|
medpundit |
||
 |
 |
|
Friday, December 20, 2002There’s also a review of past cases of transmission of cowpox from the vaccinated to the unvaccinated. Bear in mind that hygiene and universal precautions weren’t nearly up to modern standards back then, as this case of urinary-catheter transmitted cowpox demonstrates : After her older brother received vaccine,a 13-month-old girl had initially undiagnosed genital lesions and dysuria resulting from vaccinia infection.At the hospital,she was catheterized,and the catheter was then placed in a pan of Citrosil solution for sterilization.Several other urinary catheters were soaking in the same pan.Within a five-week period,there were 23 secondary cases with vulvar urethral vaccinia;each of the patients had been catheterized with one of the contaminated catheters. About half had high fevers,and some had gross hematuria.Virus was cultured from the urine of several children. It’s also quite possible that many of the hospital-transmitted cowpox cases were transmitted through the bed linens, which would have been changed daily and laundered together. It might be prudent to recommend that those who receive the vaccine launder their clothing separately, and of course to keep their vaccine site covered with a bandage at all times. There was also this: “...many hospitals remain uncomforable with the recent recommendation against the provision of administrative leave for newly vaccinated health care workers.” Who made that recommendation? If hospitals are concerned that vaccinated workers would transfer cowpox virus to their patients, then they should insist that their vaccinated workers stay home until their vaccine site heals. It wouldn’t take all that long, a matter of days. And introducing a voluntary vaccine program now, when coverage of absences can be planned and arranged, makes more sense than waiting for a smallpox attack, when vaccination has to be quick and universal, especially among exposed healthcare workers, and when they would be needed on the job even more. The best piece in the Journal’s collection, though is the public survey about smallpox and smallpox vaccine. People support the current policy of voluntary vaccination, but they’re suspicious of what would happen if the vaccine had to be offered quickly to massive numbers of people: The respondents were asked about two of the policy issues currently being debated: vaccination of health professionals and vaccination of the general public.A strong majority (81 percent)of the repondents favored voluntary vaccination of doctors United States (Table 2). Moreover,72 percent believed that if it was not possible to vaccinate everyone quickly,wealthy and influential people would get the vaccine first;43 percent believed that the distribution of the vaccine would discriminate against the elderly,and 22 percent believed that it would discriminate against blacks. (emphasis mine) Voluntary vaccination of healthcare workers also seems the wise thing to do when you consider that people say they would go to their own doctors and to emergency rooms if they thought they had smallpox: Approximately half the respondents (52 percent) said they would go to their own physician first for diagnosis and care if they thought they had smallpox, 40 percent would go to a hospital emergency room, and 7 percent would go to their local health department (Table 3).Most of the respondents were confident that their own physician would recognize the symptoms of smallpox (43 percent were very confident,and 40 percent were somewhat confident). In fact, one of the other pieces on the Journal’s website was a paper describing just what happened when a man in Cleveland presented with a disease similar in appearance and symptoms to smallpox. His doctors had to scramble to send specimens to the CDC in Atlanta for special testing. There was no place in Ohio capable of doing the tests. They had to fill out special forms, by typewriter, to get a courier to handle the specimen and deliver it to Atlanta, and they faced a time deadline to get it to the courier’s office. What they don’t mention in this paper, but which was detailed in a Cleveland Plain Dealer article about the same case last month (no longer on line), is that before the man turned up in these doctors’ offices, he had also been to two emergency rooms and a family practice clinic. No one in any of those places considered smallpox. If it had been smallpox, a good many people would have been exposed by the time it was recognized. It underscores the dire need for physician education on bioterror, and the importance of voluntary vaccination among healthcare workers. But back to the survey. It also asked about people’s attitudes toward the vaccine. They apparently harbor no illusions about its dangers: Although serious adverse reactions to the vaccine are expected to be relatively rare in patients without contraindications to the vaccine, a substantial proportion of the respondents thought that serious complications from the vaccine,including death,would be likely. So much for the argument that the public has unrealistic expectations of the vaccine’s safety. posted by Sydney on 12/20/2002 08:27:00 AM 0 comments 0 Comments: |
|
