Several obstacles to vaccination have been identified, not the least of which is the uncertainty surrounding the potential threat of a deliberate release of the smallpox virus. The risk of such an exposure is presumed to be low, but the population at risk cannot be estimated should an exposure occur. As a result, the ACIP and HICPAC, acting on the directive from the President, have devised recommendations for each acute-care hospital to identify groups of health care workers who could be vaccinated so that they would be able to respond to an exposure. These recommendations must be put into the context of the likelihood of exposure for each acute-care setting and the resources available, either within that center or as a coordinated effort among centers where no single institution might have all essential personnel.
It is anticipated that these health care teams would be available to provide care 24 hours a day for the first two days or more until additional personnel could be vaccinated (Table 3). The composition of these teams would vary but should include physicians, nurses, and ancillary personnel in sufficient numbers to provide continuity of care. canadian pharmacy cialis
Table 3 Smallpox Health Care Response Teams (ACIP and HICPAC)
|• Emergency-department staff|
|• Intensive-care unit staff|
|• General medical unit staff|
|• Primary care house staff|
|• Medical subspecialists, including infectious disease|
|• Infection-control professionals|
|• Respiratory therapists|
|• Radiology technicians|
|• Security personnel|
|• Housekeeping staff|
Concern has been raised about the possibility of inadvertent spread of vaccinia virus from vaccinated health care workers to patients who might be immunocompromised either in the hospital or in the outpatient setting. The ACIP/HICPAC guideline recommends that health care workers with direct patient contact maintain the vaccination site with gauze in combination with a semipermeable membrane and a layer of clothing. A furlough from patient-care duties should not be necessary.
Despite optimistic estimates of adverse effects from the vaccine and even with optimal screening of vaccine recipients, serious adverse events can be expected to occur as the number of vaccinees increases. The question of workers’ compensation and the liability of insurers and other providers in this voluntary program remains substantial. Section 304 of the Homeland Security Act protects the vaccine manufacturer and the qualified entities providing vaccine (e.g., health departments, clinics, and hospitals) from liability for injuries suffered during the National Smallpox Immunization Plan. However, a formal compensation plan for individuals experiencing adverse events has not been devised. Many of these issues are still unresolved and may require recommendations at the state and local level for adequate resolution. online pharmacy prescription drugs
The role of the medical community in response to potentially contagious diseases has historically been one of leadership. Current evaluations of smallpox vaccination strategies have reached similar conclusions favoring the vaccination of health care workers to provide initial care and respond to any smallpox threat. Although the response to vaccine enrollment has been slower than anticipated, the absence of reported severe adverse events is encouraging validation of the screening process and infection-control procedures that are already in place. By providing a core group of immunized individuals, the health care community has an unprecedented opportunity to increase the level of preparedness and thus limit any potential harm from the threat of smallpox.