Dr. Falstaff [Health care workers refusing smallpox vaccinations]

Tech Central Station ^ | 03/18/2003 | Sydney Smith

[aculeus]

Here is at least one poet whose words have had an effect on the war effort - Shakespeare. Not only did he aptly describe all of the conflict's major players, but his line from Henry IV about discretion being the better part of valor has been taken to heart by the healthcare professionals responsible for the pre-attack smallpox vaccination program - both those called to implement it and those called to receive it.

The plan was to have 500,000 health care workers immunized against the disease, the better to care for victims of a possible attack. By the end of February, only 7,354 people had volunteered, just a little over one percent of the goal. Three hundred and fifty hospitals decided unilaterally not to offer the vaccine to their employees, fearing reactions to the vaccine would leave them short-staffed, and that the cowpox virus used in the vaccine would be transmitted to patients. At least one San Francisco hospital has barred its staff members from vaccination, even if they get it elsewhere. The American Nurses Association has been a vocal opponent of the program. Their widely distributed decision tree for nurses contemplating the vaccine is heavy on the negatives, largely of the "what's in it for you?" variety. The nurses obviously spent more time studying the recommendations of the Service Employees International Union, a division of the AFL-CIO, than those of the CDC.

Meanwhile, public health officials claim that they're so busy vaccinating people, they could miss a smallpox epidemic. Around the nation, public health departments complain that the smallpox program costs too much. That despite a $1 billion infusion of federal money into the system, they haven't the manpower or the money to effectively implement the program. That it's distracting them from protecting us against other less deadly, less contagious threats such as anthrax and botulism, or less likely threats such as Ebola. That it's taking staff and resources away from their other, established programs. And worst of all, that it's preventing them from protecting us against sexually transmitted diseases and obesity.

None of this reflects well on the healthcare profession. Like Falstaff, the character who uttered that famous Shakespearean phrase, their concern is more for themselves than the greater good. Hospitals worry that they'll have to pay worker's compensation to employees with even minor side effects, that they'll be sued if a patient contracts cowpox from an employee, and that complications of the vaccine will leave them short-staffed. The American Nurses' Association and the Service Employees International Union, both of whom provide health-related insurance programs for their members, worry about the financial costs of vaccine side effects. They would prefer to have taxpayers bear the burden. And the regional public health departments? Well, no one likes to give up autonomy or to see their pet projects superceded by mandated programs. They're having a little trouble adjusting to the changing times.

But how realistic are these fears? In its most recent recommendations, the CDC says that keeping the vaccine site covered with a dressing eliminates the risk of transmitting the cowpox virus to patients. So far, in the U.S. there have been two cases of transmission of the cowpox vaccine to another person, both involving intimate contact. About a third of vaccine recipients become ill enough to miss work for a few days, due to arm soreness or flu-like symptoms, but serious reactions occur at a much lower rate. To date, vaccination programs in Israel and the U.S. military have had similar rates of side effects as those observed in the 1960's. - a death rate of .0001 -.0002%, and around .005% life-threatening reactions.

In comparison, smallpox, with its one in three death rate and its highly contagious and severe nature, has the potential to decimate hospital staffs and the patients they care for, both directly and indirectly. Far better to struggle with a few, short absences after vaccination than face an epidemic in an unprotected hospital. Far better to pay out healthcare, workman's comp, and disability benefits to a couple of hundred people nationwide than to pay healthcare and death benefits to several thousand after an attack. Far better to put sexually transmitted diseases and obesity on the back burner while vaccination is addressed than to put them on hold indefinitely to address a smallpox epidemic.

We may be a fat and promiscuous nation, but those character flaws aren't our immediate threat. Instead, it's our inability to see beyond our own narrow self-interests that's the greater threat. Like Falstaff.

Copyright © 2003 Tech Central Station Tech Central Station - www.techcentralstation.com

[First_Salute]

Bump.

[First_Salute]

Somewhere I ran across a proviso on the vaccine.

