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Docs Split on Getting Smallpox Vaccine

First Shipments Arrive, but Docs Worry About Risk to Patients
WebMD Health News

Jan. 29, 2003 -- The first federal shipments of smallpox vaccine this week began arriving at state health departments. But the vaccine is getting only a lukewarm reception from doctors.

Some major hospitals on the front lines of emergency care won't be giving the vaccine to their first responders. Even in hospitals that are offering the vaccine, doctors aren't rushing to get it. Atlanta's Grady Memorial Hospital -- Georgia's largest public hospital -- won't be offering the vaccine to its doctors.

"For a variety of reasons, the infection-control committee at the healthcare system where I work decided for the time being we are not going to immunize doctors or healthcare workers," says Carlos del Rio, MD, Grady's chief of medicine. "Most important, Vice President Cheney says there is no credible current threat of a smallpox attack. So in a risk-benefit analysis, the risks of the vaccine outweigh the benefits."

Del Rio has nothing against vaccines. As a matter of fact, he's glad his wife has already been given the smallpox vaccine.

"My wife works in a lab at the CDC. Because of her work, the benefits outweigh the risks," del Rio tells WebMD. "In each individual you need to make this decision."

Current smallpox vaccine stocks contain a live virus -- vaccinia. It's not the same as smallpox virus (variola), but people immune to vaccinia are also immune to smallpox. Normal people rarely get sick from vaccinia, and when they do it's usually not a life-threatening illness. But certain medical conditions make vaccinia a very dangerous virus. People who have AIDS or other immune diseases, who take cancer chemotherapy or transplant drugs, or who have certain skin conditions are at very high risk of serious disease. Such people should never get the smallpox vaccine -- but they could still catch the vaccine virus from a recently vaccinated person.

That's what most worries doctors -- even those who plan to take the vaccine. Rathel "Skip" Nolan, MD, is in charge of the smallpox vaccination program at the University of Mississippi Medical Center, Jackson. An infectious disease specialist, he'll get vaccinated in the next day or two.

"I don't expect I will have a problem with it myself," Nolan tells WebMD. "The unknown risk that many doctors balk at is that the CDC guidelines say you should not take the vaccine if you have a family member at home with an immune problem or certain skin conditions. But you can go to work as a doctor and treat immune-compromised patients. That is a mixed message for us. That's a leap of faith that a lot of us have had a difficult time getting over."

Nolan says that many doctors at his hospital worry that recently vaccinated emergency-room doctors will find themselves treating patients who may have immune problems. Yet it's ER doctors who would be on the front lines in case of a smallpox attack. And emergency personnel aren't the only doctors who face this dilemma.

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