Nurses set to give smallpox vaccines

Anne Terrell is on the front line of those nurses who will, if necessary, administer the smallpox vaccine to area residents — a position which gives her little concern, she says.

The Prince William Health District nurse manager gave the vaccinations 30 years ago when they were routinely given as protection against the deadly virus.

“I’m comfortable with it,” she says.

Terrell along with other nurses from the health district attended a smallpox vaccination training course in Alexandria a couple of weeks ago. They will be giving the inoculations to each other and other health and hospital officials within the month.

For Terrell and some other health district nurses who have had experience with the vaccine in the past, the training was more of a refresher course.

The vaccine is the same as the one given in the 1970s and it is administered the same way.

There will, however, be some changes. “We are certainly going to be a lot more cautious,” Terrell said.

Unlike in the 1970s, the nurses will wear gloves and the site of inoculation will be covered with bandaging.

Precautions are being taken, Terrell said, because of a population that largely has never been exposed to smallpox or the vaccine.

The smallpox vaccine is highly effective but it comes with risks.

It is not an injection with a standard hypodermic needle nor will it be given routinely.

As public health and hospital workers are given the opportunity to be vaccinated, they also are being asked to weigh those risks.

“This whole process is voluntary. This is not a benign vaccine,” said Dr. Jared Florance, director of the Prince William Health District. “We don’t want people to be macho. If you have a reason not to [be vaccinated,] don’t do it.”

After health care workers, the next to get the vaccine are police officers, firefighters and rescue squad members, the so-called first responders in emergency situations.

All vaccinations are voluntary.

The final phase may include the general public and will probably come late this year or in 2004, according to the Virginia Department of Health.

Before anyone is given the opportunity to be vaccinated, they received a great deal of information about the benefits, the protection it provides as well as the risks involved.

There are side effects to the vaccine. Usually they are mild and include rash, fever as well as head and body aches.

About 40 percent to 50 percent will experience sore muscles; 10 percent will run a fever; 35 percent will experience local pain and soreness around the inoculation site; and only 2.4 percent to 6.6 percent will develop more severe but still normal side effects, according to the Centers for Disease Control.

The more severe, but still normal side effects, include lesions developing around the inoculation site as well as increased swelling of the site.

Data indicates that for every one million people who receive the vaccine, about 15 will have more severe or even life threatening side effects, according to the CDC.

About one or two people out of a million vaccinated may die, according to the CDC.

These life-threatening reactions include a serious skin rash causing widespread infection of the skin leading to tissue destruction and encephalitis, an inflammation of the brain.

Health officials do not recommend that everyone receive the vaccination, especially if they have certain risk factors.

Those include: a weakened immune system, a history of eczema or some other skin conditions; women who are pregnant or planning to become pregnant within a month of vaccination and those under the age of 18.

Additionally, someone who has a family member with any of the risk factors are not recommended for vaccination, according to health officials. The vaccine can be unintentionally passed on to another.

“The only way for the vaccine to be transferred to another person is through physical contact,” Florance said.

Non-physical exposure to a vaccinated person does not run the risk of unintentional inoculation, Florance said.

While it is possible to have complications to the vaccine if a person has one of the risk factors, “not everyone [with a risk factor] gets the complications. The numbers are very small,” Florance said.

The smallpox vaccine does not contain the smallpox virus so the vaccine can not give a person smallpox, Florance said.

The vaccine, however, does contain a live “pox” type virus related to smallpox. It helps the body develop immunity to smallpox It is this virus that people can have a reaction to.

The vaccine is given using a two-pronged needle that is dipped into and holds a droplet of the vaccine. The needle is then used to poke the skin about 15 times.

The poking is not deep but causes a sore spot that will form a blister and eventually leave a small scar in about three weeks.

After receiving the vaccine, the recipient must follow instruction to care for the site until the area has healed. Those receiving the vaccine are monitored by public health officials to ensure there are no severe complications and any found would be reported, locally and eventually to the CDC.

“A tremendous amount of precautions are being taken by the medical community,” said Ric Crosby, bioterrorism coordinator for the Prince William Health District.

