Thursday, January 23, 2003

Ohio smallpox vaccine limited

Kentucky taking a more aggressive approach

By Tim Bonfield
The Cincinnati Enquirer

Kentucky will be among the first dozen states to receive a shipment of smallpox vaccine as part of a federal plan to protect against a bioterror attack.

But just north of the Bluegrass State, Ohio health officials aren't ready to place an order for the vaccine, much less start administering it. And in both states, it remains unclear how many hospital workers will be willing to take the shots once the vaccine arrives.

Come Friday, the long-debated Homeland Security Act takes effect. That date has become an unofficial starting point for a complex and controversial plan to protect the American public from a disease that might never strike.

Like every state, Kentucky has developed a "Pre-Event Vaccination Plan" to cope with a smallpox attack. It calls for vaccinating up to 8,000 public health officials, hospital workers and emergency personnel, with some shots starting within a week.

"Having this initial workforce trained and experienced in using smallpox vaccine will make it much easier to expand the program to large numbers of people if it should become necessary because of the international situation or actual exposure to the disease," said Dr. Rice Leach, Kentucky commissioner for public health.

But in Ohio, preparations are moving more slowly.

Local health department nurses in Ohio have been trained to give the shots. But state public health officials are waiting until later this week or early next week just to set a deadline for hospitals to turn in a list of willing volunteers.

Those lists will determine how much vaccine the state will need to order, said Bret Atkins, spokesman for the Ohio Department of Health.

When the vaccine would arrive and when hospital workers would actually get the shots remain unknown.

Part of the situation in Ohio stems from hospitals, health care unions and others asking a flurry of questions about the smallpox protection plan, at local and national levels. There are questions about liability and logistics; concerns about vaccine safety; and doubts about the risk of attack.

"First of all, it is really hard to assess the risk of attack. My political feeling is that this is more about getting people excited about what Bush proposes in Iraq," said Dr. Judith Feinberg, an infectious disease expert at University Hospital. "My concern is the population is just full of people walking around with damaged immune systems that could be killed by exposure to this vaccine. Back in the late 1960s, there wasn't much cancer chemotherapy to speak of. AIDS wasn't a disease. And there were few organ transplants."

Ohio's estimates of the hospital workers to be vaccinated have ranged from 13,000 to 5,000.

"The lists wax and wane. Most hospitals say they are willing to participate with some caveats," said Dr. Judith Daniels, medical director for the Cincinnati Health Department

In several states - but not in Ohio or Kentucky - some hospitals have refused to participate in the initial vaccination plan.

Hospitals have argued that the Homeland Security Act doesn't offer enough liability protection should employees, their families or patients suffer harmful side effects. Federal officials have promised to issue further clarifications.

The smallpox vaccine, unused since 1972, carries higher risks than any modern vaccine. Based on old studies, one or two people per million vaccinated could die; 40 per million could suffer serious illness; and up to one third of all those vaccinated could feel flu-like illness for a day or two.

At Cincinnati Children's Hospital Medical Center - where some smallpox vaccine research has been done in adults and a child study has been proposed - volunteers have been hard to find, said vaccine expert Dr. David Bernstein.

"E-mails went out asking people to come to one of several meetings but not many showed up. We wanted 50 volunteers. We have closer to a dozen," Dr. Bernstein said.

"Clearly, if there's a strike anywhere in the world, everything changes. But the bottom line is that people are looking for more proof that the threat is real. Until then, people aren't willing to take even a small risk."

The Associated Press contributed.


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