The Rhode Island Department of Health has begun recruiting health-care workers to volunteer for smallpox vaccines, aiming to vaccinate some 1,200 people over the next few months.
The Bush administration has instructed health departments around the country to vaccinate a half-million health-care workers against smallpox, so that they can care for smallpox victims if the contagious virus -- which does not exist in nature -- is used in a terrorist attack.
But the state's largest health-care unions are urging their members not to participate, saying the risks of the vaccine, which uses a live virus, are too great.
Tuesday night, the Health Department held the first in a series of educational programs for hospital officials, through whom it will recruit volunteers.
"We are being extremely conservative in how we approach this," said Dr. Patricia A. Nolan, state health director. "We are going quite slowly."
Although the U.S. Centers for Disease Prevention and Control began shipping vaccine to states yesterday, Nolan said that her department has not requested the vaccine and is not yet ready to vaccinate anyone.
The smallpox vaccine, which has not been routinely used in this country since 1972, uses a live virus that is related to smallpox and that can make people ill. Of every million people who were vaccinated years ago, about 1,000 had serious reactions, 14 to 52 had life-threatening illnesses and one or two died. Because smallpox itself is a deadly illness that kills nearly one-third of its victims, the vaccine's benefits outweighed its risks when the disease was still a threat.
Now, smallpox is merely a hypothetical threat. Vaccination has eliminated it from the human population throughout the world, and only humans can carry it. But it is feared that laboratory stockpiles of the virus may have fallen into terrorists' hands and may someday be used in a biological attack.
"There is a small, incalculable risk that smallpox will be introduced," Nolan said. "It's greater than zero; we think it's not much greater than zero."
"The Department of Health is offering this. In no way are they encouraging or discouraging it," said Dr. Andrew W. Artenstein, director of Memorial Hospital's Center for Biodefense and Emerging Pathogens, which is advising the Health Department. "Everyone needs to make their own decision based on what is known. And what is known is unfortunately much less than [what] we'd like to know."
Today, there are many people whose immune systems have been weakened, by cancer treatment, by drugs to prevent rejection of transplanted organs, or by HIV infection, among other things. These people are more likely to be hurt by the vaccine, and the vaccine will not be offered to them.
In asking for volunteers, the Health Department will first inform workers who should not get the vaccine. These include pregnant and breastfeeding women, people who have had skin conditions and anyone whose immune system is weakened.
Those who believe they are eligible will need to first obtain a free HIV test at one of the state's anonymous testing sites. They will take the test results to the clinic, where they will undergo further screening -- including a pregnacy test for women of child-bearing age.
Volunteers will be interviewed about their history and informed of the vaccine's risks.
Those who decide to proceed will be vaccinated in the arm with a series of 15 pricks with a two-pronged needle. A blister and then a scab will form at the vaccine site, and will fall off after about 17 to 21 days. The blister and scab are infectious, so workers will need to keep it covered and wash their hands carefully if they touch it.
The plan calls for first recruiting about two people from each hospital who will undergo training in care of the vaccination site, get vaccinated, and then take on the role of "arm checkers" for other volunteers in their respective hospitals -- making sure the vaccine takes, that nothing is going wrong at the site, and that workers take proper care of the lesion.
So far, Nolan said, the state is just starting to recruit the first 30 or so volunteers, who will get vaccinated at Memorial Hospital of Rhode Island, possibly in the first week of next month. After those volunteers have gone through the entire process and their wounds have healed, then additional volunteers will be sought. They will be vaccinated at the state-run Eleanor Slater Hospital.
"Our plan is to take roughly two months to immunize the rest of the 1,200 people," Nolan said, "so we won't have an impact on a particular hospital, a large number of people out at the same time."
About a third of the people who get vaccinated will feel poorly for a day and need to take time off from work. This will probably come out of their sick-day allotment. If they become seriously ill, it is not clear whether health insurance or worker's compensation will pay for their care, nor whether there will be any compensation. It is also not known who would be liable for costs and damages if someone is seriously injured.
If someone becomes seriously ill from the vaccine, they can be treated with vaccine immune globulin or VIG. The state will not have VIG supplies on hand, but will request them from the CDC as needed, Nolan said. Jim Celenza, of the Rhode Island Committee on Occupational Safety and Health, expressed concerns that VIG supplies would not be adequate.
"We're working very closely with the Department of Health to meet this federal mandate," said Cathy E. Boni, vice president of the Hospital Association of Rhode Island. "There are still a whole host of unanswered questions."
