Nurses urged to
refuse vaccinations
Texas group says
smallpox shots carry risks, wonders who would foot medical bills
02/01/2003
By SHERRY
JACOBSON / The Dallas Morning News
Texas' plan to vaccinate as many as 40,000 health-care workers
against a possible smallpox threat appears to be running into
resistance.
The Texas Nurses Association began urging its 5,000 members by
e-mail Friday not to volunteer for a smallpox vaccination. The
association's board of directors voted unanimously last Saturday not
to support the vaccination effort because of growing concerns over
who would cover medical costs if nurses suffered adverse side
effects or were forced to take sick leave from their jobs.
"We're telling our members they should decline the shots," said
Clair Jordan, executive director of the state's largest organization
of registered nurses. "As an organization, we have asked the
government a lot of questions, and we're not getting answers. So we
hope our decision will force the issue."
The group's national counterpart, the American Nurses
Association, expressed the same concerns and asked federal officials
to delay the nationwide vaccination process, which got under way
Jan. 24 in Connecticut. The first round of immunizations in Texas is
scheduled to begin during the week of Feb. 17.
Resistance to vaccination has arisen elsewhere in the country,
but this appeared to be the first organized opposition in Texas.
About 375 of Texas' 550 hospitals have indicated that some of
their employees will participate, along with workers at 70 public
health departments around the state. The plan is to have a team of
vaccinated workers who are prepared to take care of potential
smallpox patients until more workers and the general population
could be vaccinated.
President Bush authorized the initial phase of a national
vaccination effort in December after noting the possibility that
terrorists could have obtained the smallpox virus from stockpiles
around the world. Smallpox was declared eradicated worldwide in
1980, eight years after the United States stopped public
vaccinations against the disease. The last U.S. smallpox case was
reported in 1949, and the last naturally occurring case in the world
was documented in Somalia in 1977.
Bringing back vaccination against the disease has caused
widespread concern in various employee groups – even though
participation is voluntary. Calls for a slowdown in the government's
distribution plan also have come from the Service Employees
International Union, the American Federation of State, County and
Municipal Employees and the American Public Health Association,
among other groups.
Texas doctors are not actively opposing the idea of a vaccine,
but they share many of the same concerns as other workers.
"The doctors are calling us about putting together their response
teams and wondering whether they will be covered if something bad
happens," said Heidi Jackson, a lawyer for the Texas Workers'
Compensation Commission, the regulatory agency that handles workers'
compensation appeals. So far, there is no definitive answer about
claims that may arise from the vaccinations, she said.
"It's like every other workers' comp case; it depends on the
facts," Ms. Jackson said.
The voluntary nature of the shots could be an issue in deciding
whether or not an insurance claim would be paid for an extended
illness related to the vaccination, she said. "That they are calling
it voluntary makes it more difficult to make a call."
However, such uncertainty isn't stopping some health-care workers
from signing up for the shots, said Dr. James Luby, acting chairman
of infectious diseases at the University of Texas Southwestern
Medical Center at Dallas.
"On a personal level, there are doctors who are concerned about
potential complications and the cost of dealing with them," he said
after signing up for the vaccination. "The problem with adverse side
effects from the immunization is a real one. But we are committed to
doing this, slowly and carefully."
Wade Dansby, a registered nurse, said he joined about 100
employees at Parkland Memorial Hospital who signed up recently to
get the vaccine. The hospital has been seeking only those employees
who have previously been vaccinated against the disease in hopes
they will have fewer side effects.
"I didn't have an adverse reaction the first time around,"
recalled the 45-year-old associate director of infection control.
"Knowing what I know now, I should have been more worried when I got
the shot as a 6-year-old."
Local hospital officials said they are unsure whether the
decision by the Texas Nurses Association would present a roadblock
to their efforts to seek volunteers for the vaccinations. Dallas
County has requested 5,400 doses of the vaccine.
"We've had 18 employees volunteer for the shots in the emergency
room; many of them are nurses," said Dr. Ron Anderson, Parkland's
president and chief executive officer. "I think some will drop out
if the ... [Nurses Association] says no."
Dr. Anderson said that Parkland, which is self-insured, intends
to offer medical coverage and sick leave to patients who have
problems with the inoculation.
Adverse reactions to the shots can include minor complaints such
as fatigue, muscle aches and low-grade fevers. A recent vaccination
trial of 680 people – all of whom received a smallpox inoculation
for the first time – found that a third were sufficiently ill to
have trouble sleeping, which caused them to miss school, work or
recreational activities.
Severe side effects from a smallpox vaccination are considered
rare but are estimated to affect 52 people for every million
vaccinated. The illnesses include encephalitis, or swelling of the
brain; severe skin rashes that can lead to scarring or death and
ongoing infection of the vaccination site, which can cause tissue
destruction.
One or two deaths per million people vaccinated have been
recorded in previous smallpox vaccination efforts.
However, the U.S. Centers for Disease Control and Prevention has
been working for more than a year on guidelines that attempt to
limit such severe reactions. Much of the effort has focused on
defining which people should not be vaccinated, including those who
suffer diseases that suppress their immune system, including lupus,
cancer and HIV, and those with any history of skin disorders such as
eczema and atopic dermatitis.
But there are many more disqualifications. For example, anyone
being treated with steroid eye drops should not get the vaccine.
Anyone who is breastfeeding or planning to become pregnant in the
month after the vaccination is excluded. The same is true for people
who've had life-threatening reactions to certain antibiotics,
including polymixin B, streptomycin and neomycin. Likewise, people
should not be vaccinated if they have close contact with anyone
suffering these conditions.
Despite the long list of disqualifying conditions and the ongoing
concerns about side effects, state officials said they remain
convinced that enough health-care workers would be vaccinated to
handle any future smallpox threat.
"If we get 20,000 people instead of 40,000, that will be fine as
long as we have sufficient numbers prepared in each community," Doug
McBride, spokesman for the Texas Department of Health, said Friday.
E-mail
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