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Florida to offer smallpox vaccine to health, emergency workers

By Bob LaMendola
Health Writer

December 24, 2002

Florida expects to vaccinate more than 35,000 hospital and public health workers against smallpox starting Jan. 24, then will offer shots to 400,000 police and firefighters in spring and to the public as early as January 2004.

While conceding that the vaccine in rare cases can cause serious side effects and even death, state health officials on Monday said they would begin vaccinating key health workers on the first day recommended by the federal government.

"This will be strictly voluntary," said Dr. John Agwunobi, state secretary of health. "We're not in the business of trying to convince people to get vaccinated. [But] should a smallpox case appear, we would have the protected resources to respond at our hospitals."
The state detailed its plan that was approved last week by the U.S. Centers for Disease Control and Prevention, which is overseeing preparations for a possible bioterrorist attack.

The nation's first smallpox inoculations since 1972 would be given Jan. 24 to health department workers who would give the shots to others and who work in labs that would test samples from victims.

After observing that group for about two weeks, health officials would begin giving shots to emergency room doctors, nurses and other staffers who would have contact with infected patients, including about 3,500 in Broward County and more than 2,000 in Palm Beach County. Because the vaccine often brings a brief flu-like illness, the shots will be staggered over a few weeks to dilute absenteeism.

"We asked for a little more vaccine than that," said Dr. Robert Self, medical director of the Broward County Health Department. "What we've been allocated is fairly close. It'll be adequate for the first stage."

In March or April, a second wave of vaccinations will cover 400,000 police officers, firefighters, paramedics and other emergency "first responders," about one-third of them in South Florida, officials said.

Next year, about 10 million Floridians would be eligible for shots, as was tentatively approved by President Bush and the CDC. Agwunobi said the vaccine would not be given to people at high risk for complications, such as pregnant women, people with HIV or weakened immune systems, babies younger than a year, millions of people with eczema and certain other skin diseases -- or anyone who lives with someone in those groups.

In the past, for every million people vaccinated, one or two people died, about 40 were hospitalized and about 1,000 had mild to moderate illnesses such as skin infections, flu-like symptoms and fevers.

The state has already started campaigns to educate health workers about the risks so they can decide for themselves whether to volunteer, Agwunobi said.

Asked whether he would be vaccinated, as Bush was over the weekend, Agwunobi said he was "leaning toward" getting a shot when it's made available to the public.

Despite the new plan, questions and doubts remain.

A few hospitals might not let their employees be vaccinated, out of fear of being held liable for complications or risking patient health. Of about 50 in South Florida, only one, in Palm Beach County, was known to be opposed to the plan. County health department officials were still talking to officials at the facility, said department spokesman Tim O'Connor. He would not identify it.

HCA The Health Care Co. will let employees be vaccinated, but will not allow the vaccine inside its hospitals until observing any complications that emerge during the first wave of shots, spokeswoman Kristin Degina said.

No one is sure how much the vaccination effort will cost the state, although federal grants will cover the vaccine, two-pronged needles, an "immune globulin" serum to treat people with side effects and other obvious costs.

Federal officials have not determined how vaccinated employees who miss work will be compensated, and who will pay, the single biggest issue for hospital unions.

"Hopefully, it's not going to be a battle," said Martha Baker, president of Local 1991 of the Service Employees International Union, which represents hospital workers in Miami and in West Palm Beach.

Hospital employees have doubts and fears about the shots, Baker said, but so far no emergency room worker surveyed has refused to be vaccinated.

The state's timetable for giving shots to "first responders" and the public will be flexible, Agwunobi said, because there's no rush.

"It is expected we could afford to take time and get it right so it does not involve long lines of people and overburdening complexity," Agwunobi said.