US hospitals balking at smallpox vaccination
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* Barbara Sibbald

US President George Bush got his. So did Defence Secretary Donald Rumsfeld. But some hospitals across the US are balking at immunizing their staff against smallpox because they think the risks outweigh the threat posed by bioterrorism.

Based on studies reported by the US Centers for Disease Control (CDC) in 1968, 1000 of every million people receiving their first vaccination against smallpox will report serious reactions. These include an allergic reaction at the vaccination site, spread of the vaccinia virus to other people (inadvertent inoculation) and spread of the vaccinia virus to other parts of the body (generalized vaccinia). Between 14 and 52 of these 1 million people will experience potentially life-threatening reactions to the vaccine, and 1 or 2 will die.

The CDC notes that there may be more adverse events today because more people are at risk due to immune suppression caused by diseases such as cancer and AIDS. It estimates that one-third of those vaccinated will experience symptoms severe enough to cause them to miss work.

In February, hospitals in Maryland, Colorado and Washington were weighing the pros and cons of the vaccine. At least 2 hospitals in Georgia and Virginia have refused to inoculate employees because there is no credible risk of infection. In Atlanta, the Grady Memorial Hospital has refused to immunize its front-line workers until there is clear and “imminent danger” of smallpox transmission.

In December, Bush had proposed voluntary vaccinations for up to 10 million people, including the 400 000 health care workers who would likely be first responders during any smallpox outbreak following an attack with biological weapons. The first wave of about 450 000 voluntary vaccinations began in January. — *Barbara Sibbald*, CMAJ

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/168/8/1034.2/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/168/8/1034.2/F1)

Figure. **Smallpox vaccination: health workers saying no** Photo by: Canapress