New York Times:Smallpox Vaccine Transmission Raises Liability Issue

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THE BIOTERROR THREAT

Smallpox Vaccine Transmission Raises Liability Issue

By LAWRENCE K. ALTMAN

f a smallpox vaccine recipient inadvertently transmitted the virus

in the vaccine to other people and they fell ill, who would pay for the sick

people's medical care?

The question arose over the weekend after President Bush announced a

plan to vaccinate about 10 million health care and emergency workers with

smallpox vaccine, which contains a live virus that is closely related to the one

that causes smallpox. Smallpox vaccination differs from other immunizations

because recipients can accidentally transmit vaccinia, the virus in the vaccine,

to others, in effect involuntarily vaccinating them and putting some at risk of

life-threatening complications.

General recommendations are that people who have recently been

vaccinated stay out of close contact with others or cover the vaccine site with

a bandage, because the virus can be shed from the site for several weeks after

inoculation. Some hospital officials say that newly vaccinated workers who take

care of patients will be required to wear special semipermeable bandages at

work, because they are better than gauze at containing the virus.

Smallpox vaccine is the most dangerous of all human immunizations,

and the risks of adverse reactions are higher for people whose immune system has

been weakened by cancer, AIDS or other diseases. The risk also includes two

common skin conditions, eczema and atopic dermatitis. These conditions affect as

many as 50 million Americans.

Complications include rashes that can destroy the skin, blindness,

brain inflammation and even death. Before the United States stopped smallpox

vaccinations in 1972, life-threatening complications occurred at the rate of 14

to 52 per million. The rate of other serious complications was 49 to 900 per

million.

Tom Ridge, the president's domestic security adviser, said on Friday

that the vaccine was essential only for those on the front lines of emergency

response and patient care. " Consistent with the national strategy, I will not be

vaccinated, " Mr. Ridge said. He recommended that the general public — and that

included Congress and the cabinet — not be vaccinated either.

President Bush's decision on Friday to offer smallpox vaccinations

to up to 10 million health care workers, firefighters, police officers and other

emergency workers suddenly makes relevant the question of who pays the medical

costs of illness from accidental infection.

Tommy G. , the secretary of health and human services, and

other federal experts on smallpox were asked on Saturday who would pay. They

said they expected standard health insurance to pay for such medical care.

But they left unanswered the question of who would pay if the

accidentally infected individual was among the estimated 41 million Americans

who had no health insurance.

In recent weeks, many states voiced concern that workers'

compensation would not cover the costs of illness to health care workers who

became ill after vaccination.

But after checking, " we have not yet identified a single state which

has refused to cover this program under the workmen's compensation program, "

said Dr. T. Osterholm, a former Minnesota state epidemiologist who now

is an adviser to Mr. .

Successful vaccination produces a sore that recipients will be told

to cover with a gauze bandage and tape for two to three weeks.

If secretions from a smallpox vaccination soak into clothing or

blankets, the vaccinia virus may survive in the fabric for a day or two and

could theoretically infect someone else who comes into contact with the item,

said Dr. A. , the epidemiologist who led the global smallpox

eradication program and who now is a senior science adviser to Mr. .

To prevent transmission of the vaccine virus, the Centers for

Disease Control and Prevention recommends that clothing soiled by secretions be

washed in hot water and detergent and, if possible, bleach.

Mr. Bush's plan calls for vaccinating 500,000 health care workers by

spring, followed quickly by offering vaccinations to the 10 million more

workers. Only about half are expected to be vaccinated, the officials said.

Many health care experts have warned the government to proceed

cautiously with the larger group.

Colorado is the only state not to meet the Dec. 9 deadline that the

agency set for filing full plans for smallpox vaccinations, Mr. said.

God Bless,

Hazelpone