Patients may face risks from contact with vaccinated doctors

CHICAGO -- More than half of all New York state hospital patients may face an increased risk of complications from contact with smallpox-vaccinated health care workers, a study suggests.

With the voluntary vaccination of health care workers under way nationwide, the study's results underscore the need for strict adherence to safety guidelines, the researchers said.

The federal Centers of Disease Control and Prevention recommends daily inspection and bandaging of the vaccine site, meticulous hand-washing after contact and administrative leave if vaccination-related complications develop.

"Successful implementation of this policy will require the complete cooperation of every vaccinated health-care worker to avoid complications among vulnerable hospital patients," said the study by Dr. Perry Smith and Hwa-Gan Chang of New York's health department and Dr. Kent Sepkowitz of Memorial Sloan-Kettering Cancer Center in New York.

The study appears in today's Journal of the American Medical Association.

The smallpox vaccine is made with a live virus called vaccinia that can infect those who come into contact with people who have been vaccinated. Such infections are called contact vaccinia.

The CDC says no doctor-to-patient cases have been reported in the voluntary program in which more than 21,000 health care workers have been vaccinated since January.

The researchers examined data on 2.4 million patients discharged from New York hospitals in 2001; about 1.3 million of them had conditions that may put them at increased risk for contact vaccinia.

Those at increased risk include: newborns; patients with immune system diseases; those with skin conditions including eczema; and cancer patients and others on immune-suppressing medication.

The CDC has estimated that between 15 percent and 18 percent of the general population has an at-risk condition. The percentage among hospitalized patients naturally would be higher.

CDC immunization specialist Dr. Walter Orenstein said the risk of doctor-to-patient transmission is very small if precautions are taken.

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On the Net:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov