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.
Copyright 2002 Reuters News Service. All rights reserved. This
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