Something like 20% of the population is automatically exempt from taking it, because of allergies or resistance. I don't remember the particulars.

[Endeavor]

We'll see if they change their tune once we discover Saddam's smallpox stores. I just hope he hasn't been able to shorten the virus' incubation period - which would pretty much negate the positive effects of vaccination and quarrantine.

Let's just pray that we don't have to find out the hard way.

[rellimpank]

--I don't understand.. I had my first smallpox vaccination 61 years ago -when I was six weeks old. Every four or five years after that til adolescence I-and virtually all of my contemporaries-had it repeated-sometimes with a small reaction , sometimes not. I never heard of anyone having an adverse reaction to a smallpox vaccination other than a slightly sore arm-(we proudly showed our scars to each other).

What has changed? More lawyers, maybe?

[struwwelpeter]

A nurse friend told me that she wanted the immunization, but their guidelines at the time stated that they could not provide direct patient care for two weeks after receiving the vaccine.

Apparantly this has just been changed, but her hospital hasn't yet ordered any. And it's probably too late, either way.

I sure hope we've been running lots of blood tests on our Iraqi defectors, to find out what THEY have been vaccinated against.

[not too stupid]

I don't know what's the big deal? For health providers, who routinely give vaccines which are guaranteed to cause an adverse reaction in some small segment of the population, to refuse the smallpox vaccine is hypocritical. My wife, who had never before received the vaccine volunteered to get the vaccine when many primary first response providers refused the vaccine. Hard to believe but true.

[jiggyboy]

More lawyers, more America Is Always Wrong, less common sense. I'm starting to wonder if part-timing at a given hospital for two weeks would allow me to get a shot.

[Vets_Husband_and_Wife]

In reading up on this matter.. I don't know why the healthcare workers are so against immunization. The risks are extremely LOW compared to being infected and playing catchup!! We don't need a bunch of healthworkers getting immunized AFTER a threat.. then having to stay away from patients for up to a three week period!!!!! Not to mention perhaps feeling flu like symptoms and staying home!! How responsible is that?

I'm NOT hearing a lot of negative responses to the vaccine. I wish I'd posted the recent articles I read on this. But they are proving to show the incidents are extremely low..and there haven't been any deaths.

A lot of PARANOIA.. when it isn't warranted. IMHO

[Steve_Seattle]

Am I a cynic for thinking this is all political? As others have noted, for many years the entire population of school children routinely received this vaccination, with nary a word of warning. But now that BUSH is proposing it, it is suddenly viewed as dangerous, unnecessary, etc.

[aculeus]

Am I a cynic for thinking this is all political?

Bingo!

[bonesmccoy]

absolutely!

BUMP-a-roo!

[Gritty]

The risks are extremely LOW compared to being infected and playing catchup!!

You got that right.

In the 1970 Meschede, West Germany, outbreak, a single patient in isolation in a hospital infected 20 people, including those on other floors of the hospital outside the isolation room who never came in any contact with him.

The case was diagnosed as smallpox and the vaccinations given around the 5th and 6th day of exposure (after entry into the hospital), but was too late for the ones who were exposed and subsequently caught it.

The patient was placed in isolation for undiagnosed symptoms on January 11th, but no rash broke out until the 14th. On the 15th he started to blister and smallpox was identified. The WHO started vaccinations on all patients and staff right away, on the 5th and 6th days after the patient was admitted. The hospital and all in it were locked down for the duration. Those who came down with the disease were taken to another isolation area until they either died or got better.

The vaccinations were too late for many of them - and they got both the German vaccine and the WHO vaccine - a twofer. The patient was apparently highly infective long before the rash showed. However, the vaccine is "useless" if it is given more than 4-5 days after exposure. For many it was too late to save them from full blown cases and in some cases, death. They got the vaccine one day late! (source: The Demon In The Freezer by Richard Preston)

The moral of the story is, these health care workers remaining unvaccinated may be too late if they get exposed, even if they are vaccinated quickly after recognition of the disease. They are playing with fire if a real outbreak happens.

