Governor's Advisory Council on HIV/AIDS (GACHA) says HIV-infected persons, as well as others with immune system problems should not get the smallpox vaccine, and should be cautious of those who do.
As public health officials in the state prepare to begin vaccinating perhaps thousands of "first-responders," the Governor's Advisory Council on HIV/AIDS (GACHA) is warning thousands more in the state to stay away from the smallpox vaccine.
"While GACHA is very concerned about the use by terrorists of any biologic agent, such as smallpox, we believe more than a half-million persons in our state need also to be warned that the vaccine itself is potentially very risky to some of them," said Judith Billings, chair of GACHA. "We are concerned not just for those with HIV, but for others with weakened immune systems, including transplant patients, and people receiving chemotherapy or immune-suppressing steroid treatment, and for people with certain very common skin conditions (eczema, atopic dermatitis), as well as pregnant women, and infants under the age of one. Even if these persons don't receive the vaccine themselves, they can still be put at serious risk by coming into direct contact with someone who was recently vaccinated. There is absolutely no reason for these people to panic, no need for them to avoid those places where vaccinated workers might be present such as hospitals or medical clinics. But those at risk should be cautious and those who are vaccinated should be careful," said Billings.
To help mitigate any complications, GACHA is issuing the following recommendations and concerns:
- HIV infected, and other immune-compromised people should not receive the smallpox vaccine, even if their T-cell counts are high, unless they are actually exposed to a person with smallpox in which case they should seek medical advice before receiving the vaccination.
- HIV-infected, and other immune-compromised people should be aware that coming into direct contact (skin-to-skin), or direct household contact (from bedding, towels, or clothing) with a recently vaccinated person does put them at risk for contracting contact vaccinia, which can pose serious health risks. If they are unsure HIV-infected and other immune-compromised people should ask people with whom they have direct skin-to-skin or direct household contact with if they have had a recent smallpox vaccination.
- HIV-infected and other immune-compromised people should not stay away from health care, but they should ask their health care provider or organization what the institution's policy is for recently vaccinated health care workers working with immune-compromised people.
- At institutions where workers have been recently vaccinated, those institutions should take prudent measures to protect potentially vulnerable patients.
- All people considering receiving the smallpox vaccine should be encouraged to first learn their HIV status, and have the opportunity for an anonymous, voluntary HIV test. This recommendation applies to everyone to be vaccinated, even if they do not perceive themselves to be at risk of HIV infection, unless they are certain that they are not infected with HIV. (The newly approved OraQuick HIV test allows for the result in 20 minutes, should be available in early 2003, and should facilitate HIV testing.)
- All potential smallpox vaccination candidates must be fully informed about the risk of spreading vaccinia through direct contact to other persons. Examples include bed partners and other close household contacts.
- Smallpox vaccination should be completely voluntary and no health care worker should be forced to receive the vaccine or be identified to colleagues as someone who refused the vaccine. This is to protect people's job security, confidential medical history, and that of their partners and close household contacts.
- The State Department of Health, and local health departments, in consultation with the Centers for Disease Control and Prevention, should work with local hospitals and health care organizations to ensure that policies are in place and standardized to minimize the risk of transmission of vaccinia virus from a health care worker to an immune-compromised patient and vice-versa.