Know these facts before facing smallpox vaccine

Others’ experiences help you avoid problems

Ever since ED managers learned that their staff could be among those to receive the smallpox vaccine, there have been concerns about risks to both staff and patients, and staffing problems of epic proportions. Now there is real-life experience to draw upon. "Our experience can serve as a model for hospitals that haven’t started yet," says Kathy Lynn Emanuelsen, RN, director of occupational health at Hartford (CT) Hospital.

She reports that 80% of staff participated in the medical screening process leading up to vaccination, with no significant adverse outcomes for anyone vaccinated. These positive results came from careful planning, she emphasizes. "It’s a lot of work, and you need to put resources behind it," Emanuelsen says.

Costs included supplies used to care for the vaccine site, such as occlusive dressing with gauze, and packets given to vaccinated staff containing gloves, extra dressings, disposal bags, and hand cleaner. Other expenses included time spent on preparing and presenting educational programs, and staff time away from work to attend these sessions, she adds.

Lessons learned from facilities that have participated in the vaccination program, which can help you avoid poor participation, scheduling problems, and adverse outcomes, include:

Staffing problems can be kept to a minimum.
The targeted number of individuals to be vaccinated at Hartford Hospital was between 200 and 225, reports Emanuelsen. "We will get very close to 200 by the time we are done," she says.

In the ED, seven physicians, two nurse practitioners, four nurses, two patient care assistants, and three secretaries have been vaccinated so far, Emanuelsen reports.

"I planned it so that on each vaccination day, we took only a few of each group in the hospital so that should anyone need time off, we could continue to take care of patients," she says. Staff were told they would be given an excused day off for any lost work and would not have to use sick or vacation days, Emanuelsen adds.

"This was presented at the educational program, which included an hour of presentation by an infectious disease physician," she says. "Anybody stepping up to the plate to receive the vaccine knew they would be given an excused day if they felt unwell."

Not a single ED staff member took time off because of the vaccine, Emanuelsen reports. However, some staff members said they didn’t think the threat was real and wanted to wait and see what happened, while others expressed fears about receiving the vaccine, says Emanuelsen.

"If anyone said they were afraid, I told them I respect their decision," she says. "If an individual came and got educated and didn’t volunteer, that decision was equally valued."

Adverse events were rare, but they did occur.
In Tennessee, out of 2,400 vaccinations in 137 hospitals, there were 15 minor adverse events and two serious adverse events, reports Allen S. Craig, MD, a state epidemiologist with the Tennessee Department of Health in Nashville.

"One patient had a headache and was admitted to rule out encephalitis. She did not have encephalitis and has recovered," Craig says.

A second patient had chest pain and dehydration, he says. "The electrocardiogram was normal, and the patient was discharged after an overnight stay with no further problems," Craig adds. "This case occurred before the recent information on cardiac adverse events came to light."

Based on reports of cardiac events after smallpox vaccinations including myocardial infarction (MI) and angina, the CDC added known cardiac disease such as previous MI, angina, congestive heart failure, or cardiomyopathy to the list of contraindications for the vaccine.

There is a need to educate about risk of transmission.
Some hospitals chose not to participate largely due to fear of nosocomial transmission of vaccinia to an immunocompromised patient, says William Schaffner, MD, professor and chairman of the department of preventive medicine at Vanderbilt University Medical Center in Nashville, TN.

"Frankly, it was a huge issue motivating Vanderbilt not to vaccinate at the present time," he says. The risk of this occurring is virtually zero, according to Schaffner. "And even that low risk can be virtually eliminated by simple contact precautions," he says.

There is a need for more education about the actual risks of transmission, as evidenced by the unfounded fears of some health care workers, Schaffner adds. (For information about risks of transmission, click here and scroll down to "Preventing Contact Transmission of Vaccinia Virus.")

When two recently vaccinated individuals were admitted to the hospital’s trauma unit after a motor vehicle accident, clinicians worried about airborne transmission from the vaccine site, Schaffner says.

"We did a quick inservice to reassure everyone that there was no risk of this and explained that the vaccination site should be treated with simple straightforward contact precautions," he says.

Vaccinated ED staff must perform daily bandage checks to assure they do not have vaccination site exudates leaking from the semipermeable dressing, emphasizes Craig.

"They also must have meticulous hand hygiene to decrease the small risk of transmission from vaccinee to patient," he says. "To date there have been no transmissions from health care worker to patient reported."


For more information about the smallpox vaccine program, contact:

  • Kathy Lynn Emanuelsen, RN, Director of Occupational Health, Hartford Hospital, 80 Seymour St., Hartford, CT 06102. Telephone: (860) 545-2298. Fax: (860) 545-2137. E-mail:
  • Allen S. Craig, MD, State Epidemiologist, Tennessee Department of Health, 425 Fifth Ave. N., Nashville, TN 37247-4911. Telephone: (615) 741-7247. Fax: (615) 741-3857. E-mail:
  • William Schaffner, MD, Chairman, Department of Preventive Medicine, Vanderbilt University Medical Center, A-1124 MCN, 1161 21st Ave. S., Nashville, TN 37232-2637. Telephone: (615) 322-2037. Fax: (615) 343-8722. E-mail: