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Smallpox Vaccine: What Workers Need To Know

What is the federal smallpox vaccination program?

The federal smallpox vaccination policy is intended to inoculate health care workers and other emergency responders on a voluntary basis. It is a pre-event program, meaning the vaccinations are to be given before any smallpox cases appear. Approximately 500,000 health care workers are to be vaccinated in the first phase, followed by a second wave of an additional 10 million health care and other emergency responders. There has not been a smallpox case in the world since 1977, but the U.S. government has developed the vaccination program to protect against the possibility of an intentional release of smallpox. AFSCME has called for a delay in the vaccination program in order to address serious safety and workplace issues.

How does the vaccine protect against smallpox?

The vaccine is made from a "live" virus called vaccinia, a "pox"- type virus that is related to smallpox. The vaccine produces an immune response that protects against smallpox. Routine vaccination was stopped in the U.S. in 1972. The vaccine is highly effective when given before exposure. In addition, vaccination within 3 days after exposure will completely prevent or significantly modify smallpox in the vast majority of persons. Vaccination 4 to 7 days after exposure likely offers some protection from disease or may modify the severity of disease.

Can smallpox vaccine cause smallpox?

No! The vaccine does not contain the smallpox virus (variola) and cannot cause smallpox.

Are vaccinations received years ago still effective?

The smallpox vaccine provides a high level immunity for 3 to 5 years. The effectiveness fades after 5 years and is probably negligible after 20 years. Revaccination provides longer lasting immunity.

What side effects does the vaccine cause?

It is estimated that for every one million people who are vaccinated, there would be:

• One or two deaths,
• Between 14 and 52 people would have a potentially life-threatening reaction,
  
• inflammation of the brain (encephalitis)
• progressive vaccinia, an ongoing infection that destroys skin tissue
• eczema vaccinatum, skin rashes caused by infections such as eczema
  
• About 1,000 people would have serious but not life-threatening reactions. These include a toxic or allergic reaction at the inoculation site and spread of the vaccinia virus to other parts of the body and to other people.

The smallpox vaccine also causes milder reactions that usually go away without treatment:

• The arm receiving the vaccination may be sore and red where the vaccine was given.
• The glands in the armpits may become large and sore.
• The vaccinated person may run a low fever.
• An estimated one-third of vaccinated workers would miss work from one to a few days.

Who is at risk from the vaccine?

Workers with certain conditions should not be vaccinated in a pre-event situation. In addition, vaccinated workers can also cause vaccinia infection among other family members, co-workers, other close contacts and patients if there is contact with the site of the inoculation!

Individuals in the following categories should NOT be vaccinated:

• A weakened immune system caused by cancer treatment, an organ transplant, HIV, etc.
• Eczema or atopic dermatitis (even if the condition is not active.)
• Burns, chickenpox, shingles, impetigo, herpes, severe acne, psoriasis, or other skin conditions until they have completely healed.
• Breastfeeding and pregnant women or women who may become pregnant within a month of vaccination.
• Are allergic to the vaccine or any of its ingredients.
• Are younger than 12 months of age.
• Experiencing a moderate or severe short-term illness. People should wait until they have recovered.
• Currently using steroid drops in their eyes.

Does the smallpox vaccine cause heart problems?

Investigation is underway to determine if reported cases of heart attacks and other heart ailments were caused by the smallpox vaccine. Two health care workers have died of heart attacks. A fatal heart attack and other heart problems have also occurred among recently vaccinated military personnel. There is evidence which suggests that smallpox vaccination may cause heart inflammation, angina (chest pain caused by lack of blood flow to the heart), and other conditions. A growing number of states have temporarily stopped their vaccination programs.

As an interim measure, the Centers for Disease Control and Prevention (CDC) is recommending that people with a history of heart disease not be vaccinated. In addition, CDC recommends that those who have three or more risk factors for heart disease such as high blood pressure, diabetes, or high cholesterol not get the smallpox vaccine. The CDC has information posted on this issue available online.

"As a precautionary step, if you have been diagnosed by a doctor as having a heart condition with or without symptoms you should NOT get the smallpox vaccine at this time while experts continue their investigations. These include conditions such as:

• known coronary disease including:
  
• previous myocardial infarction (heart attack)
• angina (chest pain caused by lack of blood flow to the heart)
  
• congestive heart failure
• cardiomyopathy (heart muscle becomes inflamed and doesn't work as well as it should)
• stroke or transient ischemic attack (a "mini-stroke" that produces stroke-like symptoms but no lasting damage)
• chest pain or shortness of breath with activity (such as walking up stairs)
• other heart conditions under the care of a doctor

In addition, you should NOT get the smallpox vaccine if you have 3 or more of the following risk factors:

• You have been told by a doctor that you have high blood pressure.
• You have been told by a doctor that you have high blood cholesterol.
• You have been told by a doctor that you have diabetes or high blood sugar.
• You have a first degree relative (for example mother, father, brother, or sister) who had a heart condition before the age of 50.
• You smoke cigarettes now.

Many people do not know if they already have heart disease or conditions that put them at higher risk of developing heart problems. Therefore, AFSCME recommends that workers receive thorough medical screening for heart disease and risk factors for heart problems BEFORE deciding whether to volunteer to be vaccinated. In addition, workers need to know whether any of their household members and other close contacts have any of these conditions, since those who are vaccinated can pass the vaccinia virus to others.

What other health hazards could vaccination cause?

The vaccine is administered by dipping a small two-pronged (bifurcated), single-use needle into a vial containing the vaccine and then jabbing the inoculation site numerous times. The Centers for Disease Control and Prevention has distributed needles with the vaccine that do not have a safety device to prevent needlesticks, even though safer needles are available. AFSCME is working to get safer needles approved for use with the smallpox vaccine. The Needlestick Safety and Prevention Act of 2000 revised the Occupational and Health Administration (OSHA) Bloodborne Pathogens Standard. The law requires the use of needles and other sharp devices that have a built-in safety feature to reduce the risk of a needlestick or other blood exposure that could transmit HIV, hepatitis, or other bloodborne diseases.

What protections are needed to prevent safety risks and protect workers' pay and other benefits?

Education - Workers must receive education about smallpox vaccine health risks to themselves and their family members, other close contacts, and patients.

Screening - Workers must be carefully screened to make sure that they or their close contacts do not have any of the conditions that would put them at risk. The screening should include confidential and free medical testing if necessary.

Voluntary Participation and Informed Consent - Workers must not be pressured into volunteering by their employers, and there should be no discrimination or reprisals against workers who decline to be vaccinated for any reason. In addition, there must be no discrimination against workers who experience an adverse reaction to the vaccinia. Informed consent should also cover the availability of medical care and compensation, or lack thereof, in the event of side effects that require time from work. Potential responders should be fully informed of their job responsibilities in the event there are smallpox cases.

Monitoring of the Inoculation Site and Medical Treatment - The inoculation site must be carefully monitored to rapidly identify and treat any adverse reactions. Hospitalization is required for severe side effects. Vaccinia Immune Globulin (VIG) is used to treat certain conditions such as progressive vaccinia and eczema vaccinatum.

Full Coverage for Medical Costs, Pay, and Benefits - Workers should receive first-day and first-dollar coverage for all medical costs and lost income due to vaccine side effects. Workers should not have to use accrued leave to cover lost time.

More information can be found on the Centers for Disease Control and Prevention website.

April 2, 2003

For more information about protecting workers from workplace hazards, contact the AFSCME Health and Safety Program at (202) 429-1228, or 1625 L Street, N.W., Washington, DC 20036.

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