CDC recommends vaccine for 510,000 workers
Emergency department (ED) nurses in every hospital in the country are expected to be offered smallpox vaccine as part of bioterrorism response plan approved in October by advisors to the Centers for Disease Control and Prevention (CDC) in Atlanta.
The CDC’s Advisory Committee on Immunization Practices (ACIP) approved a plan that calls for smallpox immunization of some 510,000 health care workers. As outlined at the meeting, all hospitals should designate a "smallpox care team" that will be immunized prior to any release of the virus. ACIP recommends that the team include about 40 health care workers per hospital, including 15 ED physicians and nurses. In addition to emergency staff, the teams will include the hospital epidemiologist and infection control professional(s), eight intensive care nurses for adult patients, eight pediatric ICU nurses, one infectious disease consultant, one dermatology consultant, four respiratory therapists, four radiology technicians, two engineers, and selected staff from the security and housekeeping departments.
"ACIP will provide guidance for developing a hospital care team prepared to respond and take care of the first smallpox patients," says Jane Siegal, MD, who advised ACIP on the issue as a member of the CDC’s Healthcare Infection Control Practices Advisory Committee. "[This is the] suggested composition of the team. I think individual hospitals have to look at that and look at the types of patients they see, the type of care they provide, and decide who it will be [on the team]. This provides some guidance."
In making the recommendation, the committee was well aware of the possible adverse effects of giving people vaccinia virus (cowpox) to protect them from variola virus (smallpox). Progressive vaccinia, a potentially fatal complication of vaccination, has occurred almost exclusively among immunocompromised people. Approximately 15%-25% of vaccinees who develop post-vaccinal encephalitis die, and 25% have permanent neurological sequelae. Most deaths caused by vaccination are the result of post-vaccinal encephalitis or progressive vaccinia. Overall historical death rates are approximately one death per million people on initial vaccinations and 0.25 deaths per million revaccinations. Thus, health care workers with a history of prior smallpox vaccination should be given preference for selection to the hospital care team, Siegal says.
Still, the decision to immunize 500,000 people against a disease that no longer occurs in the wild was worrisome to some.
"We haven’t seen a case of smallpox on this planet in 25 years," warned Paul Offit, MD, ACIP member and infectious disease chief at the Children’s Hospital of Philadelphia. "Would it not be reasonable to put this system in place — make the vaccine and get it out there under lock and key, make guidelines [stating] clearly who should be vaccinated — [and then implement it] following a single documented case? If you immunize 500,000 people, there will be people who have serious adverse events. There will be contacts of [immunized] people who will have serious adverse events. We will do more harm. I wonder if we could jump with a [safety] net a little bit by waiting for just the first confirmed case, but be ready when that happens."
However, other committee members warned that last year’s anthrax attacks showed how vulnerable the nation is to bioterrorism agents. The prevailing opinion was that the price of unpreparedness against smallpox would be immense. Offit’s was the only dissenting vote on the 12-member panel.
"If there is not a case of smallpox, we will be doing more harm than good," he said. "I guess at this point we don’t know whether or not there will be a case of smallpox. This is like a case study in how terrorism works."
The CDC recommendation awaits the approval of the Department of Health and Human Services and top government officials, who have been mulling the pros and cons of immunizing all or portions of the populace. However, the tone of discussions at the ACIP meeting indicated a full expectation that the government is preparing to move ahead with smallpox immunization of health care workers. The process of licensing the vaccine is expected to be completed by the end of the year, and health care immunizations may follow early next year, committee discussion indicated.
The hospital recommendations are designed to complement — not necessarily replace — previous ACIP recommendations to immunize state-based smallpox teams. Though those June 2002 recommendations have yet to be approved by the government, the end result is expected to be some combination of immunizing public health response teams and hospital-based teams. What the CDC is clearly moving away from is the concept of "designated" smallpox hospitals. In addition to logistical concerns of with that plan, there was little interest among hospitals in volunteering for the duty, ACIP discussions revealed.
Emergency department nurses in every hospital in the country are expected to be offered smallpox vaccine as part of bioterrorism response plan approved in October by advisors to the Centers for Disease Control and Prevention in Atlanta.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content