February 13, 2004

"Preparing for the worst and hoping for the best clearly is prudent when there is even the slightest risk of such a devastating and potentially fatal disease as smallpox,"
– Jeanette Ives Erickson, RN, MS

Protecting MGHers: Smallpox response plan developed

Hospitals must be ready to deal with whatever health care crises may arise — even when the risk is small. That's why planning, preparing and protecting have long been the cornerstones of ensuring a safe hospital environment for patients, families, employees and the entire community.

This week, for example, the MGH staged a tabletop disaster drill designed to help staff sort through the myriad issues that could arise in the unlikely event of an outbreak of severe acute respiratory syndrome (SARS). Each fall, the MGH prepares for the uncertain risk posed by flu season when it encourages employees and patients to consider getting the influenza vaccine.

And for the past year, the MGH has been planning for the small — but very real — risk that dangerous smallpox virus in the wrong hands could be used as a bioterror agent. In conjunction with local and state health officials, the MGH has developed a detailed smallpox emergency response plan that provides a blueprint to guide the hospital's actions should a case of smallpox be identified here or elsewhere. Fortunately, the smallpox virus is one of the few potential bioterror threats that is preventable by vaccine. A vital component of the hospital's plan, therefore, is to be able to vaccinate all exposed or at-risk individuals promptly if smallpox is diagnosed. Prompt vaccination after exposure can at least partially reduce the risk of smallpox.

The greatest level of protection from smallpox, however, clearly comes from vaccination before exposure. With this in mind, the MGH is continuing to offer smallpox vaccinations to volunteer health care workers who might be involved directly in the care of a smallpox patient in the hospital.

"If we are going to ask health care workers and others to tend to the needs of a patient with smallpox, then we need to make sure these employees are well protected," says David Hooper, MD, chief of MGH Infection Control and co-chair of the MGH Smallpox Committee. "We have developed a plan to vaccinate our workers promptly should any exposure occur, but we also want to offer those workers at highest risk of exposure the greatest level of protection with prior vaccination."

In the past year, approximately 30 MGH staff members have been vaccinated against smallpox. The hospital continues to seek employee volunteers who might be involved in the care of a smallpox patient and are interested in considering pre-exposure vaccination.

MGH Occupational Health is coordinating the hospital's smallpox vaccination program. Those who volunteer will be educated about the vaccine and its risks and screened carefully using the national Centers for Disease Control and Prevention guidelines. Volunteers who have potential contraindications will not be vaccinated.

Across the country, nearly 40,000 health care workers and more than 500,000 military personnel have been vaccinated against smallpox with very low rates of adverse events.

"Preparing for the worst and hoping for the best clearly is prudent when there is even the slightest risk of such a devastating and potentially fatal disease as smallpox," says Jeanette Ives Erickson, RN, MS, senior vice president for Patient Care Services and chief nurse, who co-chairs the MGH Smallpox Committee. "While the risk of smallpox seems remote, the threat does exist. And the consequences of not being adequately prepared could be enormous."

For information about the hospital's smallpox vaccination program, contact Occupational Health at (617) 726-2217.