated in 1980, but an outbreak caused by release of a hidden supply could be catastrophic. Most Americans under age 33 have no immunity against the virus. Smallpox kills a third of those infected and can leave survivors badly scarred.

But the Bush administration initiative to create a first line of defense against a smallpox attack has run into a nationwide revolt by doctors and nurses. Opponents say the campaign is not worth the risk of adverse reactions to the vaccine and financial hardship for those made ill by it.

"We're discouraging nurses from participating in getting the smallpox vaccine," said Malinda Markowitz, a nurse at Good Samaritan Hospital in San Jose and secretary of the California Nurses Association.

"We feel there isn't any proof yet of a risk of a smallpox attack, but there are known dangers of getting the vaccine and then exposing it to our patients or our own families," she said.

According to the federal Centers for Disease Control and Prevention, between 14 and 52 people out of every million who get the smallpox vaccine will suffer a severe or life-threatening reaction, and one or two will die.

The smallpox vaccine consists of a vaccinia, a live virus that causes cowpox. The disease is far less dangerous than smallpox, but is still a threat to pregnant women, people with compromised immune systems or those with a history of eczema.

About 1 in 3 Americans would be disqualified from taking the vaccine today - - although the government would encourage most to be vaccinated if a single case of smallpox appeared anywhere in the world.

Sal Rosselli, president of Local 250 of the Service Employees International Union, said there is no reason why health care workers who would treat smallpox would need to be vaccinated in advance: The vaccine can prevent disease up to three days after exposure.

"As long as we're prepared with the vaccine itself, and a system to deliver it, there's no need to get vaccinated at this time," he said.

But Dr. Scott Morrow, San Mateo County health officer, believes it is wise to vaccinate a core group of health care workers. "It's an important preparedness effort, one of the small prices we have to pay," said Morrow, who received the first vaccination Wednesday, then administered a dose to Bonta himself.

San Mateo County has set up 50 sites that would provide vaccine to the entire population in the event of an attack. The county hopes to inoculate 100 to 300 health care workers in this early round.

Ernie Gallego, a 35-year-old psychiatric hospital technician, was among the first to volunteer. "I feel I have a responsibility to the public," he said. "To me, it's just a small risk, and I feel healthy enough."

Those vaccinated Wednesday said the experience was easier to handle than a hypodermic injection. "It's kind of like getting poked with a pin," Gallego said.