Smallpox Inoculation Urged for Employees of Hospitals

By LAWRENCE K. ALTMAN

TLANTA, Oct. 16 — A panel of specialists advising the government on smallpox vaccinations recommended today offering the immunization to an estimated half-million emergency room and other hospital workers because of the possibility of a bioterrorist attack.

The panel chose not to recommend offering vaccinations to the estimated 10 million paramedics, firefighters, police officers and other health care and law enforcement workers who might also be among the first to respond to a biological attack.

The proposal to vaccinate the larger number of workers was one of the options that the government's top smallpox health officials said they had presented to Tommy G. Thompson, the secretary of health and human services, earlier this month. Aides to Mr. Thompson said he had made his own confidential recommendation to President Bush.

The decision on how many people to vaccinate has been complicated and contentious because the vaccine is dangerous, smallpox was eradicated in 1980 and the threat of a bioterrorism attack that releases that smallpox virus is unknown.

The government usually follows vaccine recommendations from the panel, which advises the Centers for Disease Control and Prevention, based here where the panel is meeting today and Thursday.

But in this case Mr. Bush, who is expected to make the decision on who should be eligible for vaccinations, has gotten several proposals, including the possibility of offering the vaccine to up to 10 million health and emergency workers, or all Americans before any attack occurs.

Dr. Paul Offit of Children's Hospital of Philadelphia was the only member of the panel to dissent from the vote to recommend vaccinating hospital workers.

"We're thinking about immunizing 500,000 people for a disease that is still theoretical," Dr. Offit said. "We haven't seen a case of smallpox on this planet for 25 years. If there is not a case of smallpox, we will be doing more harm than good."

After the president makes his decision, the recommendations of the panel will provide guidance for local and state health officials.

At the hospitals, the panel said, those eligible for vaccination would include doctors, nurses, respiratory therapists who work in intensive care units and x-ray technicians.

Those volunteering to be vaccinated would be expected to care for smallpox patients in shifts for the entire first week.

Dr. Jane D. Siegel of the University of Texas Southwestern Medical Center in Dallas said experts estimated that vaccinating 100 hospital workers in these jobs should allow for care of three or four patients with a presumptive diagnosis of smallpox.

The first group of workers expected to be vaccinated are those who were immunized before the government stopped smallpox vaccinations in 1972 as smallpox was being eradicated, in part because they may be expected to have fewer complications.

The panel also said workers should be asked whether they are pregnant or infected with the AIDS virus, H.I.V., before receiving the vaccine. Both conditions can increase the risk of adverse reactions to the smallpox vaccine, which experts consider the most dangerous of all immunizations.

The panel did not require that workers be tested for H.I.V. or pregnancy before being vaccinated.

The vaccine is delivered into the upper arm with a two-pronged needle. The panel recommended that vaccination recipients place a strip of gauze covered by a bandage over the vaccination sore because the immunization contains a live virus that can spread elsewhere on the body and to other people.

Health officials said they did not know the number of hospitals that would participate in a smallpox vaccination program but expected it to depend in part on population and geography.

In June, the panel said that only about 10,000 to 20,000 health care workers might have to be vaccinated at one or two designated hospitals in a city or region. But panel members have now increased the number of hospitals that would be involved.

In June, the panel rejected a proposal to offer smallpox vaccine to every American at this time. But earlier this month top Health and Human Service officials said that they had not yet ruled out offering smallpox vaccine to all Americans; however, they said they would prefer to do so after a newer version of the vaccine is licensed, which cannot occur before 2003.

Vaccinations cannot begin until the federal government, which owns all stocks of smallpox vaccine in this country, begins to release it.

After the government stopped routine smallpox vaccinations in 1972, it classified the vaccine as "investigational." Until the older version of the vaccine is relicensed, its use would require each person to sign a form noting that the risks and benefits have been explained.