Smallpox success: No problems with vaccine

Plan worked smoothly at Nebraska hospital

Despite reports about a possible link between heart problems and the smallpox vaccine, most vaccination sites have reported little more than discomfort among the vaccinees. At one Omaha, NE, hospital, prescreening and preparation led to a smooth, problem-free experience.

Omaha hospitals began working together to plan for bioterrorism in 1998 — long before Sept. 11. That advance coordination and education helped set the stage for successful smallpox vaccination, says Sandra Vyhlidal, RN, MSN, CIC, epidemiology coordinator at Methodist Hospital.

As of March 14, 2003, about 1,400 health care workers had been vaccinated in Nebraska. At Methodist Hospital, 26 nurses and physicians received the vaccine; none had serious adverse events.

When the vaccination program began, Vyhlidal gathered a task force to determine who should get the vaccine. Although the health department had suggested that the hospital vaccinate 228 employees, the hospital decided to limit the vaccine to nurses and physicians who could administer it to other employees if a case occurred.

"We wanted to have health care workers who could immediately go in, diagnose, care for the patient immediately and reduce the risk to our employees," she says, noting that "every hospital had their own approach, their own plan within the city." She sent out letters to nurses and physicians with a prescreening tool and information on the vaccine and received a positive response from 69 potential vaccinees.

At an educational session, Vyhlidal provided additional screening and more information on the hospital’s policies. Anyone who worked with newborns, immunosuppressed patients such as oncology or AIDS patients, or in the operating room would be reassigned until their scab separated — about three weeks after vaccination.

The hospital also told employees that they would not be covered by workers’ compensation. Medical care would be covered through their regular health insurance. "We did say at the education that our preference was people who had been vaccinated before," says Vyhlidal. "We felt that reduced their chances of having any serious side effects."

After additional screening and education, 26 employees ultimately received the vaccine. These were some of the results:

• Four were revaccinated and failed to have a take either time; they’re considered nonimmune.

• Itching and swelling at the vaccine site were the most common reactions.

• 17 employees suffered from irritation from the bandage adhesive.

• Four employees had a fever, and two missed some work.

• Skin conditions and desire not to be reassigned were the most common reason for declining the vaccine.

Although the hospital’s overall number is relatively small, Vyhlidal says the program met the goal of vaccinating enough nurses and physicians to care for a patient and provide vaccinations to other employees if a smallpox event occurred. "I wanted to get the word out so other hospitals would see we’ve had a good experience."

Methodist Hospital is discussing phase two with the state health department, which will focus on first responders, but could include nurses and physicians who were unable to receive the vaccine earlier due to scheduling difficulties. In phase three, when the vaccine is offered to the general public, other hospital employees may be included, Vyhlidal says.