Nurses educated on smallpox shots

Tuesday, February 11, 2003

How's your arm?

That was the big question asked Monday morning among the four nurses who received the smallpox vaccine on Friday as part of a governmental program to protect the U.S. against a possible bioterrorism attack.

The answer so far? Basically just itchy.

"It's itching, but that might be the dressing," said registered nurse LaRue McAllister, examining the quarter-sized, red circle on her arm. "It looks like a pimple. If it doesn't get any worse than this, then I can deal with it."

Charlotte Craig, director of the Cape Girardeau County Public Health Center, said none of the four nurses -- herself included -- had developed any symptoms yet. Those nurses were among the 100 or so county nurses statewide to receive the smallpox shot Friday.

"We're all doing pretty well," Craig said. "It's pretty much just show and tell today."

The four nurses were showing other nurses from both Cape Girardeau hospitals what the vaccinated arms looked like and telling them how the area should be covered and treated. Those nurses should be informed for when they get the shot and for later, should they ever have to inoculate others, Craig said.

Closely monitored

The health-care workers are being closely monitored for reaction to the vaccine, with the vaccine site checked daily and the dressing changed every three days. The hospital nurses who haven't yet been vaccinated crowded around those who have and watched as the dressings were changed.

The CDC reports that about one in 1,000 can become seriously ill and about one in 1 million can die from the vaccine's side effects. Most people experience normal, usually mild reactions that include a sore arm, fever and body aches.

But the vaccine being used contains a live smallpox-related virus that can cause brain damage or even death in a small percentage of those inoculated, usually children and people with weak immune systems. That's why it has to be so closely watched.

"Everybody thinks about that," said McAllister, who works in the public health center's clinic. "Nurses are probably the worst about thinking about that sort of stuff."

But like other nurses, she said she saw it as necessary.

"Hey, somebody's got to inoculate these people," she said. "I'm too old to go into the Army, so if this is what I can do to do my part, this is what I'm going to do."

The fear of those side effects has caused some workers in other states to refuse to get vaccinated for smallpox, which kills about 30 percent of its victims and scars the remainder for life.

Smallpox vaccinations have begun in 18 states, although the number of volunteers has been fairly low. According to the federal government, about 800 people nationwide had receive the vaccine through Friday. The goal is 500,000.

The next phase is to vaccinate more health-care workers, such as at the hospitals. A Cape Girardeau doctor who works at the center and four more nurses are expected to get the shot later this month. Then, thousands of first responders -- police, firefighters, ambulance workers, and others -- are expected to get the shot later this year.

The goal for making the shot available to the public is January 2004.

Hammer didn't fall

While there is concern about symptoms, Craig was quick to point out any symptoms -- even fever -- may never occur.

"I kept waiting for the hammer to fall all weekend and it didn't," she said.

Carolyn Gerecke, a registered nurse at Southeast Missouri Hospital, attended the brief Q-and-A Monday. She said she was glad she did.

"I probably feel a little more comfortable about it now," she said. "None of them had any bad reactions, no illnesses with it so far. I was planning to go ahead with it anyway, but I was glad to see someone who had done it."

Leslie Stanfield, a registered nurse and infection control coordinator at St. Francis Medical Center, agreed.

"It's important to make sure you see the reactions and to be able to know what you're looking for," she said.

Stanfield is not eligible for the vaccine because her son has a form of arthritis, which means he has a decreased immune system. Her son could be put at risk if Stanfield's vaccinated area oozes and he comes into contact with it.

But Stanfield said she would have no qualms about taking the shot if she could.

"There's always a healthy fear about the side effects," she said. "But today did make me more comfortable. It will be a good educational tool."

Mary Burton, director of the American Red Cross' Southeast Missouri chapter, was also there. As a first responder, she and her employees may be called upon to get the smallpox vaccine.

"What really concerns me is the risk factor," Burton said. "On a personal level, I want to see the reaction these folks are getting. I know some of them were incredibly nervous about getting this. So I want to know benefit versus the risk. This way I can make an informed decision about whether or not I want to get this done."

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