Dimensions Healthcare System

By David Nakamura and Eric M. Weiss
Staff Writer - The Washington Post

Local Workers Weigh Benefits And Risks of Vaccination

He works in the emergency room of one of Washington's largest hospitals, just two miles from the hub of the federal government. So when Aaron Snyder heard President Bush's official announcement yesterday that smallpox vaccinations would be offered to hospital workers and emergency medical personnel, he didn't hesitate.

"I personally would receive the vaccine," said Snyder, a physician at Washington Hospital Center. "The benefits, in proximity to where I work, outweigh the risk."

But D.C. paramedic Carlo Pacileo had another view.

"I don't even get flu shots. I would never get a smallpox vaccine," Pacileo said, sitting in an ambulance outside George Washington University Hospital. "If there's that very small percentage that could kill you, I'm not into that."

Across the region and the country, medical workers were put in the position of making a difficult and very personal decision. Bush ordered some military personnel to receive the smallpox vaccinations but left it voluntary for the nation's medical workers.

Although the announcement had been expected for months, hospital officials said they will have to move fast to meet Bush's 30-day window on the vaccination procedure.

Some medical officials repeated concerns about that timetable yesterday, saying they worry that it could lead to rushed training, liability concerns if workers get sick from the vaccinations and staffing shortages if the shots result in widespread side effects.

The vaccine is estimated to be lethal to one in every 1 million recipients and to require long-term care in one in every 1,000. Smallpox kills about one in three people exposed. The vaccination also has side effects, including fever, swollen glands and swollen, red arms.

"If we're talking 30 days, hospitals are not going to step forward until all those liability issues are adequately addressed and confidently described, so people feel comfortable moving forward," said Dan Hanfling, director of emergency management and disaster medicine for the Inova Health System in Northern Virginia.

Officials in the District will offer the vaccine to as many as 5,000 public health workers and private physicians and nurses, including hundreds of workers at 11 hospitals.

In Montgomery County, 50 health department workers will receive the vaccine, and an additional 500 hospital personnel are expected to volunteer, officials announced. In Fairfax County, the numbers are similar.

"It could be as high as 500 people," said Kathy Simmons, a Fairfax Health Department spokeswoman. "We can manage that fairly well. We could do it in a couple hours. But if we give everyone on a team a shot and half have a [bad] reaction, we need to make sure we've got staff to back them up."

Those were the administrative concerns. A more pressing question for many staffers yesterday: Should I get the vaccination?

"I'd be a little hesitant to do it up front until a documented case breaks out," said Sgt. Chris Vogel of the Loudoun County Sheriff's Department . "If they order me to do it, I'd do it. But if volunteering, I'd want to wait until others take it and see how it works out. The odds are in your favor, but I'd hate to be one of the 15 with side effects."

Members of the Manassas Volunteer Fire Company sat around a table in their break room and discussed the options. "I have mixed feelings," Capt. Mike Rohs said. "Who's going to provide service if we're down -- or dead" from the vaccination?

Jackie Anderson, director of the emergency department at Prince George's Dimensions Healthcare System, said: "Before I say, 'Yeah, I would, or I would not,' I need to get the information we need to make an informed decision and give that to my staff. There is some concern among them. It's always hard to plan for the unknown."

Kenneth Lyons, who heads the D.C. emergency medical workers union, said his membership would ask the fire department to allow medics who have bad reactions to the vaccinations to miss work without their leave being docked.

Shmuel Shoham, an infectious disease specialist at Washington Hospital Center, said he will receive a shot. But his decision was not simple: While the vaccine does not contain smallpox, it does contain a related live virus that can be contagious, and Shoham has worried so much about his 14-month-old son that he is considering living elsewhere during the 21-day vaccination incubation period.

"Knowing what I know now, only someone who is going to have a chance to be exposed to the first case should get the shot," Shoham said. "If you're an emergency room doctor or an infectious disease doctor, you should probably get it. But if you're in medical records and a transcriptionist, you're unlikely to come into contact with the first case."

Washington Hospital's Snyder summed up the moment by saying, "There's a realism working here, especially after anthrax. People accept that this is the reality of living in Washington, D.C., nowadays."

Staff writer David A. Fahrenthold contributed to this report.

© 2002 The Washington Post Company

back to Press Releases