December 13, 2002

Vanderbilt prepares staff for smallpox vaccination

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The vaccine is administered by 15 shallow skin perforations using a bifurcated needle dipped into the liquid vaccine. (photo by Dana Johnson)

Vanderbilt prepares staff for smallpox vaccination

Vanderbilt University Hospital officials have begun briefing faculty and staff about the Tennessee Department of Health’s plan to vaccinate front-line health care workers against smallpox.

President Bush asked states to prepare a plan that would put into place a smallpox health care response team in every hospital. The President is expected to release the smallpox vaccine and enact the plan this week; if so, Tennessee will begin the vaccination process on Jan. 13, 2003.

The plan to have smallpox health care response teams in each hospital is phase one of a three-phase plan that the President could activate. The three-phase plan would extend phase two to encompass other health care and emergency workers — paramedics, firefighters, and police officers. Phase three of the plan, if activated, would recommend vaccination of the general public.

“Vanderbilt will be recruiting volunteer faculty and staff (physicians, hospital administrative personnel, nurses and some ancillary staff) from the Emergency Department, MICU, and PICU that will serve as our health care response team in the event a smallpox patient shows up to be treated at VUMC,” explained Dr. Melanie Swift, assistant professor of Medicine and medical director of the Occupational Health Clinic.

Swift said Vanderbilt would recruit a maximum of 300 individuals, while smaller hospitals in Tennessee would be seeking a maximum of 100 volunteers. And while the vaccination is voluntary, employees who do participate will receive paid administrative leave up to seven days should they become ill.

“The smallpox vaccine has more side effects than other vaccines, so our first priority is to ensure the health and safety of our Vanderbilt faculty and staff who step forward to volunteer for this vaccine,” Swift said. “The plan also provides for extra precautions to protect patients, family and coworkers of those who get the vaccine”

Smallpox is an acute, contagious and sometimes fatal disease caused by a virus and marked by fever and a distinctive progressive skin rash. In 1980, the disease was declared eradicated following worldwide vaccination programs. However, in the aftermath of the events of September and October 2001, the U.S. government is taking precautions to be ready to deal with a bioterrorism attack using smallpox as a weapon.

The vaccine that will be used consists of the live virus vaccinia, or cowpox virus. The vaccination is administered in the arm by administering 15 shallow skin perforations using a bifurcated needle dipped into the liquid vaccine. Following vaccination, a fluid-filled blister will form, surrounded by redness. The blister will later crust and separate, leaving a scar. The entire process takes about 21 days.

Vanderbilt has until Dec. 20 to forward the list of health care workers who will participate in the vaccination program to the Tennessee Department of Health.

Vaccination will be delivered at seven sites throughout the state. In Davidson County, the Lentz Public Health Center will serve as the vaccination site.

Because the vaccine consists of a live virus, it can cause illness through a number of mechanisms. The progression of redness, blister, scab and scar outlined above are normal, expected effects of the vaccine. In addition, vaccinees may experience fever and flu-like symptoms about a week after vaccination.

The vaccination cannot be given to anyone who meets the criteria set below:

• Eczema or a history of eczema (or “atopic dermatitis”) or a household contact with eczema or a history of eczema.

• Pregnancy or intention to become pregnant within one month of vaccination, or a household contact who is pregnant.

• Altered immunocompetence, including HIV infection, or a household contact with altered immunocompetence including HIV infection.

• Allergy to vaccine components.

• Breastfeeding. This is not because the virus is transmitted via breast milk, but because of the close skin contact between mother and infant.

Swift and her staff have already started briefing faculty and staff, and will thoroughly educate those who are interested in volunteering about the vaccine, its side effects and potential adverse effects, vaccine site care, and medical contraindications to the vaccine. The educational sessions are lasting approximately two hours.

If a faculty or staff member is vaccinated, he or she will report to a vaccine site care team nurse each day, who will inspect the vaccine site, perform dressing changes as needed, assess fitness for duty, document side effects and adverse events, triage vaccinees who are experiencing adverse effects, consult with designated smallpox resource physicians, and document vaccine “take.”

Provisions will also be made to stagger the vaccinations, so that a particular area is not left short staffed due to the anticipated number of days a staff member may not be able to report to work.

Swift said volunteers will be screened thoroughly, and emphasized the program is completely voluntary.

“The primary emphasis is on safety,” she said. “We shall be extraordinarily conservative in selection of vaccinees.”