Beth Miller-Zuber, a nurse with the Fairfax County Health Department, had been vaccinated for smallpox before, so she had some idea what to expect when she took part in a two-day training seminar for public-health workers last week. The purpose of the seminar was to give the workers first-hand experience administering the vaccine, in preparation of implementing Phase 1 of the state’s smallpox preparedness and response plan.
This time around, however, Miller-Zuber has to think about her children, ages 18 and 20 — one an emergency medical technician and the other going to medical school. If Miller-Zuber is vaccinated, they too would have to be, as would anyone living with her, to prevent spreading the virus at home.
"While I've been vaccinated, they haven't. I would recommend it for them," Miller-Zuber said.
DURING THE FIRST PHASE of the plan, a team consisting of public-health providers and about 135 hospital-care providers from the various health districts throughout the state, including Fairfax, Arlington and Loudoun counties, will be voluntarily vaccinated against smallpox, as soon as the vaccine is made available. Those workers will then be responsible for vaccinating, also on a voluntary basis, first-responders such as firefighters, police and rescue personnel, once more vaccine becomes available. The vaccine would then be made available to the general public, most likely as a post-event response, after cases of smallpox were confirmed.
For many health-care providers, however, administering the vaccine is just a page in a textbook. Routine vaccinations in the United States stopped in 1972, and the last natural cases of smallpox occurred in Somalia in 1977.
"In terms of actual vaccine administration, this is the first time many are learning how to do it," said Dr. Gloria Addo-Ayensu, assistant director of the Fairfax County Health Department. "In medical school, they've seen videos, but it's different looking at something and doing it."
So last Wednesday and Thursday, volunteer team members from the local health districts took part in a training session, which culminated with their giving the "vaccine" to each other. Actually, they used the bifurcated needles used to administer the vaccine, but they were dipped in saline. The vaccine is given by poking the skin 15 times with the needle.
"It wasn't bad," Miller-Zuber said after being "vaccinated." "Practice will make perfect. It's not that difficult to do. You have to count, that's the hard part."
WHILE HEALTH-CARE providers are preparing for smallpox, it is not something the general public needs to be concerned with at this time, the officials said.
"If the public needs to be vaccinated, it's way down the line," said Lucy Caldwell, spokesperson for the state Department of Health. “We don't want to unnecessarily concern people. We're following the guidelines set by the federal government — public-health workers and some hospital personnel first. The public is way down the line."
Plans are being made, however, for when the public may need to be vaccinated. The county health department has met with Fairfax County Public Schools officials and held a training session for principals. In the case of a post-event, the schools would be used as vaccination sites, and volunteers from the school system would provide support to the medical personnel, which would require them to also be vaccinated, along with their families.
"No one will be vaccinated for a post-event at this point," Addo-Ayensu said. "They will be vaccinated after a case is reported."
The 83-member support team, including about 50 nonmedical personnel, will be responsible for collecting required forms, child-care and other administrative functions during a mass vaccination. The support staff will be vaccinated after a post-event has been identified and before mass vaccinations begin.
"WE DON'T HAVE the vaccine yet. When it's released, it will be for health-care workers," Addo-Ayensu said. "Then the public, only if something happens."
So far, all vaccinations are being done on a voluntary basis because of the nature of the vaccine itself. It is a live virus related to smallpox. Once administered, it will start to take effect within three days and is believed to last three to five years. However, there are risks to being vaccinated.
"In some people it can be dangerous," Addo-Ayensu said. "There are all kinds of screening sheets."
There is a list of pre-existing conditions that help identify people who should not be vaccinated unless exposed to the virus. Those include people with weakened immune systems; transplant recipients; people with a history of eczema or atopical dermatitis, described as an itchy, inflamed skin disease; people with active skin conditions, such as burns, chickenpox, shingles, severe acne and herpes; pregnant women or those planning to be pregnant within one month of the vaccination; women who are breast-feeding; people who are allergic to the vaccine or any of its ingredients; people suffering moderate or severe short-term illness; and people under 18.
The vaccine can cause side effects, including rash, fever, and head and body aches. According to a state Health Department fact sheet, for every one million people who receive the vaccine, about 15 will have more severe or even life-threatening side effects. About one to two people per million may die as a result of being given the vaccine.