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01/12/03 - Posted 11:25:24 PM from the Daily Record newsroom
Smallpox vaccine gets shot in the arm

By Rob Seman, Daily Record

Just days before the first phase of the state's plan to start smallpox inoculations gets under way, some health care professionals remain reluctant to get the vaccinations.

The first phase of a three-pronged plan seeks to vaccinate up to 15,000 volunteer public health workers and hospital staff workers. Two Morris County health representatives met with representatives from the state and other counties on Friday in Princeton to review the plan.

Kathy Skrabola, a nurse from the Lincoln Park health department, and Kathy Whitehead, a nurse from the Kinnelon health department, both members of the county's bioterrorism task force, represented Morris County at the meeting. Both have been trained to administer the shot.

They will teach about 20 other public health nurses how to administer the vaccine. Representatives from hospitals also attended the meeting, where they were trained to administer the vaccine and teach other volunteer professionals.

The second phase of the plan will be to inoculate first responders, such as police, fire and rescue workers. The third will be to inoculate the public.

Howard Steinberg, Morristown's health officer, who recently was hired to coordinate the county's health agency, said the first phase of the plan is about to get under way. Morris County is working with Warren, Passaic and Sussex counties to implement the plan as a region and will select a single site in one of the four counties to perform the inoculations.

Although state spokesman Tom Slater said Friday that the site had not been chosen, Cathi Dages, a nurse from St. Clare's Hospital who attended the meeting in Princeton, said afterward that the Dover Armory had been selected.

Many public and hospital health care professionals are less than enthusiastic about getting the inoculation, primarily because of the possible adverse reactions.

One in a million people might die from the vaccination, which uses the live virus, said Hanover health officer George Van Orden. Fifteen in a million will face adverse or life-threatening effects, he said.

"They are concerned that the precautions they take may not be sufficient to prevent the spread of the virus to other people in the hospital or family members when they go home," said Pasquale Pignatelli, health officer for Lincoln Park.

The area in which a person gets the shot would be covered by a 3-inch-by-3-inch gauze pad and a semi-permeable covering, and the person will be asked to wear a long-sleeve shirt and then an outer garment or jacket, Pignatelli said.

Dr. John Salaki, chairman of the infection control committee at Morristown Memorial Hospital, said only a few physicians are among the volunteers who have signed up so far.

"From a physician's standpoint, many of us are dealing with patients who are compromised in one way or another on a day-to-day basis," which poses the risk of spreading infection with the virus, Salaki said.

Steinberg said the smallpox vaccination has no set side effect. "Someone could go through and have a sore arm or they could have some kind of symptom from it," he said. "But that's not everybody. You don't know what. It all depends on your immune system."

Also keeping health care professionals at bay is the question of insurance coverage and workers' compensation in the event of adverse reactions.

"The biggest thing is about the workman's compensation issue. There are not a lot of people stepping up to the bat to get the vaccination," Pignatelli said. "I think quite a few people are concerned about the adverse effects."

Kinnelon health officer Calliope Alexander said recipients of the vaccination typically experience malaise for six to eight days. The fatigue may be enough to cause vaccinated public health officials or hospital staff members to take days off from work. Alexander said the state needs to create a policy that allows an official to receive workers' compensation in that event.

Dages of St. Clare's Hospital, who attended the meeting in Princeton on Friday, said it now appears that the attorney general will put such a policy in place.

"Right now it looks like workers' comp will cover any type of medical leave of absence because of the vaccination," Dages said. "I think that will certainly help enhance the program because now the workers will have an extra reason to get vaccinated."

But reluctance still lingers among medical professionals, Dages said.

"I think a lot of us are feeling, 'Why are we going through this if there is no immediate threat?'" Dages said. "I think we just want a little more information."

Salaki acknowledged that those who do receive the inoculations will face additional responsibility in the event of a smallpox outbreak.

"There's going to be a lot of responsibility on their shoulders that they're going to have to be the first responders or screeners," he said.

Rob Seman can be reached at rseman@gannett.com or (973) 428-6631.

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.