Betting against smallpox

LAS VEGAS -- In a town known for high-stakes gambling, Suzanne Lau is ready to risk a small chance of injury and even death to be vaccinated against smallpox.

A nurse at one of the city's busiest emergency rooms, she probably will be among the first Americans in three decades to be offered the vaccine. She does not betray any of the angst that has consumed federal officials now completing vaccination plans for the nation.

"It's what you do. It's part of the risk of the job," said Lau, whose hospital ID hangs on a red, white and blue cord, stamped USA, around her neck. "We're here to take care of the patients. That's the bottom line."

The government is preparing for the possibility of a bioterror attack that would use smallpox, a deadly and incurable virus, but President Bush has yet to say who will be offered the vaccine.

The plan being considered would offer the inoculation first to those most likely to come in contact with a contagious smallpox patient; that would be people assigned to special smallpox response teams in each state, and those who work in hospital emergency rooms. In total, they expect about a half-million vaccinations during this first stage.

It will put emergency rooms such as University Medical Center's at the forefront of that readiness effort. If there were to be an attack, doctors at the Las Vegas facility also would be responsible for spotting smallpox, a particular challenge given that the disease has not been seen in this country for half a century.

Understanding risks

Now, the issue is vaccination.

The government soon will undertake an education campaign to ensure that people understand the risks of the vaccine, which is more dangerous than any other.

In the 1960s, 15 out of every million people being vaccinated for the first time faced life-threatening complications, and one or two died. Side effects included horrible rashes and brain-destroying diseases.

Some people who came into close contact with those vaccinated also got sick when the live virus used in the shot escaped and touched them.

But most workers at the University Medical Center emergency room voice little concern and say smallpox is much more to be feared than the vaccine.

"The odds are with you," nurse Tom Erichsen said. Added nurse Beth Leoni: "I've seen pictures of smallpox, and it scared the hell out of me."

Lau says she would send her 6-year-old son to live with his grandparents during the days after her inoculation, just to be sure he is not exposed.

Hearing the statistics about side effects, Dr. Tom Higgins is nonchalant. "That's probably safer than most drugs we use on a daily basis," he said.

This instinctive willingness to be vaccinated has some worried. Health care workers need to understand the vaccine's dangers, said Cheryl Peterson, senior policy analyst for the American Nurses Association.

"Most of us got the vaccine when we were a child, and we never heard about any problems. We just went and got it," she said.

But that was a time when the disease was still prevalent. The last smallpox case was in 1977, and it was declared eradicated in 1980. Experts now worry it could be unleashed again in an attack.

There is some nervousness about the vaccine in the Las Vegas emergency room.

Secretary Patti McGill said she does not trust the government enough to get an annual flu shot, much less be vaccinated for smallpox. "I'm not a big believer in vaccines, especially this one," McGill said.

Dr. Wes Kaplan wants more information about the risk of an attack and about the vaccine before making up his mind. He is not particularly worried that smallpox would hit his hospital.

"It's like saying, 'Am I worried about a bomb going off in the hospital?"' Kaplan said.

Spotting smallpox

Kaplan, a resident in internal medicine who helps cover the emergency room, said he doubts he could spot a case of smallpox, which easily is confused with chickenpox.

"I don't know the first thing about smallpox," he said.

To help doctors such as Kaplan, the Centers for Disease Control and Prevention has created a poster that explains the differences between chickenpox and smallpox. No one at University Medical Center can recall seeing the poster.

Dr. Dale Carrison, director of the emergency department, said he is confident he would catch "a classic case" of smallpox, though a more subtle one might get by.

He said the biggest difference between smallpox and chickenpox is that smallpox lesions are all in the same stage of development, which is true. But when asked about another classic difference -- chickenpox usually occurs on the body's trunk, whereas smallpox is usually on the face and hands -- he said he knew nothing about that.

Dr. Mario Pineiro and others say they are not thinking much about smallpox, either how to spot it or how to protect against it.

He's worried about his next 10 gastrointestinal consultations and the shift at work coming up.

"And my mom is having back pain, and I'm worried it's some kind of cancer, and I have to move by Saturday," said Pineiro. "Those are my worries."