CDC expects most hospitals listed in state plans will give smallpox shots

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Dec 26, 2002 (CIDRAP News) – State plans for giving smallpox shots to frontline healthcare workers list more than 3,600 hospitals that may participate in the program, and most of those hospitals have agreed to take part, according to federal health officials.

Julie Gerberding, MD, director of the Centers for Disease Control and Prevention (CDC), said in a news briefing last week that the hospitals are listed in the "pre-event" vaccination plans the states submitted recently to the CDC. "The majority of the hospitals included in that 3,600 have agreed to participate," she told reporters at the Dec 19 briefing, a transcript of which is posted on the CDC Web site.

Gerberding's comment came a day after officials at two teaching hospitals, Grady Memorial in Atlanta and Virginia Commonwealth University in Richmond, rejected President Bush's recommendation to vaccinate staff members who could be involved in caring for smallpox patients. Officials at those hospitals said they concluded that the risk of vaccine-related complications and transmission of vaccinia virus to patients outweigh the risk of a terrorist release of smallpox virus, according to newspaper reports. Three other large hospitals were reported to be considering not going along with the program.

Bush announced Dec 13 that the government would begin vaccinating military and other government personnel who could be deployed to high-risk areas and was recommending vaccination of healthcare workers who volunteer to serve on smallpox response teams. The president said the government was not recommending smallpox shots for the public now but will try to make the vaccine available within a few months to those who want it.

Following up on a promise he made in his announcement, Bush received his own smallpox shot Dec 21, according to newspaper reports. Bush had said that as commander-in-chief of the armed forces, he didn't think he should ask troops to take the vaccine and the risk of side effects unless he was willing to take it too.

At the Dec 19 briefing, Gerberding said that more than half of the pre-event vaccination plans submitted to the CDC had met the agency's criteria for starting vaccinations of public health and medical response teams early in 2003. "We don't anticipate any significant problems in the remainder of the plans meeting criteria," she said.

After getting their plans approved, states still have a lot of work to do before they will be ready to vaccinate healthcare workers, and the CDC won't pressure them to start prematurely, Gerberding said. "We've actually always said that they would have at least 30 days from the point that [plan approval] occurred, before we would realistically expect them to begin any kind of immunization program," she said. "So vaccine is going to be made available to them when they're ready to receive it, when they want it, and when they're ready to go with their program."

Also at the news briefing, Joseph Henderson, CDC's associate director for terrorism preparedness and response, said the agency is working on various educational materials for healthcare workers considering getting a smallpox shot. He said plans call for giving workers information in advance and then presenting it again when they come to a vaccination clinic. (The CDC presented a satellite broadcast Dec 20, and it will be presented again Jan 9.)

Gerberding said workers will be assured that getting the shot is entirely voluntary. Officials will make it clear that anyone who has risk factors for vaccine complications, or who lives with someone who has risk factors, should not be vaccinated, she said.

In response to a question, Gerberding said that special needles designed to prevent needlestick injuries can't be used in the smallpox vaccination program for now, because they are too short to fit in the vaccine vials. "We're hoping that products that meet those specifications become available," but the bifurcated needles available now can be used safely, she said.

In other comments at the briefing, Henderson said that vaccinia immune globlulin (VIG), used to treat serious vaccine complications, will be kept in the CDC's custody and released for use only when needed. If consultation with a vaccinee's physician indicates that VIG is needed, "by access to the National Pharmaceutical Stockpile program we'll provide VIG to that healthcare provider . . . within 12 hours," he said.

In some other recent smallpox-related developments:

  • Among the first 276 military personnel screened for smallpox shots, 102, or 37%, were exempted because they or people they lived with had risk factors for complications, according to newspaper reports. William Winkerwerder Jr., assistant defense secretary for health affairs, reported the figures Dec 19 at a meeting of an Institute of Medicine (IOM) committee that is advising the CDC concerning the vaccination program.
  • At the same meeting, several healthcare groups urged the CDC to move more slowly on the vaccination program. Patrick Libbey, executive director of the National Association of County and City Health Officials, said the CDC should "slow down and stay small." And Cheryl Peterson, a policy analyst for the American Nurses Assocation, called for "a more measured and deliberate process" to make sure people are screened thoroughly before getting a shot.
  • Israeli officials announced Dec 25 that they will not vaccinate the country's entire population but will increase the number of soldiers and healthcare workers who will be vaccinated to 40,000 or more. The officials said they had concluded that the risk of a smallpox attack is small, according to a New York Times report. At the IOM committee meeting last week, an Israeli official said that about 17,500 Israelis had been vaccinated to date. The official, Yehuda L. Danon, said four Israelis had been hospitalized with conditions possibly related to the vaccine. Minor reactions were common, including fatigue or weakness in nearly a third of recipients, headache in 28%, muscle pain in 18%, and nausea in about 10%, according to news reports of the meeting.

See also:

Transcript of CDC Dec 19 news briefing
http://www.cdc.gov/media/transcripts/t021219.htm

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