Hospital Emergency Room Personnel

179 SMALLPOX, ERADICATED WORLDWIDE IN THE 1970s, has reemerged as a possible bioterror threat.1 Following the events of 9/11 and the subsequent anthrax poisonings, experts’ concerns heightened over the use of smallpox as a bioterror agent because it is transmitted easily from person to person. The population is immunologically susceptible, since U.S. civilians were last vaccinated more than 3 decades ago and less than 20% of the people vaccinated before 1972 are estimated to have retained protection.2 In addition, most healthcare workers have never seen a case of smallpox, and emergency department personnel, who would be critically needed to contain an epidemic, are particularly vulnerable to exposure. As a result, a smallpox outbreak could overwhelm public health and healthcare systems and result in public panic.3 In December 2002, the federal government initiated the National Smallpox Vaccination Program (NSVP), with plans to voluntarily vaccinate 500,000 healthcare workers in its first phase, up to 10 million first responders in the second phase, and, in the final 2 phases, the entire civilian population.4 The Phase I plan recommended that every U.S. hospital vaccinate 50 to 100 healthcare workers to form a Smallpox Health Care Team2 that would include physicians, nurses, midlevel practitioners, and ancillary