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Health & Safety

American Journal of Nursing - January, 2003 - Volume 103, Issue 1

Smallpox Vaccines
What are your risks and rights?

By Cheryl Peterson, MSN, RN

My hospital has been discussing vaccinating health care workers, particularly those in the ED, against smallpox. What are the risks associated with this vaccination and what are my rights in deciding whether to be inoculated?

In October 2002 the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommended that 500,000 health care workers be vaccinated against smallpox in at least half the nation’s hospitals. As the year ended, the Bush Administration was expected to implement this recommendation. While the ANA supports the initial vaccination of some health care workers, it has stipulated that the following considerations be taken into account in any pre-event vaccination scenario:

• The decision to be vaccinated should be voluntary and at the discretion of the health care worker without reprisal from either the employer or the government.

• Health care workers should receive complete information regarding the potential risks associated with the vaccine. Extensive screening must be done to clearly identify those persons at increased risk.

  For every 1 million people immunized against smallpox, one to two people would die from the vaccine, according to the CDC. Studies from the 1960s suggest that 15 of every 1 million people vaccinated for the first time will have life-threatening complications. People at risk for complications from the vaccinia virus include those who are HIV positive or immunosuppressed or have skin diseases or dermatitis such as eczema. (The ANA believes that dermatitis due to latex sensitivity may confer this risk.) The ACIP recommends that anyone with HIV or skin diseases not be vaccinated. The ACIP recommends that the vaccine not be given in a preevent scenario to children or pregnant women or those trying to get pregnant, and states that women should be counseled not to get pregnant for four weeks after vaccination.

• In the absence of additional information regarding its effectiveness or alternative treatments, sufficient doses of vaccinia immune globulin (VIG) should be available to counter adverse reactions.

  In 2002 there was only enough VIG to treat 600 serious adverse events. The government is currently negotiating a contract with the manufacturer to develop more doses.

• Costs related to vaccination and treatment for any side-effects must not be shifted to the health care worker. In addition, any liability or malpractice insurance costs related to administering the vaccine should not be borne by the health care worker.

• Registered nurse staffing coverage must be assured at any facility that initiates a health care worker vaccination policy.

• Standardized policies must be developed regarding how much time a health care worker needs to be furloughed from work following administration of the vaccine and the use of an occlusive dressing. The ACIP does not recommend that health care workers be placed on leave following smallpox vaccination but does recommend that those involved in direct patient care keep their vaccination sites covered with gauze or similar absorbent material in order to absorb exudates that could develop. The site should be covered until the scab separates, even when those vaccinated are not providing patient care, to prevent person-to-person transmission.

• Any time off associated with the vaccination process should not be charged to the health care worker’s sick or vacation time and should be considered paid time. Among adults being vaccinated for the first time, 20% to 30% become ill enough to miss a few days of work, according to the CDC. The ANA believes this should be paid leave, as should any furlough time that might be required postvaccination.

• Consideration must be given to developing a vaccine administration system to eliminate the potential for needlesticks in accordance with the 2000 Needlestick Prevention and Safety Act.
• A specific plan should be in place to monitor and evaluate all vaccinated people.

The ANA will continue to provide recommendations on the smallpox vaccine process and to advocate appropriate protections for nurses in all preevent vaccination scenarios. For updates on the smallpox vaccine debate and other bioterrorism issues, go to the ANA’s bioterrorism Web page at www.nursingworld.org/news/disaster.

Cheryl Peterson is a senior policy fellow at the ANA

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