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ACP-ASIM Recommends Limited Number of First Responders be Vaccinated Against Smallpox

(Washington, DC): A limited number of first responders should be vaccinated against smallpox as recommended by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), according to a position paper released by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) on February 28.

"As health care professionals, we are trained to make recommendations using 'evidence based' medicine," said Cecil Wilson, MD, FACP, chair, Board of Regents of the ACP-ASIM. "We believe that treating first responders as recommended by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) is the best course without evidence that there is a substantial risk of a smallpox attack."

Most medical experts tend to be more conservative than national security experts in calling for a policy of widespread vaccinations, largely because they believe that the considerable risks of the vaccine to patients cannot be justified.

"Policymakers must balance the potential for saving lives from a smallpox attack against the likelihood of losing lives from complications associated with vaccination," said Dr Wilson. "It is essential that policymakers and healthcare professionals work together to evaluate and weigh all the relevant scientific data against the likelihood of an attack.

The decision as to whether to expand the smallpox vaccination program beyond ACIP's recommendation to a much larger population of "first responders" must be made with extreme caution.

"It is ACP-ASIM's belief that each stage of vaccination should proceed with prudent forethought, evaluating all the relevant scientific data available and future assessments should be weighed before proceeding further," said Dr. Wilson. "HIV/AIDS, cancer and certain skin conditions leave a much larger percentage of the population vulnerable to complications from the vaccine."

As the nation's largest medical specialty society, the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) recommends the following:

  1. Vaccination should be reserved only for those health care workers people serving on designated Smallpox Public Health Response Teams and Smallpox Health Care Teams as recommended by the ACIP. Acute care hospitals with emergency rooms and outpatient clinics are at greatest risk; this does not mean, however, that the entire hospital staff needs to be vaccinated.
  2. Any expansion of the smallpox vaccination program should proceed slowly, weighing all the known relevant scientific data against the imminence of a smallpox attack.
  3. The smallpox vaccination program for non-military personnel should be voluntary and strict guidelines be adhered to, utilizing an informed consent process and appropriate screening prior to vaccination.

Because the risk of a smallpox outbreak is considered low by most experts, the College recommends that any smallpox vaccination program remain voluntary with strict guidelines to provide the proper informed consent and appropriate screening for known risk factors.

The American College of Physicians-American Society of Internal Medicine is the nation's largest medical specialty organization and the second largest physician group. Membership encompasses more than 115,000 internal medicine physicians and medical students.

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