Rush job on smallpox vaccinations

Public health officials in Washington will announce today their plan for vaccinating a small vanguard of hospital and public health workers against smallpox in case of bioterrorism.

All states were required to submit their smallpox vaccination plans to the federal government Monday, but Washington did not submit its proposal until yesterday and would not release details. The states were given only about five working days' notice to submit their plans, which sent many scrambling.

Washington's plan will follow guidelines established in June by a national medical panel known as the Advisory Committee on Immunization Practices, according to Donn Moyer, a state Health Department spokesman.

The panel recommended that an average acute-care hospital vaccinate 40 to 50 people -- mostly doctors and nurses working in emergency and intensive care. The number would vary according to each facility's size and patient population.

Washington has 90 acute-care hospitals. The region's trauma center, Harborview Medical Center, plans to vaccinate about 125 people. Another large urban hospital, Swedish Medical Center, plans to vaccinate about 90 people at its main campus on First Hill, about 65 at its Providence branch and 45 at the Ballard branch.

The smallest hospitals in the state are expected to vaccinate fewer than 10 workers.

Harborview is asking staff to volunteer for the vaccine and is preparing to screen out those who aren't candidates, said Chief Operating Officer Jonese Spisso.

People with compromised immune systems, such as those with HIV or AIDS, and those who have certain skin conditions, such as eczema, should not get the vaccine because of possible adverse reactions. Pregnant women and people with very young children are also precluded from getting the vaccine, which is made from a live form of virus.

While effective, the smallpox vaccine poses some risk. About 1 in a million people who get it die, and others suffer severe side effects, including brain inflammation, said public health officials.

"It's really pretty nasty, which makes the decision about who gets it and when a serious choice to make," said Dr. Mel Kohn, Oregon state epidemiologist. Oregon health officials plan to inoculate 100 public health workers and between 600 and 800 health care workers in advance of any smallpox cases, he said.

Idaho health officials are planning to vaccinate about 800 health care workers, said Bill Walker, spokesman for the Idaho Department of Health and Welfare.

"We plan on having at least one response team for each region of the state," he said.

Because of the risk from the vaccine, and the fact that people can be vaccinated up to four days after exposure to the virus and still be protected, some local health workers had suggested not vaccinating until after an outbreak.

Public health officials defended the strategy of vaccinating people in advance of an outbreak as a way to avoid the chaos of having to vaccinate "first responders" as well as those exposed.

Those who get the vaccine must be closely monitored for weeks while the inoculation site heals because of the small possibility of transmitting the virus from the vaccination site to another person.

Having care providers already immune and safely past the transmission window would aid in getting help to others, said Oregon's Kohn.

"In a crisis situation, it would be one less thing to worry about," he said.

However, Dr. Jeff Duchin, chief of communicable diseases for Public Health-Seattle & King County, and others expressed frustration that something so important as bioterrorism preparedness would be handled as a rush job.

"The public health community was told to do this, but we were not told why it was such a big rush," he said. "Doing all this too quickly may turn out to be counterproductive."

At the direction of President Bush, the Centers for Disease Control and Prevention told the states just before Thanksgiving that they had little more than one work week to prepare and submit their plans for vaccinating first responders in the event of a smallpox outbreak. The immunization panel's recommendations were just general guidelines.

"The specifics were unknown until Thanksgiving," Duchin said.

The risks of the vaccine combined with the logistics of immunizing not for health but as a bulwark against terrorism, he said, make the process a lot more complicated than it may appear.

"This was brand-new territory for us," said Leo Greenawalt, president of the Washington State Hospital Association. "The president just told us we had to do it now. Nobody's telling us why now, or what's the urgency."

Chances are, nobody will.

Matias Valenzuela, spokesman for the Seattle-King County health department, said the details of the smallpox preparedness plan are not subject to public disclosure and will be kept secret as a matter of national security.

"This is regarded as sensitive information," Valenzuela said.

Government experts are worried that terrorists might have the virus and could unleash it in an act of bioterrorism. Smallpox, which was eradicated worldwide in 1980, kills about one-third of its victims.

Symptoms, which include high fever, abdominal pain and sometimes central nervous system effects such as confusion, start about 12 days after exposure. These symptoms are followed a few days later by a characteristic rash.

Routine vaccination against smallpox in this country ended in 1970. Those who were inoculated as children are likely no longer immune, health officials said.

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com

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