HHS proposes smallpox vaccination for medical workers

Nov. 1, 2002

Health and Human Services Secretary Tommy G. Thompson recently recommended that President Bush adopt a smallpox vaccination program for emergency medical personnel who would be most at risk in the event of a bioterrorist attack.

Smallpox is potentially the most lethal of bioterror weapons because citizens in the U.S. have little immunity to it. Although President Bush has not officially approved the proposal, HHS is already preparing plans for vaccinating. If it is approved, some 250,000 to 500,000 hospital workers could be offered the vaccine, making this the first broad-scale smallpox vaccination program in three decades.

While many laboratory workers in hospitals would probably be affected by the proposal, Bob Neri, executive vice president of the Clinical Laboratory Management Association in Wayne, PA, says, CLMA has not heard any reaction to it from our own members. 

CLMAs 6,300 members are responsible for laboratories and clinical services in hospitals and healthcare networks, group practices, and independent settings. Neri says that as medical personnel begin to think about Thompsons proposal, It will probably sound more and more like a reasonable thing to do. Further, he says, We need to do whatever it takes to protect our population.

This latest proposal greatly expands on a recommendation issued in June by a federal advisory panel calling for the voluntary vaccination of small teams of medical workers in each state, an estimated 10,000 to 20,000 people.

Under Thompsons recent proposal, hospital workers would be the first to be vaccinated because analysts expect the first patients infected with smallpox to go to local emergency rooms. 

Unlike other vaccines, the smallpox vaccine is formed with live virus that can bring on serious complications. Some of the side effects include fever, brain inflammation, and, potentially, death.

The details of the vaccination effort for emergency medical personnel are still being ironed out. Initially, HHS officials believed that vaccinated healthcare workers would have to take about 10 days off to prevent the vaccines live vaccinia (local infection at site of inoculation) from being transmitted to patients. Now, however, HHS says the risk of this type of transmission is lower than thought. Even so, the department continues to review necessary precautions.

Acambis PLC, the company manufacturing the new vaccine for the federal government, recently indicated that it had packaged its first finished doses. Currently, the federal government has about 100 million doses of old vaccine stockpiled, and research indicates the stockpiles could be safely diluted and made available to the entire U.S. population. But experts maintain that the old supplies need to be replaced with fresher vaccine that is made with modern production methods.

In addition to proposed plans to vaccinate emergency medical personnel, the Bush Administration is still reviewing how widely to use the vaccine among the U.S. population in the absence of an attack. 

CDC is better prepared to fight bioterrorism, says Gerberding

On a related topic, Dr. Julie L. Gerberding, director of the Centers for Disease Control and Prevention (CDC), recently said that the agency had taken a number of steps over the last year to improve its terrorism preparedness.

One of the most important steps was providing $918 million to state and local health departments to help them improve their readiness, she said. The funds are being used to build better laboratories and better systems for detecting a potential terrorist attack. In addition, efforts are underway to expand communications systems to get information to public health workers and clinicians as quickly as possible.

Other steps include monitoring emergency rooms for certain ailments, educating healthcare professionals, adding more antibiotics and vaccines to the emergency stockpile, and teaching the newest epidemiologists how to quickly respond to an emergency

As part of this effort, the CDC has opened new laboratories, and its network now includes more than 200 throughout the country. Each of the laboratories can test blood, urine, spinal fluid, and other specimens for microbes and chemicals that might be involved in a bioterrorist attack. Each state has at least one of these laboratories. In addition, the CDC now has a laboratory that can test for 150 chemicals that could be used as weapons for attacking humans.

The agency also has hired more staff members to improve the health systems ability to detect diseases early and respond to them effectively. In the months ahead, the CDC plans to give its senior staff and many state and local health leaders training on how to work with emergency response agencies and the medical community. 

Said Gerberding, The process of preparing for a terrorist attack is a continual one with no real endpoint, but even today CDCs level of preparedness is very high. We have the plans, the policies, the people, the products, and now we have the practice to make sure we are ready to respond.

Joan Szabo is a Washington, DC, freelance writer specializing in healthcare issues. She has been writing the Washington Report column for MLO for five years.

2002 Nelson Publishing, Inc. All rights reserved.