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Oct. 18

— By Emma Hitt, PhD

ATLANTA (Reuters Health) - Healthcare workers who receive smallpox vaccine should keep the vaccination site covered until the scab separates, but they can care for patients immediately after vaccination, federal health officials announced Thursday.

Earlier this week, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommended that over 500,000 healthcare workers--those most likely to treat patients in the event of a smallpox outbreak--should be vaccinated against smallpox.

In a telephone media briefing, Dr. John Modlin, chair of the ACIP, summarized several specific recommendations made on the vaccination of healthcare workers.

A key issue the guidelines addressed was preventing the transmission of vaccinia virus, the virus used in the vaccine, from healthcare workers who have been vaccinated to those that have not. Vaccinia virus is related to the smallpox virus, but much less dangerous. The virus generally poses no risk to healthy individuals but could be a problem for certain individuals, including those with weakened immune systems.

Between two to six unvaccinated people might contract the virus for every 100,000 people immunized, according to a report in The Journal of the American Medical Association Tuesday.

ACIP is recommending that healthcare workers involved in direct patient care cover the vaccination site with absorbent material, such as gauze, and "at least a single layer of impermeable acoustic dressing," until the scab separates.

However, the committee recommended against the need for healthcare workers to be placed on leave after receiving smallpox vaccination unless they develop symptoms from the vaccination or do not adhere to infection control precautions.

"Very close contact required for transmission of vaccinia to household contacts is unlikely to occur in the healthcare setting," Modlin stressed during the briefing.

ACIP also recommends that healthcare workers with eczema, a type of allergic skin rash called atopic dermatitis, or other skin conditions avoid receiving the smallpox vaccine.

According to Modlin, about 2% to 5% of adults have eczema or atopic dermatitis, although when other skin conditions that could make the vaccine risky are included, the vaccine may be contraindicated for up to 10% to 20% of people.

Pregnant healthcare workers, those with HIV/AIDS or other immunocompromised individuals should not receive the vaccine, but neither routine pregnancy testing nor mandatory HIV/AIDS testing is recommended. Female healthcare workers should be counseled not to become pregnant for 4 weeks after vaccination and HIV testing should be offered, they suggest.

Smallpox vaccine may be administered at the same time as any inactivated vaccine or live vaccine, with the exception of varicella (chickenpox), according to ACIP.

Regarding the risk to household contacts of healthcare workers, Dr. Walter Orenstein, director of CDC's National Immunization Program, told Reuters Health that the same kinds of contraindications considered for those being vaccinated should be applied.

"So, for example, if a healthcare worker has a child in the home with eczema, then that worker should not be vaccinated," Orenstein said.

Modlin pointed out that "for the most part...organizations representing emergency room physicians, nursing staff and others have been very supportive of the process and have participated and, more or less, agree with the ACIP's actions."

According to Orenstein, the order in which healthcare workers will be vaccinated is still being worked out.

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