Two days before the Bush administration begins smallpox inoculations for health care personnel, a nationwide survey of practicing nurses released yesterday shows few have a good understanding of the disease or the vaccine.
Of 2,661 nurses polled by the National Network for Immunization Information, about 1 in 5 is aware that immunization given within a few days of exposure to the deadly virus will prevent the disease, a basic tenet in smallpox protection.
More than half the nurses surveyed also mistakenly thought smallpox could be spread to someone a few feet away. Transmission generally occurs through close bodily contact.
"If nurses don't understand how the smallpox vaccine works, we can be confident that the general public doesn't either," said Louis Cooper, interim director of the network and professor of pediatrics at Columbia University.
Nurses' organizations have grown increasingly vocal in their concerns about the Bush administration plan to immunize as many as 10.5 million medical workers and emergency responders as part of the nation's biodefense program. The Massachusetts Nurses Association announced Tuesday it was recommending its 20,000 members not volunteer until the government addresses several safety concerns, most prominently the issue of compensation for people sickened by the vaccine.
Twenty-two Democratic senators, led by Edward M. Kennedy (Mass.), sent a letter to President Bush yesterday pressing for a federal fund that would pay for treatment and lost work time of anyone with serious complications from direct vaccination or inadvertent spreading of the live vaccine.
"There is a clear need to vaccinate health care workers against smallpox," the group wrote, "but it is wrong to ask millions of Americans to face the risks of smallpox vaccination without doing all we can to protect their health and safety."
The Centers for Disease Control and Prevention projects that as many as 42 of every 1 million people inoculated will suffer severe side effects, such as blindness or inflammation of the brain. One or two will likely die.
The vaccine, made from a cousin of the smallpox virus, could be particularly dangerous for pregnant women, children younger than 1, people with skin conditions and anyone with a weakened immune system from chemotherapy, organ transplants or the AIDS virus. The last case of smallpox in the U.S. occurred in the 1940s, and routine vaccination ended in 1971.
Twenty states have requested a total of 100,000 doses of 30-year-old vaccine, called Dryvax. The first batches were shipped yesterday to Connecticut, Nebraska, Vermont and Los Angeles County, the CDC said. Vaccinations could begin Friday.
Louis Sullivan, co-chairman of the immunization network and former secretary of Health and Human Services, said the survey highlights the need for extensive education of a medical workforce that is largely too young to have encountered smallpox -- or even the vaccine.
"They need to be sure they are comfortable with their level of knowledge" before they can be vaccinated or begin vaccinating others, he said.
HHS Secretary Tommy G. Thompson has said he is pursuing several options to address the compensation issue.