Hospitals compiling lists of personnel to get smallpox vaccinations

The federal government is recommending 100 health professionals from every hospital and 40 to 50 people from each health department be vaccinated.

Sunday, January 5, 2003

By LIZ FREEMAN, epfreeman@naplesnews.com

Some health officials in Southwest Florida have started compiling names of medical professionals at hospitals and public health departments who are willing to get the smallpox vaccine and serve as members of response teams in case of a smallpox bioterrorism attack.

The lists are in preparation of the first phase of Florida's smallpox vaccination plan, soon to get under way after gaining approval from the U.S. Centers for Disease Control and Prevention. The plan is to vaccinate 35,000 to 40,000 health care workers statewide.

The federal government is expected to distribute the vaccine by late January or early February to local jurisdictions.

Phlebotomist Jessica Moore prepares plasma at Serologicals in Spartanburg, S.C., a center where blood donors who have been vaccinated against smallpox can take part in the test. The plasma will be sent to a company in Canada that will use it to develop a treatment for reactions to the vaccine to be sent out for testing. AP photo by Jason Parker/Greenville News

"The intent of phase one is for hospitals and health departments to have the staff they need to care for the first person who shows up with smallpox and investigate the case," said Dr. Judith Hartner, director of the Lee County Health Department. Hartner is chairwoman of the health and medical committee of the regional domestic security task force in Southwest Florida.

Hospitals must have emergency room employees vaccinated because an individual or group stricken with smallpox is likely to come to an emergency room first. Others in the hospital, from floor staff to respiratory therapists, who will be caring for the smallpox victims once hospitalized, likewise need to be inoculated, she said.

Every county health department needs employees who are protected against smallpox because they will be interviewing the victims, tracing their contacts and conducting a vaccination program.

There's no firm date for when the vaccine will be available, but officials are looking to Jan. 24 based on language in the federal government's Homeland Security Act.

Hartner said the plan is to inoculate 3,000 to 4,000 hospital and health department personnel in the region, which covers Lee, Collier, Sarasota, Charlotte, DeSoto, Glades, Hendry, Highlands and Okeechobee counties.

There has been mixed response from hospital to hospital so far, she said.

"This is a voluntary program," Hartner said. "People must make a clear and informed choice. We're happy to see people ask great questions."

Most side effects are mild reactions such as a sore arm and redness at the injection site, low fever and swollen armpit glands. One out of three people may feel bad enough to miss work, according to the CDC.

In addition, about 1 out of 1,000 people vaccinated may develop reactions that require medical attention, namely a rash or outbreak of sores. Some people accidentally spread a vaccine rash by touching the inoculation site and touching other areas of the body or other people.

When the vaccine was given routinely until 1972, an estimated one or two people out of every 1 million people vaccinated died as a result of life-threatening reactions, such as serious skin conditions or encephalitis.

"Once the vaccine is released, we will vaccinate people within 30 days," said Judy Nuland, disaster coordinator for the Collier County Health Department and chairwoman of Collier's bioterrorism committee.

The federal government is recommending 100 health professionals from every hospital and 40 to 50 people from each health department be vaccinated, Nuland said. Collier is eyeing that guideline.

How the smallpox vaccination is administered. Click on the image above for a full size version of the graphic.

"So we will vaccinate roughly 250 to 300 people in the first stage," Nuland said. "The hospitals are now preparing lists of health care workers."

When and where the health professionals will get vaccinated is confidential for security purposes, she said. The process is expected to take 30 days.

"We've got about 45 or so volunteers, physicians, nurses and staff who are going to be intimately involved in providing care in the emergency room," Geoffrey Moebius, administrator of Cleveland Clinic's hospital in North Naples, said of recruiting volunteers. "We are going through that process right now of talking to physicians, infectious disease control staff, emergency room technicians and clerical staff in front of the emergency room."

Officials at the NCH Healthcare System are educating employees about the vaccine, its side effects, and who isn't eligible for medical reasons. After an educational program Tuesday, administrators will start putting the list of volunteers together, said Anne Kithcart, an infectious control specialist with NCH.

