ICPs will be offered smallpox vaccination
General public could be offered vaccine as early as 2003
Beginning early this year, infection control professionals will be offered smallpox vaccine along with about 500,000 other hospital workers who volunteer for smallpox care teams in the nation’s hospitals. Approved by the Bush administration Dec. 13, 2002, the Centers for Disease Control and Prevention (CDC) plan cites ICPs and hospital epidemiologists as key members of immunized smallpox teams to be formed at acute-care hospitals.
That means infection control professionals will be offered the smallpox vaccine as part of the "pre-attack" bioterrorism response plan to vaccinate some 510,000 health care workers. The vaccination of health care workers will follow the immunization of some 500,000 military personnel, who will be offered the vaccine first under the government’s three-tiered plan. In a somewhat surprising development, President Bush said he will make the vaccine available to the general public sometime in 2004, but the government will not necessarily encourage immunizations.
From relative conservative origins — teams totaling 15,000 were first recommended last year — the government is moving ahead aggressively. That suggests to some — particularly if the vaccine is offered to the public next year — that the government fears smallpox bioterrorism beyond any short-lived war with Iraq. "It’s got to more than Iraq," explains William Schaffner, MD, chairman of the department of preventive medicine at Vanderbilt University Medical Center in Nashville, TN. "They must believe there is a continuing risk of some sort."
Indeed, the tone of the decision runs counter to the measured view taken by medical officials, many of whom would prefer to carefully study vaccinees before moving to larger numbers. "I like the staged approach, and I have from the beginning," says Schaffner, who recently observed vaccinations firsthand because Vanderbilt is one of the National Institutes of Health (NIH) test sites. "We have been so wonderfully informed by the NIH research sites and their experience. That has enabled us right now to plan realistically and sensibly. I would have hoped we would have digested the lessons of phase one — logistics, scheduling, frequency of adverse events, absenteeism, cost, personnel time — before we commit to phase two and three."
The CDC’s Advisory Committee on Immunization Practices’ (ACIP) plan calls for smallpox immunization of roughly 100 health care workers per hospital. In addition to ICPs, ACIP recommended that the team include hospital epidemiologists and physicians, nurses, and other staff in the emergency department; intensive care units; respiratory therapy; radiology; engineering; security; and housekeeping. The composition and size of the teams are expected to vary by hospital because the program is voluntary.
About 20% of Americans are contraindicated for smallpox vaccine because of various immune deficiency and skin conditions. That would include health care workers, and there is some question of how many will step forward to join the hospital care teams. Most deaths caused by vaccination are the result of postvaccinal 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.