Smallpox vaccinations 'must be voluntary'
WASHINGTON, Nov. 27 (UPI) -- As the White House readies a national smallpox vaccine plan, representatives of nurses and firefighters -- who would be among the first to receive the smallpox vaccinations -- this week said they would strongly object to mandatory inoculations.
Smallpox inoculation carries a deadly risk. When administered in the United States in the late 1960s, between 14 and 52 people per million experienced potentially life-threatening reactions, while one or two in a million died, according to the Atlanta-based Centers for Disease Control and Prevention.
Smallpox hasn't occurred naturally since 1977, but experts fear it could return through a biological terror attack.
"In a pre-incident environment, to mandate that every firefighter in this country take a shot that might kill them is of great concern to us, to say the least," said Craig Sharman, the director of government relations for National Volunteer Fire Council, the nation's largest volunteer firefighter association.
"It would have to be a voluntary situation."
Cheryl Peterson, a senior policy analyst at the American Nurses Association, which represents the nation's 2.6 million nurses, said that her association was concerned that there could be reprisals against nurses who refused the vaccination.
"We have some concerns that nurses understand the full risk they are taking when they are vaccinated," she said. She also said that nurses should not feel they have to take the shot in order to keep their jobs.
The concerns were expressed amid growing media reports that the White House will soon release a vaccination plan that would require an initial wave of up to 500,000 U.S. military personnel and 500,000 health workers to be immunized against the disease.
Millions of firefighters, police officers, and other emergency workers -- so-called "first responders" -- could be inoculated in a second series of vaccinations.
The White House has been preparing a plan for months but hasn't yet officially indicated who would be immunized and under what circumstances.
Preparing for potential smallpox attack has been a top priority of infectious disease specialists in the United States since the Sept. 11, 2001 terror attacks.
Numerous working groups have already made recommendations, according to Judy English, the chairwoman of bioterrorism readiness at the Association for Professionals in Infection Control and Epidemiology.
In advance of a finalized national plan, the CDC has posted instructions and forms on its Web site to be used by health care workers in the event of an attack. States are due to present their own response plans in the case of an outbreak by Sunday.
"We support careful vaccination because the health care providers in this country must feel safe to do their job," English said.
Smallpox is a highly deadly disease that kills up to 30 percent of those it infects and leaves more blind or disfigured. It last occurred naturally in Somalia in 1977.
But the vaccination -- which requires people to be infected with a weaker pox called vaccinia -- carries its own risks.
"It is the most dangerous vaccine that we have. It will cause some healthy people to have adverse reactions that they would not have otherwise had," English said.
People at greater risk of serious side effects include those who have had eczema, even if it is not currently active; those with a weakened immune system -- such as people with cancer or HIV -- and pregnant women.
The vaccine is also not recommended by the CDC for those with skin conditions such as burns, chickenpox, shingles, impetigo, herpes, severe acne or psoriasis -- nor those under 18 years of age.
Because the vaccination consists of a live virus, it can infect others in a household if the inoculation site is not treated meticulously. For this reason, those with young children or elderly people in their homes might not want to be immunized, English said.
English, who has been consultating with other medical professionals on a finalized plan for months, said: "Everything I know about the vaccination plan demonstrations that it will be a voluntary vaccination."
However, she and other health care professionals stressed the need for more education and clear procedures to be established before any plan moves forward.
"Any inoculation plan of this scale will be extremely complex," said Peterson, adding that nurses had many questions.
"Will nurses be permitted to work while their inoculation is shedding? Are there sufficient provisions for patient safety? What provisions will be made for those nurses who have an adverse reaction?" she asked.
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