Health Beat-Update on Smallpox Vaccination; SARS Overview

By Mary Jane Dittmar

Cardiac Effects and the Smallpox Vaccination. Individuals with known underlying heart disease and those with three or more major cardiac risk factors have been added to the Centers for Disease Control and Prevention (CDC) list of contraindications for the smallpox vaccination until it completes an investigation to determine if there is a link between the smallpox vaccine being used in the current voluntary smallpox vaccination program and inflammation of the heart and other cardiac-related problems.

The CDC took this action based on an opinion from its advisory medical board. The CDC had asked the board to meet to evaluate the issue after receiving the following reports (as of March 31):

  • Two cases of myopericarditis (inflammation of the membrane covering the heart and of the heart itself) among 25,645 civilians vaccinated as of March 21. The patients have recovered.
  • Eleven cases of myocarditis and/or pericarditis among the approximately 325,000 military troops vaccinated between December 13, 2002, and March 31, 2003. All were vaccinated for the first time. Ten patients, with mild to moderate disease were reported to have recovered fully; one patient remained hospitalized as of March 31.
  • Two cases of angina and three cases of heart attack among the 25,645 civilians vaccinated as of March 21. Two of the three patients with heart attacks were women health care workers who died as a result of the heart attacks. Four of these five patients, including the three with the heart attacks, had “clearly defined risk factors for coronary artery disease known in their medical history.” Some of these cardiac events, the CDC says, may be coincidental and may not necessarily have been caused by the vaccine. As noted, the cases are under investigation.
    Individuals who have received the smallpox vaccine are advised to immediately see a health care provider if they develop chest pain, shortness of breath, or other symptoms of cardiac disease. For additional information, consult www.cdc.gov
.

Congress Passes Smallpox Compensation Legislation. Congress passed the Smallpox Emergency Personnel Protection Act of 2003 on April 11. Health care workers, law enforcement officers, firefighters, security personnel, emergency medical personnel, and other public safety and support personnel specified in the legislation (or their survivors) will be compensated for significant injury, illness, and disability or death resulting from receiving the smallpox vaccine as part of the voluntary smallpox emergency response plan. The major provisions include the following:

  • A disability benefit of up to $50,000 a year if the worker were permanently and totally disabled; there would be no lifetime cap. The benefit for temporary or partial disability would be subject to a lifetime limit of about $262,000.
  • In case of death, the spouse would receive approximately $262,000. Dependents may be awarded the $262,000 in a lump sum or choose annual payments of $50,000 until the age of 18. The payment portion of the bill is modeled after that of the Public Safety Officers’ Benefit Program (PSOB).
  • Lost wages would be compensated at two-thirds to three-quarters of the employee’s income, according to the number of minor dependents. There would be no compensation for income loss for the first five days unless the period for which income is lost exceeds 10 days.
  • Benefits would supplement (be secondary to) other benefits to which the employee may be entitled from the state, locality, or other federal programs.
  • Prior to vaccination, workers must be informed on the issues pertaining to the smallpox vaccine/vaccination and be medically screened. They are to be monitored medically post-vaccination.

The entire bill may be viewed at www.loc.gov (Library of Congress), click “Thomas Legislation Information,” enter “H.R. 1770.ENR” in the appropriate search slot.

SARS Severe Acute Respiratory Syndrome. As of May 5, 320 U.S. cases of Severe Acute Respiratory Syndrome (SARS) were reported to the Centers for Disease Control and Prevention (CDC), from 38 states. Of these, 255 are considered Suspect Cases, and 65 Probable Cases (see definitions below). No deaths have been reported.

States with 20 or more reported cases of SARS as of May 5 were the following: California-64 total, 41 Suspect Cases, 23 Probable Cases; New York–38 total, 29 Suspect, 9 Probable; and Washington State-23 total, 21 Suspect, 2 Probable. Massachusetts had 19 total cases (16 Suspect and 3 Probable), and Florida had 18 total (15 Suspect and 3 Probable).