[Vets_Husband_and_Wife]

I agree a thousand times with your statements in post 13!!!

Thanks for sharing it, because the fear factor is over-ruling common sense.

God Bless, FRegards Vets

[Paleo Conservative]

Somewhere I ran across a proviso on the vaccine.

Something like 20% of the population is automatically exempt from taking it, because of allergies or resistance. I don't remember the particulars.

Here they are. I copied them from an article I previously posted.

Govt. Devotes $20 Million to Safer Smallpox Vaccine

According to the Centers for Disease Control and Prevention (CDC) the number of Americans unable to take the current smallpox vaccine is substantial. These include people who:

• have or have had eczema or atopic dermatitis;

• have skin conditions such as burns, chicken pox, shingles, impetigo, herpes, severe acne or psoriasis;

• have weakened immune systems from cancer treatments, an organ transplant, HIV, primary immune-deficiency disorders, some severe autoimmune disorders and medications that treat autoimmune disorders, and other illnesses that can weaken the immune system;

• are pregnant or plan to become pregnant within one month of vaccination;

• are allergic to the vaccine or any of its ingredients;

• are younger than 12 months of age (the Advisory Committee on Immunization Practices advises against nonemergency use of smallpox vaccine in children younger than 18 years of age);

• are 65 or older and in nonemergency situations;

• have moderate or severe short-term illness;

• currently are breast-feeding;

• or are using steroid drops in eyes.

According to McInnes, there are "15 million people in the U.S. with symptoms of atopic dermatitis and roughly 4 million births per year." That's 19 million people in just two of the categories listed by the CDC who are unable to take the current smallpox vaccine, so it certainly makes sense that a safer vaccine is being developed. The problem, however, is that it may take years before the new vaccine is available to the public

[First_Salute]

Thanks for finding that info.

[bonesmccoy]

I would add that many of us think these exclusions for allergies are idiotic. While is may be true that data from 25 years ago may have indicated a link between vaccine side effects and certain skin conditions, we are skeptical of the conclusion.

By writing exclusion criteria that prioritizes workers comp legal liability issues higher than national security and homeland security issues; there is a profound bias in the conclusion.

[Paleo Conservative]

So do you believe modern antiviral drugs could prevent the severe reactions that would have occurred 25-30 years ago? I personally have a history of eczema, and currently am having problems with dermatitis. My brother has much worse problems with eczema and psoriasis. You seem pretty confident about the ability of current medical capabilities to deal with the potential side effects.

I think it is crazy that so few first responders are not getting immnunized. Our population is about as vulnerable today as the American Indians were when Columbus discovered the New World.

Paleo

>I would add that many of us think these exclusions for >allergies are idiotic. While is may be true that data from >25 years ago may have indicated a link between vaccine >side effects and certain skin conditions, we are skeptical >of the conclusion.

[bonesmccoy]

Anti-Viral drugs probably would not help with rashes like eczema. Anti-Virals could help control generalized vaccine-related problems, but data is limited.

Actually, it isn't that I'm confident of current medical capabilities. I'm actually quite convinced that current medical capabilities are too weak. However, physicians should not be too scared to take a 25 year old vaccine.

It is not acceptable to have organized labor claiming that workers should NOT participate in the Homeland Security processes.

[Paleo Conservative]

i-Viral drugs probably would not help with rashes like eczema. Anti-Virals could help control generalized vaccine-related problems, but data is limited.

So what should someone like me do? Why can't ordinary citizens get their choice of Dryvax, Acambis, or Bavarian Nordic (safer?) vaccines? I know that no one has proved the Bavarian Nordic vaccine effective against smallpox, but it has been shown to boost antibody levels enough to tolerate standard live vaccines. Why should any government have the right to deny me the right to make my own decisions about the vaccines I want to take?