Engine Company, Firefighter Training, Health & Safety

Health Beat – Smallpox Vaccination: Assessing The Issues, Part 2

By Mary Jane Dittmar

For Part 1 of this three-part series, see January Health Beat.
For Part 1 of this three-part series, see the March Health Beat.

  • Contraindications for receiving the vaccine. Before administering the vaccine, the physician should complete a thorough patient history to document the absence of vaccination contraindications among the persons being vaccinated.
    The categories of individuals at a high risk for complications from the vaccine-and who should not receive it for routine nonemergency indications-are listed below.
    • Individuals who have or have had (even though they may be healed at the time) eczema; atopic dermatitis (even if the condition is not currently active, is mild, or was experienced as a child). Persons with an acute, chronic, or exfoliative skin condition (burns, chickenpox, shingles, impetigo, herpes, severe acne, psoriasis) should not get the vaccine until they have completely healed.
    • Individuals with suppressed immune systems, such as those who have had solid organ transplantation; are HIV-positive; have leukemia, lymphoma, generalized malignancy, or cellular or humoral immunity disorders; and received therapies involving alkylating agents (inhibits cell division), antimetabolites, radiation, high-dose corticosteroids, or chemotherapy.
    • Individuals under the age of 18.
    • Individuals with moderate or severe short-term illnesses, until they are fully recovered.
    • Women who are pregnant, plan to become pregnant within one month, or are breast-feeding.
    • Individuals who are allergic to the vaccine or any of its ingredients.
      Dryvax(r) contains trace amounts of the antibiotics polymyxin B sulfate, streptomycin sulfate, chlortetracycline hydrochloride, and neomycin sulfate. It does not contain penicillin. Future supplies of the vaccine will be reformulated and might contain other preservatives or stabilizers. Refer to the manufacturer’s package insert for additional information.
      If you have any of the above conditions or live with someone who does, you should NOT get the smallpox vaccine. If you have had an exposure and you were not vaccinated, you must be quarantined until you are vaccinated and medically released. If you are directly exposed to the smallpox virus, and you have not been vaccinated, you should get the vaccine immediately, regardless of your health status. The risk of the disease outweighs the complications associated with the vaccination.

  • Vaccination site care. It is important to meticulously follow instructions for caring for the vaccination site. The virus used in the vaccination (vaccinia) is live and can spread to other parts of the body or to other people from the vaccination site, beginning two to five days after vaccination–at the time a papule develops-until the scab separates from the body. During this entire period, inadvertent contact can cause the virus at this site to spread to another area of the vaccinated individual’s body or to another person.
    Proper site care will also help prevent secondary infection. High-risk individuals in the household or workplace especially may be vulnerable to virus shedding and scab particles from a vaccinated employee during the post-vaccination healing period.
    Hand washing is the most important measure for preventing inadvertent contact spread from vaccination sites. After touching the vaccination site area, the hands should be washed with soap and water–or, when unavailable, with an alcohol-based waterless antiseptic solution.
    Nonvaccinated persons should not come in contact with the site or contaminated materials from the site.

  • Medical care and expenses. Medical care and expenses can be a weighty issue, as we have seen with regard to hepatitis C and cardiovascular disease in recent years. What would happen if you or a member of your household should have an adverse reaction to the vaccine? Vaccine manufacturers and those who administer the vaccine have been offered immunity from liability through Homeland Security legislation.
    The International Association of Fire Fighters is advocating that, in the case of an adverse reaction, employers pay all medical costs, including providing immediate medical and follow-up care; that the adverse reaction be ruled as a line-of-duty injury; and that the employee receive the same disability benefits that would be given for any other on-duty injury or illness for the duration of the disability.
    What is more likely to happen, however, is that policies and workers’ compensation rules will vary from state to state. Many states may not cover these expenses. In those cases, it is important to ascertain whether your individual health plan will cover the expenses.
    As the Phase I inoculation programs were getting underway in some states at the end of January, some unions representing nurses and other health-care workers opposed the vaccination because of the lack of compensation provisions for people who may be adversely affected by the vaccination. (“Unions Want Delay on Smallpox Vaccine,” AP, Jan. 16, 2003)
    A 15-member Institute of Medicine panel, formed at the request of the Centers for Disease Control and Prevention (CDC), cited the need for more “safeguards” before implementing Phase II of the program. The panel members, most of whom are medical school professors, also expressed concern about who would cover lost wages and medical expenses for people who experienced adverse effects from the vaccine. They asked that the CDC and state health departments clarify this issue and “make sure that consent forms describe what compensation is available.”
    The CDC said, “Both compensation and consent forms would ultimately be decided by the individual states.” (“Slim turnout for first smallpox shots,” MSNBC News (contributions from AP and Reuters), Jan. 24, 2003.)

In Part 3: Training, Checklist of Questions, Resources.

Mary Jane Dittmar is senior associate editor of Fire Engineering magazine and fireengineering.com. Before joining the magazine in 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.

References and additional resources

Additional Sites
http://www.bt.cdc.gov/agent/smallpox
http://www.bt.cdc.gov/agent/smallpox/vaccination/facts.asp
http://www.bt.cdc.gov/agent/smallpox/vaccination/contraindications-public.asp
http://www.bt.cdc.gov/agent/smallpox/index.asp
http://www.nlm.nih.gov/medlineplus/smallpox.html
http://www.who.int/emc/diseases/smallpox/factsheet.html
http://www.acponline.org/bioterro/index.html
http://www.bioterrorism.uab.edu/EIPBA/Smallpox/moreExtInfo.html.
http://www.vaccines.army.mil.
http://www.vhcinfo.org