Area Hospitals Slowly Preparing Smallpox ëResponse Teamsí by Gina Shaw The first mass vaccinations for smallpox in the United States in three decades began in February as hospitals in the Washington area and around the country began inoculating ìresponse teamsî of physicians, nurses and other health care workers. The Centers for Disease Control and Prevention (CDC) has sent some 275,000 doses of the vaccine to 49 states and four county health departments around the country as part of the national inoculation program, which aims to vaccinate hundreds of thousands of health care workers who might be on the ìfront linesî of treating any new smallpox cases. As many as 10.5 million emergency medical technicians, police officers and firefighters will be inoculated in later phases. In the Washington area, a handful of volunteers at Prince William Hospital in Manassas, Va., were among the first in the area to receive the smallpox vaccine, beginning inoculations on Feb. 21. The first to be vaccinated was Prince William Health System President and Chief Executive Officer Michael J. Schwartz. ìI canít stress strongly enough the importance of emergency preparedness,î said Schwartz. Virginia Hospital Center in Arlington, Va., which cared for several dozen victims of the Sept. 11 Pentagon attack, began its inoculation program during the last week in March. ìThe purpose of the teams is to more safely care for an initial case of smallpox,î said emergency physician Dr. John Sverha, who heads up the hospitalís emergency preparedness committee. ìIf someone with smallpox were to come to our hospital, the first one or two cases would be cared for by people already vaccinated against smallpox.î Virginia Hospital Center has identified some 75 volunteers who will receive the vaccine. ìThe team would have staff members from every capacity needed to care for a patientóphysicians, nurses, respiratory therapists, radiologists, housekeeping,î Sverha noted. However, not everyone is enthusiastic about the program. The CDC had hoped to inoculate some 500,000 health care workers by the end of February, but the actual total, according to the Associated Press, has been closer to 1 percent of that number. Each hospital was told their ìresponse teamsî could include up to 120 people, Sverha said, but few are receiving that many volunteers. ìNo hospital that Iím aware of has had an excess number of people volunteering beyond the number allotted for the response teams,î he said. Many health care workers are reluctant to take on the risk of complications from the vaccine, several of which have been reported already among the first group of those vaccinated. Some people have contracted eye infections from touching the vaccination site and then touching their eyes, and at least one woman, a nurse from southwestern Virginia, is recovering from a rash and related symptoms known as ìgeneralized vaccinia.î Although you cannot get smallpox from the vaccineóbecause itís not made from smallpox virus but from a related virus called vacciniaóit still poses dangers that, for some people, outweigh the unknown chances of a biological attack involving smallpox. According to the CDC, the chance of death from vaccine complications is rare, but not nonexistent: Between one and two cases in 1 million vaccinations result in death. Estimates of ìlife-threateningî reactionsósuch as a skin infection called progressive vaccinia or a brain infection called post-vaccinal encephalitisórange from 14 to 52 per million vaccinations. Rates of ìseriousî reactionsósuch as the generalized vaccinia diagnosed in the Virginia nurseócould be as high as 1,000 per million vaccinations. Normal reactions include mild redness and soreness at the vaccine site, and as many as one in three people vaccinated may feel ill enough to miss a day or two of work or school. More health care workers may be persuaded to volunteer for the early response teams and get vaccinated if a compensation plan proposed by the Department of Health and Human Services (HHS) moves ahead in Congress. Currently, if health care workers become ill after volunteering to be vaccinated, the government has no provision to compensate them or their familiesóemployers and private insurers, or workmanís compensation, take on that responsibility. The proposed HHS plan, now being debated, would provide $262,100 to workers who are permanently disabled or die because of adverse events related to the vaccine. Injured workers could also be compensated for ìreasonableî medical expenses that are not covered by health insurance. Another problematic issue is the question of whether the smallpox inoculations will overburden already strained hospital resources. The Washington Post recently reported that the Bush administrationís call to vaccinate millions of people against smallpox is shifting priority and important funds away from a host of services at hospitals across the country, including prenatal care, AIDS prevention, tuberculosis tracking, and research into anthrax and other deadly forms of bioterrorism. Itís unlikely, however, that the massive inoculation campaign will expand to the general public unless the situation changes dramatically, Sverha said. ìGeneral vaccination would be very controversial. I donít see the government extending vaccination beyond the response teams in the immediate future, unless an actual case is discovered, which would change everything.î What happens if a smallpox case does appear at a hospital in the Washington area or elsewhere? At that point, the public health department takes over. It has the authority to take actions, such as quarantining smallpox patients. The first step in such a situation would be whatís called ìring immunizationîómeaning that the health department contacts everyone who has recently come into contact with the ill person and vaccinates them against the disease. ìThen they go a step further and contact all the contacts of those people for vaccination,î Sverha explained. ìThatís how smallpox was originally eradicated from the earth, using those strategies.î The last reported case of smallpox in the United States was in 1949; smallpox was officially declared eradicated in 1980. Thereís no specific treatment or cure for smallpox, and the disease has a mortality rate of 30 percent. ìAny new case would be a public health emergency anywhere on the planet,î Sverha said. ìHospitals really want to be as careful with the program as possible and make sure people are well educated.î For more information on smallpox and the Centers for Disease Control and Prevention health care vaccination program, please visit www.bt.cdc.gov/agent/smallpox. Gina Shaw is the medical writer for The Washington Diplomat.