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Reasonable Rascal
09-27-02, 00:09
By Anne Barnard, Globe Staff, 9/25/2002

Doctors and nurses expressed concern yesterday that a draft state plan to vaccinate health care workers for smallpox in case of a bioterrorist attack could exacerbate a more immediate problem: a staffing crisis that is shutting down beds in emergency rooms and on hospital wards.

Under the draft plan, up to 20,000 health care workers would be asked to take three weeks off work after being vaccinated, to protect patients and workers from a small risk that the vaccine could spread illness. It contains the vaccinia virus, which can cause rashes or even kill patients with weakened immune systems.

Caregivers vowed to carry out any final state plan, but said the three-week furlough would be very difficult to implement during an acute nursing shortage.

Dr. Brien Barnewolt, chief of emergency medicine at Tufts New England Medical Center, said that taking doctors and nurses out of the hospital for three weeks at a time - even if the vaccines were done on a staggered basis - would further strain a system in which emergency rooms are already turning away patients or forcing them to wait too long for hospital beds, even without a major flu outbreak or other epidemic.

''Frankly, I'm more worried about a potential flu problem than about smallpox,'' he said. ''Flu we know is going to occur. Should we have that problem it could be quite devastating.''

Jeanette Ives Erickson, vice president for nursing at Massachusetts General Hospital, said that in the current climate, ''Even one nurse that is not present to a patient is a lot.''

Barnewolt called the Department of Public Health plan a conservative approach that might turn out to be the right one. Other options, he said, include immunizing health care workers after a case is reported, when there is still a window of time in which the vaccine can be effective.

Dr. George Thibault, director of quality improvment at Partners HealthCare System, which includes Brigham and Women's Hospital and MGH, said hospitals are still discussing with the state the number of workers to be immunized and that 20,000 might not be the final number.

The Massachusetts Nurses Association, the state's largest nurses' union, said it would support the program as long as vaccinations would be voluntary and caregivers would get the financial and logistical support they need.

This story ran on page B4 of the Boston Globe on 9/25/2002.

© Copyright 2002 Globe Newspaper Company.

http://www.boston.com/dailyglobe2/268/metro/Doctors_nurses_raise_concerns_over_smallpox_plan%2 B.shtml

walz
10-11-02, 23:51
[QUOTE]Originally posted by Reasonable Rascal
[B]By Anne Barnard, Globe Staff, 9/25/2002

"Under the draft plan, up to 20,000 health care workers would be asked to take three weeks off work after being vaccinated, to protect patients and workers from a small risk that the vaccine could spread illness. It contains the vaccinia virus, which can cause rashes or even kill patients with weakened immune systems."

I was just invited to a week-long smallpox treatment course that was to include a vaccination and "training how to give one". No mention of a reccommended 3-week "stay-away from work" program. The CDC could consider giving the vaccination during a two-week civilian CME conference on chem/bio-warfare/disaster response. I am not a smallpox vaccination expert, yet, but I do not believe the vaccine virus can spread without direct contact to the leision. If so, a health care worker could be assigned to another low-risk area of the hospital until the leision is healed. Sounds like a bit of exaggeration to me, but most nurses deserve the time off anyway. What will the nurse shortage be if there is a smallpox outbreak? Think about it.

Reasonable Rascal
10-12-02, 00:19
Walz, I tend to agree with your reasoning. Unless my memory fails me (it happens, what can I say) there was no isolation period for vaccinees (correct term?) when the Vacinnia was being administered as a matter of routine.

As you coreectly pointed out the danger lays with direct contact. As we are normally talking the shoulder (deltoid) area I don't see much chance for that in the normal clinical environment. One would think a simple barrier patch would suffice to prevent contamination of clothing and thence from there to a patient or other individual.

The article simply shows the confusion widely evident in the smallpox vaccination program being proposed. Initially we started out with 20,000 "first responders" being vaccinated - nationwide, mind you, or 400 per state if equally divided. Lately we have seen updated numbers of 250,000 first responders and care givers being touted. That number is more realistic - providing they can find a quarter million willing volunteers in light of the admissions of lack of information about the new DryVax. Without a serious and immediate threat IMO response would be slow.

The article represents well the spin that is being placed on this entire affair. *If* they decide on an isolation period it would have some effect on an increasing shortage of nursing staff. But as you say, what about mass innoculations during an actual outbreak. I dare say the volume of resignation we'd see initially would more than create a serious shortage without isoaltion periods.

BTW, welcome! Hope to see more from you in the future.

RR

walz
10-12-02, 00:48
I agree. "Without a serious and immediate threat IMO response would be slow." I do not know if there is an immediate threat, and nobody who would know is sharing if there is. We do know small-pox potential, and if it got into the wrong hands (unlikely, but possible) it would be an "ideal" terrorism weapon to shut us down. I support the current thought process of vaccinating at least a core group of voluntary first responders, heck, I am in line. I will inquire about the "new" vaccine, and post more if there is any interest in such information.
Thanks for the "welcome", I think this is a great site, and I will spread the word in my circles to generate more input.