The hospital's medical board recently ruled against vaccinating some of the facility's first-response emergency personnel, citing the promise every physician makes not to cause harm when practicing, according to Dr. William Schaffner, chair of the Department of Preventative Medicine.

The decision comes after Vanderbilt health officials determined the vaccination could pose danger to patients with weak immune systems, who could contract the small amount of the smallpox virus administered in a smallpox vaccination from a medical caregiver.

"As smallpox is not an immediate threat, the board has taken the position of the boy scouts and girl scouts of the medical community and be on the lookout," Schaffner said. "Right now the risk is very low, but if we needed it, we could get the vaccination in a pinch."

The World Health Organization declared smallpox eradicated in 1979.

Currently, the 50 state health departments have control of the stockpile of vaccinations. The vaccination, if needed, could be delivered within 12 hours time, according to Schaffner. There is a three-day window between exposure and infection in which a person can be effectively vaccinated against smallpox, he said.

Schaffner explained that there was a three-pronged influence on the board members' decision.

The primary concern when choosing not to vaccinate was the danger of putting hospital patients with compromised immune systems in jeopardy.

"With the way that the smallpox vaccine works, someone who is vaccinated might inadvertently transfer the disease to someone (who has a weakened immune system), and the damage could be very substantial," Schaffner said.

The smallpox vaccination is a live virus that is injected into the arm and, by the nature of the disease, is highly capably of being transmitted accidentally from the vaccinated person to another person.

Additionally, board members did not perceive the smallpox admonition as a viable threat. After conferring with Dr. Julie Gerberding, the director of the Centers for Disease Control in Atlanta, and Health and Human Services Secretary Tommy Thompson, members acceded that the threat of bio-terrorism and the utilization of smallpox as the agent of that attack is low.

Schaffner said that members of the medical board are comfortable with the 12-hour time span in which they can receive the vaccine, should they need it.

Smallpox, for a majority of its existence, has enjoyed a unique epithet in the world of diseases.

"Smallpox has been somewhat of an anomaly in terms of being able to prevent high mortality rates," said associate history professor Arleen Tuchman, who teaches an undergraduate course, "The History of Medicine."

Tuchman noted that once the vaccination was introduced at the end of the 18th century, community members were split on whether they would want to brave the disease or incur the risks of immunization.

"Still today, everyone is evaluating the risks differently," Tuchman said.

This fact is true with the VUMC.

In an initiative independent of the VUMC Medical Board's decision-making process, staff started alerting members of the hospital's emergency and intensive care units that they were the targeted members of the CDC's voluntary vaccination program. Upwards of 250 medical workers indicated interest in participating, officials said.

But Schaffner said only 20 or so individuals were interested in participating.

Shortly thereafter, the board made its decision and the volunteers were notified.

One test-run that was completed was the volunteer vaccination that involved approximately 300 students.

According to Schaffner, there were "no serious adverse reactions" from the group; however, about one-third of the volunteers reported feeling under par and subsequently had to take days off of work or school.