“The vaccine even comes with a holder to prevent it from tipping over,” Terrell said.

Smallpox does not exist today in the United States. The last case in this country was in 1949. With the disease eradicated, vaccination for smallpox was stopped in 1972.

The last natural case in the world occurred in Somalia in 1977. The World Health Organization declared the global eradication of smallpox in 1980.

Those who were vaccinate in the past may have a residual immunity to the disease. Since health officials do not know who has the residual immunity and how much immunity is present, they are assuming that no one is currently protected.

The vaccine offers protection from smallpox for three to five years, maybe longer, according to the CDC.

Staff writer Aileen M. Streng can be reached at (703) 878-8010.

SMALLPOX VACCINE FACTSHEET

— What is the smallpox vaccine?

The smallpox vaccine is a live virus vaccine made from the vaccinia virus which is related to smallpox. The smallpox vaccine helps the body develop immunity to smallpox. The vaccine does not contain the smallpox virus and cannot give you smallpox.

— What is the length of protection?

Past experience indicates that the first dose of the vaccine offers protection from smallpox for three to five years, and perhaps as long as 10 years or more. If a person is vaccinated again later, immunity lasts even longer. Historically, the vaccine has been effective in preventing smallpox infection in 95 percent of those vaccinated.

— Can vaccination after exposure prevent the disease?

Vaccination within three days after exposure will prevent or significantly lessen the severity of smallpox symptoms in most people. Vaccination four to seven days after exposure likely offers some protection or may lessen the severity.

— Who should not get the smallpox vaccine?

People with any of the following conditions or people who live with someone with the following conditions should not get the smallpox vaccine unless exposed to the smallpox virus:

— Weakened immune systems such as HIV, AIDS, leukemia, lymphoma, other cancers, cancer chemotherapy, radiation therapy, high-dose corticosteroid therapy and other immune disorders;

— Transplant recipient;

— Any history of eczema or atopic dermatitis which include skin diseases characterized by itchy, inflamed skin;

— Active skin conditions such as burns and other wounds, impetigo, chicken pox, shingles, contact dermatitis, severe acne, herpes, psoriasis. People should not be vaccinated until these conditions are resolved;

— Women who are pregnant or planning to become pregnant within one month of vaccination;

People with the following should not receive the vaccine unless exposed to the smallpox virus;

— Women who are breast feeding;

— Allergic to the vaccine or any of its ingredients;

— Moderate or severe short-term illness. They should wait until they recover;

— Are less than 18 years of age;

— What are the side effects and chances of complications from the vaccine?

The vaccinia virus that is contained in the smallpox vaccine may cause mild reactions, such as rash, fever and head and body aches.

Since the virus in the vaccine is live, complications can occur if the vaccine site comes in contact with other parts of your body or even other people.

Previous data indicates that for every one million people who receive the vaccine, about 15 will have more severe or even life-threatening side effects.

About one or two persons per one million people may die as a result of being vaccinated.

People not recommended to receive the vaccine unless exposed may be at greater risk of severe complications.

— How is the vaccine given?

The smallpox vaccine is not given with a normal hypodermic needle and is not a typical shot. The vaccine is given using a two-pronged needle that is dipped into and holds a droplet of the vaccine.

The needle is used to poke the skin about 15 times. The poking is not deep, but will cause a sore spot that will form a blister and eventually leave a small scar.

After the vaccine is given, it is very important to carefully follow instructions to care for the site until the area has healed, up to three weeks, to avoid the complications described above.

— Is the smallpox vaccine available?

The vaccine is currently not available to the general public. The federal government, which controls the availability of the vaccine, is considering who should get the vaccine.

Routine smallpox vaccinations in the U.S. stopped in 1972. The last natural case in the world occurred in Somalia in 1977.

The variola virus that causes smallpox officially exists in two laboratories, in the U.S. and Russia, but there is concern that the virus could be used as a bioterrorism agent, which is why federal, state and local governments are taking precautions to prepare for that possibility.

— On the Web:

Virginia Department of Health at: http://www.vdh.state.va.us; The Centers for Disease Control at http://www.cdcn.gov/smallpox.

Source: Virginia Department of Health