Smallpox Vaccination Update

Our hospital (over 600 beds, more than 70,000 ED visits this year) was notified that we’re to be issued about 150 doses of the smallpox vaccine for the entire hospital. We’re to decide who should get it, who wants it, then there is to be an as-yet-to-be-defined screening process to make sure we’re ok to get it.

This is not as simple a decision as it sounds. I learned, listening to an Audio-Digest tape (my favorite form of CME, listen to good speakers on interesting talks while driving to and from work) that the smallpox vaccination program is more complicated than I would have imagined. For starters, it’s not just docs and nurses who need to get vaccinated, it’s necessary to make an entire tiny, immunized, hospital. Does no good for just the docs and nurses to be immune, we’re going to need X-ray techs, respiratory therapists, dieticians, laundry, etc. So, as I see it, those getting the immunization are, in essence, volunteering to be the smallpox eval and treatment team. Otherwise, people won’t come to work if there is an outbreak.

I wonder who will come to the ED, if there is an outbreak. It’s going to be really quiet or a complete zoo, and we’re going to have to do it with a skeleton staff. I really wonder how many of the people who get the immunization will show up for work; I think it’s a given that none of the unimmunized would come to work. It’s one thing to get the immunization to protect yourself from the rash that wanders in on day one, but quite another to go back on day 3, leaving your family to fend for themselves during a plague. Assuming there would be fuel at the gas station, etc.

Another vaccination drawback, we’re going to be (potentially) contagious until the eschar (scab) from the immunization falls off (at least theoretically), and the speaker on the tape feels we shouldn’t be in patient care until that happens, which could be about two weeks. The speaker says this wasn’t a problem when we got it a long time ago, because everyone else was immune, immunodeficiency diseases were unknown. And, then there are the people with ill household members or illness themselves, who shouldn’t have the vaccine. Then there’s the mechanics of the vaccination scheduling: two weeks off is a killer for ED scheduling for one or two docs; we have nearly 20, and almost half have to work every day. Now, try taking everyone and giving them 2 weeks off. Doesn’t work. And this isn’t just for docs, it goes for everyone involved. It’s a real can of worms.

I still want the vaccination, but look forward to more answers. And maybe two weeks off.

Update: having just reviewed the excellent government (yes, our government) website www.smallpox.org, I think the two weeks away from patient contact is overblown; it does recommend a “semi-permeable dressing” over a simple dressing for health care workers. This makes me believe the program is much more likely to be successful.