Volunteers Brace For Needle As Smallpox Vaccinations Begin

(Hartford, CT-AP, January 24, 2003) — One of the first health care workers slated to receive the smallpox vaccine under the government's anti-terrorism program, Dr. Robert Fuller said he is ready to roll.

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Connecticut is the first state to be ready to proceed with the injections. About 20 people dubbed "The Genesis Team" were slated to get the shots Friday afternoon; in two weeks, they'll fan out to hospitals around the state to vaccinate additional workers.

Despite concerns that the vaccine can cause a handful of serious reactions and even death, Fuller said his fears had been allayed. The 38-year-old emergency room physician said he believed he had been vaccinated as a child, although he wasn't certain.

"Honestly, there was no discussion in the pediatrician's office," he said. "We just lined up the siblings and they all got stabbed."

The Connecticut doctors, nurses and nurse-practitioners were the first of about 500,000 health care workers the government hopes to vaccinate nationwide. They would serve on smallpox response teams in the event of an attack.

But it was unclear as the program began how many health care workers would raise their hands - and their sleeves.

A union representing nurses in Connecticut recommended that their members not get the voluntary vaccinations, citing questions about whether workers who get sick as a result of the shots would be compensated.

The California Nurses Association on Thursday urged hospitals there not to participate in the program. The group said there is no proof that a smallpox attack is likely, while there are known dangers to caregivers and patients.

In a recent survey, 63 percent of 2,600 nurses responding said they would get the smallpox shot, 13 percent said they wouldn't and 24 percent were undecided, according to the National Network for Immunization Information, a coalition of several health trade groups.

Some major hospitals are also refusing the vaccine.

In Connecticut, where health officials set a goal of vaccinating 5,800 workers - an average of 150 people per hospital - the early response is much lower.

Christopher Cannon, system director at the Office of Emergency Preparedness for the Yale-New Haven Health System, has overseen vaccine education programs at 17 hospitals in southern Connecticut. He says those hospitals are averaging between 20 and 30 volunteers.

"It's not overwhelming," Cannon said. "I think there are a lot of people sitting on the fence at this point, waiting to see how the first phase goes."

Dr. Louise Dembry, hospital epidemiologist at Yale-New Haven Hospital, said the decisions are personal - and difficult.

"I don't think any of us expected to get 100 percent of our staff," Dembry said.

The decision is complicated by several issues, including possible side effects and the perception that the threat of a smallpox attack is relatively low.

"We've had several extremes," said Dr. Grace Kim, chief of infectious diseases at St. Vincent's Medical Center in Bridgeport, Conn. "A lot of people stepping forward feel it's their job. There are other people who are frightened. There are people who acted initially and were willingly going to get the vaccine, but as they learned more about smallpox complications, they're a little more concerned about it."

The last naturally occurring case of smallpox occurred in Somalia in 1977. The United States stopped its smallpox vaccination program in 1972, after it was eradicated from the country. The vaccination program was reintroduced in December 2002 by the Bush administration prompted by fears of an intentional release of the disease by terrorists.

Made from a live virus called vaccinia, the shot is administered by a two-pronged, three-inch needle dipped in vaccine and injected in the arm.

Side effects can include sore arms and fever, and people may feel sick enough to miss work for a few days. As many as 40 people out of every million vaccinated for the first time will face life-threatening reactions, and one or two will die from the vaccine.

It is not recommended for pregnant women, people with skin problems, or those with HIV, a history of cancer or other conditions that weaken the immune system. The CDC has recommended that people with family members suffering from those conditions also be screened out.

Under a provision of the Homeland Security Act, the federal government will take limited liability for negligence in giving smallpox vaccinations, starting Friday.

Approximately 20 states have requested the vaccine for members of smallpox response teams. The CDC delivered kits for 21,600 vaccinations this week to Connecticut, Nebraska, Vermont and Los Angeles County. Connecticut's supply arrived Wednesday, a spokesman for the CDC said.

Julie Stewart, a nurse practitioner at Stamford Hospital, has said she'll volunteer for the vaccination despite the risks. She said she received the vaccine as a child without side effects.

And she wants to help if there is an attack.

"I think that the majority of the public are underestimating the risk. I really do," she said Thursday. "We want to believe that these potentially dreadful things don't exist out there. But I think it is naive to think there aren't one or two souls out there who would consider it."

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