Thousands sign up for vaccine

Smallpox shots to prepare health workers for crisis

By MARILYNN MARCHIONE
mmarchione@journalsentinel.com

Last Updated: Jan. 17, 2003

Several thousand Wisconsin health care workers have said they're interested in being on smallpox emergency response teams and getting smallpox shots in the first round of President Bush's vaccine program, which is set to start next week.

On the Web   Centers for Disease Control and Prevention hotline: English (888) 246-2675; Spanish, (888) 246-2857; Web site. Web site: Institute of Medicine report

Meanwhile, an advisory panel urged federal officials to move slowly and solve potential problems, such as tracking vaccine reactions and compensating health care workers for lost work and medical complications. Two of the nation's largest unions urged the government to delay the program, saying workers weren't adequately protected.

But Bush said the plan must proceed on time, as did U.S. Centers for Disease Control and Prevention director Julie Gerberding in a news conference Friday afternoon.

"We need urgent and efficient action because we live in a dangerous world," she said. "We intend to make this program happen on time."

While not directly addressing the risk of war, Gerberding said the smallpox vaccine plan was a matter of "homeland security and national defense," and that officials had to weigh "the severe but rare side effects" of the vaccine against "the dreadful consequences of a smallpox attack" if the nation were unprepared.

Previously, she and other government officials have characterized the risk of a smallpox attack as low.

Smallpox was eradicated worldwide in 1977, and vaccination ended in the United States in 1972. Vaccinations are resuming because of the threat of bioterrorism.

The first phase of Bush's plan is to vaccinate up to 500,000 health care worker volunteers. Shots for about 500,000 military personnel started last month. The second phase would extend vaccination to more health care workers and others such as police officers.

Eleven states on tap

Eleven states have asked for vaccine to be shipped so they can give shots as early as Jan. 24. Wisconsin won't request vaccine shipment until volunteer counts are finalized and probably will start vaccinating in mid-February, said Herb Bostrom, director of the Bureau of Communicable Diseases for the state Division of Public Health.

Friday was the deadline that Wisconsin officials set for about 100 local health departments and 124 hospitals to tell the state how many volunteers they had.

"We've got hundreds of responses," and on average a dozen people on each response, Bostrom said. Only a few departments or hospitals said no staffers qualified because of medical conditions that make the vaccine unsafe for them.

The state had identified 15,000 health care workers who could be involved in emergency response teams, though as many as 30% are likely to be medically ineligible. Likely fewer than 5,000 actually will participate, Bostrom said.

At least 20 to 30 Milwaukee Health Department employees, including doctors, public health nurses, epidemiologists, clinical assistants and public health educators, have expressed interest, said Paul Biedrzycki, the department's manager of disease control and prevention.

Focus on risk

The risk to such workers was a large focus of the report Friday by the Institute of Medicine panel. The group included R. Alta Charo, a bioethics lawyer from the University of Wisconsin-Madison, and was led by Brian Strom, a professor at the University of Pennsylvania School of Medicine.

Based on previous experience with the vaccine, 40 of every 1 million people receiving it for the first time will develop a serious reaction, and one or two will die. The vaccine is not recommended for people who have eczema or other skin conditions, who are pregnant or breast-feeding, who use topical or inhaled steroids, or who have a weakened immune system from cancer, transplants, HIV or other causes.

As much as 30% of the general population has such conditions, the institute's report says.

"We are very concerned that people who have contraindications not get this vaccine," and are worried that many people, including health care workers now volunteering, "may be committed enough and want this vaccine" enough to get it anyway, Strom said.

Health care workers need to be told explicitly that the Homeland Security Act provides compensation only if the vaccine were manufactured or administered negligently, and that costs they may face from side effects or lost work may or may not be covered by their state's worker's compensation or their own insurance, the panel said.

"There is concern that the absence of reimbursement for some of these expenses might cause some people to decline to be vaccinated" who otherwise would be willing, and that could compromise the public health goal of having enough first responders, Charo said.

The institute's report also said a better system is needed to actively track on a daily basis adverse side effects from the vaccine.

 

 

 

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