In addition to local public health officials being on hand Tuesday, the session will include an Orlando physician, Dr. Ronald Brown, who has been giving the smallpox vaccination to volunteers in Orlando as part of a national initiative. Brown's clinic, one of 10 in the nation, is vaccinating volunteers and harvesting their plasma for an antibody called vaccinia immune globulin, which will be given to people who develop life-threatening complications from the smallpox vaccine.

Kithcart said NCH has no specific target for how many physicians, nurses and other employees it wants to voluntarily get the vaccine. The hospital system has been allocated 200 doses.

"It's really hard to say what our response is going to be," she said. "You can't have any medical issues. You must look at it from your own issues and family issues."

In Lee County, the Lee Memorial Health System is looking to vaccinate, systemwide, a total of 150 front-line emergency-room workers, said Jeff Doucette, director of emergency services for the hospital system. The Lee system runs Lee Memorial Hospital near downtown Fort Myers, HealthPark Medical Center in south Lee and Cape Coral Hospital in Cape Coral.

The hospital system hasn't started compiling names of smallpox volunteers but is ready to start when administrators learn when the vaccine will be released.

"We have put everything together and are ready to roll. We're just waiting for the date," Doucette said.

A technician holds a vail of donor plasma at Serologicals in Spartanburg, S.C., as part of a nationwide study looking at the effectiveness of a treatment based on smallpox antibodies in plasma. The plasma will be shipped to a company in Canada, where it is refined into vaccinia immune globulin, or VIG, which then will be used to treat the reactions. AP photo by Jason Parker/Greenville News

For certain, though, the vaccine will be given in phases to employees, to prevent large numbers of emergency-room employees from being off work all at once because of potential reactions, he said.

"We can't have 150 front-line workers out in the height of season," he said.

Doucette said he doesn't expect widespread response among hospital workers to get the vaccine, given that the Fort Myers region is an unlikely target for a smallpox bioterrorism attack.

Anyone with eczema, a skin disease, or who has cancer or another compromised immune system problem, and anyone who is pregnant or breastfeeding, will be excluded from getting the vaccine. Anyone with family members with such conditions or if there is a child under 1 year old in the household won't be allowed to receive it.

The reason is the vaccine, which is live cowpox virus, causes an open sore. If the sore isn't properly covered until it heals, in about three weeks, the vaccinated person could scratch it and touch someone else and spread the vaccine and potential side effects, Hartner said.

"Our reports from the military who have begun (vaccination programs) is that 30 to 40 percent of the potential (vaccine recipients) are being screened out because of potential risks," Hartner said. "We want this to be a safe program."

At Southwest Florida Regional Medical Center in Fort Myers, administrators have sent out to various hospital units information about the vaccine and its risks.

"I've got some people but don't have my final list yet," said Melanie Hall, infectious disease specialist at the hospital, adding that people need to consider the risks.

"The health department would like a hospital of this size to come up with 100 people," Hall said. "I don't know if we're going to get that many. We'll just to try to get as many people as we can."

One outstanding issue is how the state will pay for the vaccination program. The state received a $40 million grant from the CDC, but that money has been allocated to other bioterrorism response initiatives.

"When the state wrote the grant to the CDC for the $40 million, smallpox vaccination was not on the table," said Hartner, of the regional task force. "And the CDC at the time had very specific things to do with the money. Now, here we are at the end of the year with a smallpox campaign and we don't have the funding."

Hartner said state health officials in Tallahassee have approached the CDC about amending the grant guidelines so some of the money can go to the vaccination campaign. She's heard there has been verbal approval but nothing official.

She had no figures on how much the program's first phase will cost.

"I know the Department of Health is working on a cost-per-vaccine (estimate)," she said.

The second phase of the state plan, which still needs the federal government's approval, will entail vaccinating more than 400,000 law enforcement officers, firefighters and paramedics.

The third and final stage, should the federal government deem it necessary, is the voluntary vaccination of the general public. State health officials project up to 10 million people in Florida might be eligible.

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