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6 hospitals in state opt out of smallpox vaccination program

By Christopher Schwarzen and Carol Ostrom
Seattle Times staff reporters

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At least six hospitals in Washington state, including two in Snohomish County, will not participate in a statewide smallpox program set to begin the end of this month.

Officials for Providence Health System in Washington, which operates five hospitals in the state, including Providence Everett Medical Center and Valley General Hospital in Monroe, said yesterday that their employees won't receive smallpox vaccinations.

Providence made the decision after weighing risks to patients from vaccinated workers against the risk of a smallpox attack, said Dr. Rocky Fredrickson, chief medical officer for the Providence Health System in Washington. But at this time, he said, "the risk to patients is greater now than the risk of smallpox."

Unlike hospital patients in the 1960s and '70s, today's patients are the sickest of the sick, he said. "Many of them are immune-compromised ... and at higher risk."

Severe reactions among vulnerable patients who come into close contact with the live virus used for smallpox inoculations could range from a widespread rash to death.

The decision affects Providence Everett Medical Center, Providence St. Peter Hospital in Olympia, Providence Yakima Medical Center, Providence Toppenish Hospital and Providence Centralia Hospital. Providence hospitals in Oregon and Alaska have made the same decision, Fredrickson said; Providence officials in California still are weighing the decision.

Valley General in Monroe said its determination was based on not having enough volunteers to adequately create a smallpox-response team.

Providence Everett also raised the issue of staff availability.

"We'd need to vaccinate over 100 of our 3,000 personnel, so not only would we be putting them at serious risk (of reaction) but we'd also have a shortage of medical personnel we can't afford," said Dr. Anthony Roon, director of Providence Everett's trauma services.

Still, neither hospital will turn away anyone who shows possible signs of smallpox or adverse reactions from the smallpox vaccine, officials at both hospitals said.

Statistics collected in the late 1960s, just before routine smallpox inoculations ceased in this country, suggest that about 15 of every 1 million people vaccinated will face life-threatening complications — including disfiguring rashes and destruction of brain tissue — and that one or two of them will die.

"How do I explain that, if we have a death when we haven't seen a case of smallpox since the 1970s?" Roon asked.

"This has been a very complex, difficult issue," said Fredrickson, who chaired the panel that made the decision. "I don't think there's a right or wrong answer."

Ultimately, the decision made by Providence in Washington was based on what was best for Providence's patients and workers, Fredrickson said.

He stressed that Providence has participated in other aspects of the voluntary vaccination plan, including identifying "smallpox-response teams" that would be first to be vaccinated in the event of a smallpox-virus attack.

"If there was a case of smallpox, we'd be ready to go — instantly," he said.

With the announcements from Providence and Valley General, it's expected that other hospitals may follow suit.

"There are still plenty of hospitals willing to participate," said Donn Moyer, a spokesman for the Health Department. "I don't believe there's going to be an avalanche of hospitals backing out."

The department will continue with its program to begin vaccinations as early as this month, Moyer said. Two pilot clinics are being set up now for department employees from around the state who will receive the vaccine and be trained to administer it.

While the Snohomish Health District won't comment on Providence Everett's and Valley General's decisions, there are concerns about area hospitals' readiness to handle an outbreak.

"We would immediately isolate anyone with symptoms and then, if needed, give vaccines to our staff," said Martha Dankers, a Valley General spokeswoman.

The smallpox vaccine still works up to three days after exposure, and hospitals probably are betting on this to handle any potential cases, Dankers said.

Christopher Schwarzen: 425-745-7811 or cschwarzen@seattletimes.com