cur despite non-negligent manufacture and administration of the vaccine—to speedy resolution.

Workforce Issues Resulting from Vaccination

Recognizing that this first phase of smallpox vaccination will only involve public health and health care response teams, the committee encourages CDC to consider some additional issues that may affect the willingness of health care workers to participate in the pre-event smallpox vaccination program.

As phase I vaccinations begin, hospital patients could be adversely affected by the absence of health care workers from patient care duties because of adverse reactions or possible administrative leave (Altman, 2002). Most hospitals are not staffed with sufficient redundancy to absorb such staff losses safely (AHA, 2002). Depending upon the size of response teams at individual hospitals, staggering vaccinations may be a prudent step for ensuring the safety of not only the vaccinees, but also the patients. This may extend the period originally anticipated for the first phase of vaccinations. However, this will help ensure that hospitals proceed with vaccinations only as quickly as safety will allow.

It should be noted that in the Department of Defense’s initial experience vaccinating approximately 170 military personnel, there were no cases of secondary infections in contacts (Vogel, 2003). However, the committee notes that the controlled conditions of the military setting cannot always be replicated in a civilian setting.

The same concerns regarding absence of workers from hospitals during the period of phase I vaccinations also applies to state and local public health departments. Considering that the median size of a local public health department in the United States is 14 staff (NACCHO, 2001), having even a small number of staff unable to perform their duties for a few days because of adverse reactions to the vaccine could have a detrimental effect on the ability of the local public health departments to keep their standard public health programs operating sufficiently. These concerns become of even greater importance to public health departments that have even fewer staff. In terms of timing of smallpox response team vaccinations, the committee agrees with the Advisory Committee on Immunization Practices (ACIP) recommendation that hospitals and health departments stagger vaccinations within individual institutions if this is deemed desirable by the individual programs (CDC, 2002e). The committee recognizes that staggering vaccinations might prove incompatible in some instances with the necessity of minimizing vaccine wastage.

In addition to concerns about potential absenteeism and its effects on hospital functioning and patient care, there are questions about the possible



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