MASSACHUSETTS NURSE NEWSLETTER :: March 2003

Smallpox Vaccination Plan Status Report

Last month's Massachusetts Nurses featured a special section concerning the Massachusetts Nurses Association's analysis and position statement concerning the State Department of Public Health's Pre-event Smallpox Vaccination Plan for health care workers.

The MNA has taken the position that it cannot encourage its members to participate in the program until a variety of issues are addressed in the plan. Specifically, the MNA believes there should be furloughing of employees who are vaccinated to prevent exposure of the live vaccine virus to patients succesptible to severe complications; compensation for workers who suffer side effects from the vaccine, liability protections for workers who may expose a patient or co-worker, and a comprehensive education program to ensure the health care workforce and the public understand the plan, smallpox in general, and the risks of the plan.

Before releasing its position statement, the MNA called the DPH to personally discuss the issues. The MNA Smallpox Task Force continues to track this issue and as events change and issues are addressed, the MNA will re-evaluate its position and issue additional information for MNA members. Check the MNA web site for updates on these issues.

Since releasing its position, the MNA has garnered significant media attention for its stance, resulting in numerous print, radio and television interviews with MNA leaders and staff. The Boston Globe has published two editorials that support the MNA's position on the issue, specifically endorsing the need to furlough nurses to prevent unnecessary exposure to vulnerable patient populations. In a debate between MNA President Karen Higgins and Alfred DeMaria, director of the DPH smallpox vaccination effort on New England Cable News, DeMaria praised the MNA for "doing exactly what it should be doing to inform its members on this issue. Their concerns deserve to addressed."

MNA is Not Alone in Raising Concerns

The MNA has not been alone in its opposition to the plan. Shortly after the MNA announced its position, similar positions were announced by the Maines State Nurses Association, Rhode Island State Nurses Association, California Nurses Association, Texas Nurses Association and the American Nurses Association. More than 350 hospitals nationwide have decided to opt out of the plan because of safety, compensation and liability concerns and hundreds more are undecided.

A panel of experts created by the prestigious Institute of Medicine (IOM) called for better screening, a system for covering lost wages and medical expenses for people who have adverse effects from the vaccine and an independent, non-political voice for the program. The American Public Health Association has recommended additional protections to assure safe and effective implementation of the vaccine.

Cooley Dickinson Hospital in Northampton has refused to participate in the program because of the danger it may present to patient populations, and three other Boston area hospitals – Massachusetts General Hospital, Beth Israel Deaconess Hospital and Children's Hospital – were reported in the Boston Globe to have serous reservations about the program.

In February, DPH employed physicians, nurses and staff were the first in the state to receive the vaccine. As the Massachusetts Nurse went to press, very few additional health care workers had been vaccinated. The Washington Post ran a major feature story that pointed out that the program had stalled nationally as a result of the concerns raised by organizations like the MNA, and by reluctant health care workers concerned about the issues left unresolved.

Initial Complications Reported

As the Mass Nurse went to press, the Centers for Desease Control (CDC) had reported that two dozen people have reported complications associated with the vaccine, though none has been life-threatening, according to

A 39-year-old Florida nurse, after complaining of headaches and malaise, developed a severe rash called "generalized vaccinia" that is a known side effect of the inoculation. Although additional testing is being done, health officials expressed confidence that the pustules on her chest and back were caused by the live virus vaccine. She was treated with antihistamines, and doctors do not expect her to have permanent scarring, said Eric Mast, an immunization specialist at the CDC.

The two other Florida cases involved symptoms not typically associated with smallpox vaccination—angina, or severe chest pain, and gallbladder inflammation. Both patients were treated at local hospitals and are in good condition, officials said.

Health officials have expected a small number of complications associated with the inoculations. In the past, between 14 and 52 of every 1 million people immunized suffered life-threatening side effects such as encephalitis. More common reactions include fever, itching, lethargy and headache.

As of Feb. 21, 7,354 people had been immunized in the voluntary program, designed to vaccinate 500,000 health care workers who would respond to an initial outbreak and open mass vaccination clinics.

More than 108,000 military personnel have been inoculated in the past six weeks, with six serious complications reported, according to the most recent data available from the entagon. They included two cases of encephalitis, two serious rashes, one case of myocarditis (inflammation of the heart) and an eye infection.

National Legislation Filed to Address Certain Issues

In response to the broad based outcry of concerns about the smallpox plan, and as the program continues to stall, Congress has acted to try and pass legislation to address these concerns. Rep. Henry Waxman (D-CA) recently introduced H.R.865 (visit the web at http://thomas.loc.gov/cgi-bin/query/C?c108:./temp/~c108HajBNq). It is a bill to protect and compensate workers and others injured by the smallpox vaccination. It has been sent to the Health Subcommittees of the Energy & Commerce and the Education & Workforce Committees. Massachusetts Congressman Ed Markey has signed onto the bill as a sponsor.

Highlights of the legislation include:

• Establishes a no-fault compensation program for those injured by the smallpox vaccine modeled on the program for children injured by routine immunizations;
• Provides grants to states to pay for their vaccination programs, including education and testing for medical conditions that are risk factors for severe reactions;
• Provides states full funding to pay for the immediate medical care of any health care worker or first responder injured by the vaccine, or anyone injured by coming into contact with someone who has been recently vaccinated;
• Prohibits discrimination against any worker who refuses to be vaccinated;
• Permits up to four days of paid leave for health care workers who experience transient but significant local reactions. Employers can obtain reimbursement for this expense from the compensation program.
  

MNA Smallpox Conference draws 100

In an effort to increase education among nurses and other health care workers about smallpox, the MNA hosted a conference, Smallpox 2003: What Nurses and Others Must Know, at the Best Western Hotel and Conference Center in Marlboro on February 25, 2003. More than 100 nurses and allied professionals attended the event, where they learned to distinguish the signs and symptoms of smallpox from many other infectious diseases, particularly chicken pox, impetigo, and disseminated herpes zoster as well as other types of other skin lesions. Participants received a packet of information from the (DPH) that included the most recent publications on smallpox from the CDC in Atlanta.

Those who could not attend the conference can obtain much of the same information and materials online at www.cdc.gov/smallpox. Part of this web information site, entitled, Most Frequently Asked Questions, is particularly helpful.

Susan Lett MD, Massachusetts DPH Director of Immunization, presented on the history, epidemiology and treatment of the disease. During the entire day, Dr. Lett answered questions from a very interested and inquisitive audience.
Donna Lazorik RN, MS, Coordinator of Adult Immunization at the DPH, described the Massachusetts Pre-event (before a case of smallpox appears) Vaccination Plan. Ms. Lazorik noted that the volunteer vaccination program has been developed with a component to screen out those who should not participate due to personal or family risk factors.

A panel consisting of Karen Higgins,pPresident of MNA, Evie Bain, MNA coordinator of health and safety, Mike Aires, of the International Association of Firefighters and Nancy Lessin, coordinator of health and safety for the Massachusetts AFL/CIO, addressed concerns that adverse effects of the vaccine and the risks to volunteers and patients have not been adequately addressed by either the CDC or the federal government.