Several countries, including the United States, have found evidence of infection with a novel coronavirus in some patients with suspected SARS. Research in several countries indicates that a novel coronavirus may be responsible for the SARS infection. Scientists in Hong Kong, Canada, and the United States had reported sequencing the coronavirus. The CDC says, however, that more laboratory and epidemiologic data are needed before the link between the coronavirus and SARS can be fully established.

At press time, the number of SARS cases still had not peaked in China although it appeared to have leveled level off in other significantly SARS-affected countries. Health officials worldwide, however, are still carefully observing developments relative to SARS from various perspectives, including whether a “cured” patient can infect others and relapses in some patients who had been considered cured.

Given all the unknowns about SARS and its potential to kill patients, health care workers and emergency medical responders are urged to implement all infection-control precautions and to be discerning when assessing patients, especially if they have symptoms that might indicate SARS (see below).

CDC SARS Interim U.S. Case Definition. The CDC case definitions of SARS (as of April 20) are as follows:

  • Suspect Case. (1) Respiratory illness of unknown etiology with onset since February 1, 2003, AND (2) the following criteria:
    • Measured temperature greater than 100.4° F (greater than 38° C) AND
    • One or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing, hypoxia) AND
    • Travel (including transit in an airport) within 10 days of onset of symptoms to an area with documented or suspected community transmission of SARS. [The “areas” include the People’s Republic of China (Mainland China and Hong Kong Special Administrative Region); Hanoi; Vietnam; and Singapore.] Areas with secondary cases limited to healthcare workers or direct household contacts are excluded; OR
    • Close contact (cared for, lived with, or had direct contact with respiratory secretions and/or body fluids of a patient known to be a suspected SARS case) within 10 days of onset of symptoms with a person with a respiratory illness who traveled to a SARS area or a person known to be a suspect SARS case.
  • Probable Case. The same conditions as for a suspect case AND
    • One of the following: radiographic evidence of pneumonia or respiratory distress syndrome OR
    • Autopsy findings consistent with respiratory distress syndrome without an identifiable cause.

President Bush issued an executive order on April 4 that allows for the forced quarantine (if the Secretary of Health and Human Services deems it necessary) of suspected SARS patients.

CDC Issues Interim Guidance on EMS Transport for SARS Patients. On April 11, the Centers for Disease Control and Prevention (CDC) released interim guidelines for ground transport of patients with Severe Acute Respiratory Syndrome (SARS) in emergencies. The full document is at the CDC Web site at http://www.cdc.gov/ncidod/sars/emtguidance.htm.

The CDC guidance covers also Infection Control/Protective Equipment/Procedures, precautions for use with mechanically ventilated patients, handling clinical specimens, disposing of waste, and cleaning and disinfecting procedures after transport.

Health care personnel are at high risk for contracting SARS from patients with whom they are in close contact. Toronto (Canada) EMS reported in early April that at least 140 of its paramedics had been quarantined because of contact with suspected SARS patients.

The CDC recommends that personnel who develop symptoms of SARS within the 10-day post-exposure period after having transported a suspected SARS patient seek medical evaluation and that the affected employee be reported to the state health department and to the CDC. Workers who do not have a fever or symptoms of respiratory illness may continue working during the 10-day post-exposure period.

The International Association of Fire Chiefs (IAFC) issued a News Alert to its members on April 2 pertaining to “CDC Guidance on Severe Acute Respiratory Syndrome (SARS)” and is encouraging all EMS providers to review the information and take appropriate infection-control measures to limit the spread of this disease.

The CDC Web site www.cdc.gov/ncidod/sars has extensive information on the disease.

Has your department responded to a Suspect or Probable SARS patient? How did you handle it? Has your department instituted an SOP related to SARS? Let me hear from you, maryjd@pennwell.com.

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.

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