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Another cardiac complication that arose and was unsuspected was cases of heart inflammation. The number was 3.6 times the number that might have been expected to develop myocarditis and pericarditis anyway based on data from Australia and Finland, where a stronger strain of the vaccine was used. The heart attacks and heart inflammation caused the CDC to ban any immunizations for anyone with heart disease on March 25 of this year.
Others theorize that the vaccination program faltered because of the quick victory in Iraq and that many Americans felt the threat had faded. Other speculation includes resistance because there was no law to compensate people if they were hurt or became ill after being vaccinated. The bill to compensate them was not signed until April 30. There also was conjecture that SARS and monkeypox competed for state health resources and public attention.
Still others, especially in the fire service, did not promote Phase II because of the adverse impact that vaccination would have on the workforce. Common reactions to the smallpox vaccine include rashes and swelling and tenderness of the lymph nodes that could last one month; 20% of adults inoculated develop a fever that lasts two or more days. When employees of CDC were vaccinated, one-third called in sick for at least two days. Could your fire department sustain these types of absences?
In response to many questions and concerns, the International Association of Fire Chiefs (IAFC) issued a Fire Chief's Guide to Smallpox Vaccination to all its members. The guide makes reference to scheduling concerns because of members who become ill after receiving the vaccine and recommends staggering vaccinations of firefighters within a shift or fire station in order to minimize the number of personnel who would be on sick leave concurrently.
While some in the fire service did not promote vaccination, there were still others who strongly advocated fire department personnel be inoculated. As one ranking chief officer in Chicago told me, "Everybody should be vaccinated, since it would remove one weapon from a terrorist's arsenal of weapons."
The chief concern for the fire service is personnel who may come into contact with a person who is contagious with smallpox. A smallpox outbreak will not be some high-intensity event such as an explosion, building collapse, or warehouse fire. Just like the outbreak of monkeypox, people will start showing up at their doctors' offices or in some cases calling for an ambulance because of a rash that has become progressively worse. Only after five days will the classic signs of the smallpox be evident on the person's body. By that time, it would be too late. Fire personnel may have been exposed to the disease.
Although the issue of smallpox vaccination seems to be off the table at this point, just one reported case of smallpox in the United States would see a flurry of activity of even greater magnitude than last year's anthrax scare.
For more information, you can go to www.smallpox.gov.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief of Special Operations for Jefferson County, MO. He retired in 2001 as the chief paramedic for the St. Louis Fire Department after serving the City of St. Louis for 25 years. He is also vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC). He is a frequent speaker at EMS and fire conferences nationally and internationally, and is on the faculty of three colleges. Ludwig has a master's degree in management and business and a bachelor's degree in business administration, and is a licensed paramedic. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 636-789-5660 or via www.garyludwig.com.