http://www.sptimes.com/2003/05/14/State/_What_ifs__surround_v.shtml

'What ifs' surround vaccine program

As first responders step up and get their smallpox shots, many still wonder whether the risk is too high.

By TAMARA LUSH, Times Staff Writer
© St. Petersburg Times
published May 14, 2003
 

[Times photo: Thomas M. Goethe]

Tampa Fire Rescue firefighter Bosie Soloman gets a smallpox vaccination Tuesday from Lt. Chuck Nelson. He was one of a dozen firefighters and paramedics to receive the shots as part of Operation Vaccinate Florida.

Tampa firefighter Wayne Tolzman carries the necessities of his job attached to his belt: Leatherman multipurpose pliers, a walkie-talkie and scissors that can cut through the seat belts of a wrecked car.

On Tuesday, Tolzman added another lifesaving tool to his repertoire: a smallpox shot.

"In my 20 years on the job, I've noticed that we run into more and more stuff," said Tolzman, as he rolled up his T-shirt sleeve in anticipation of the needle. "I wanted to err on the side of caution."

He was one of a dozen Tampa Fire Rescue firefighters and paramedics who volunteered to receive the shots Tuesday as part of Operation Vaccinate Florida, a statewide program to protect people who may come into contact with the deadly disease. Even Gov. Jeb Bush has had a vaccination.

Earlier this year, the vaccine was available to health care workers such as doctors and nurses who would likely care for victims of a smallpox attack. Response to the offer was lukewarm - only about 3,600 people statewide were vaccinated.

Many were concerned that they or their families could become sick if they touched the inoculation site, something health officials say is a remote possibility.

Another worry has been that workers' compensation would not cover them if they or their families were made ill by the shot. Lawmakers in Washington, D.C., passed legislation to provide compensation for such unlikely events.

And then there is an even more grim prospect. A 57-year-old St. Petersburg nurse died in March of heart problems a few weeks after receiving a smallpox shot. The federal Centers for Disease Control and Prevention is investigating that case and several similar ones nationwide.

Despite the weak initial response, state health officials are moving ahead with Stage II of the program, vaccinating so-called first responders - firefighters, paramedics and law enforcement. Nationwide, the shot will be available to 10-million first responders.

About 13 first responders statewide were vaccinated last week, said officials from the Department of Health.

Most counties are in the "information stage," and are not offering the vaccines yet, said Elaine Fulton-Jones, spokeswoman for the Pinellas County Health Department.

Pasco Fire Rescue chief Christopher Alland said the vaccine has been offered to firefighters and paramedics by the Health Department - but no one has gotten the vaccine, including him.

"I'm not out in the field, for one thing," said Alland. "And I have some reservations about it, such as heart problems."

Citrus County has taken a low-key approach, with sheriff's employees being notified by e-mail about the available vaccine.

In Tampa, health department employees worked with Tampa Fire Rescue to create a Smallpox Task Force, where paramedics give vaccinations to fellow emergency workers.

Instead of going to the health department for the shot and after-care, city firefighters and emergency workers will be vaccinated by paramedics at one of four locations in the city. The paramedics will monitor people for signs of problems caused by the vaccine, and will provide followup care.

Vaccination is done with a live virus called vaccinia, which is not smallpox. There is no danger of reintroducing smallpox from the vaccine, but there are risks associated: The most common happens when vaccinia escapes from the inoculation site, often because people touch the site and then touch themselves. The virus transferred to the eye can cause blindness, according to the state Health Department's Web site.

Experts estimate that 15 to 50 people out of every 1-million vaccinated for the first time will face life-threatening complications. One or two will die.

Dr. Landis Crockett, the director of disease control for the state Department of Health, said officials have a surveillance system to monitor complications.

Tiffany Melton, an occupational health nurse who works for Tampa Fire Rescue, expects about 250 of the city's 530 firefighters and paramedics to be vaccinated.

Hillsborough Fire Rescue has a similar program, using paramedics to vaccinate their peers.

Robert Marschall, the agency's infection control officer, said he surveyed the 800 firefighters and paramedics. About 30 percent said they would volunteer to get the shot.

"The good thing is, it will be offered for nine months," said Marschall. "As people get it and others find out it wasn't all that bad, we'll probably have more interest once the see the vaccine is safe."

- Times researcher John Martin contributed to this report.