Health Workers

As an international SARS conference in Toronto concluded yesterday, Canadian officials reported two new cases of the pneumonia-like disease among health care workers in the city, a minor setback in efforts to control the outbreak. Canadian health officials noted that there have been no new infections in Toronto besides health care workers, suggesting that efforts at containment are largely succeeding. Elsewhere, a WHO official in India said 19 "confirmed" SARS cases in that country had been identified using an unreliable test, and that India might be SARS-free.

It was a difficult decision for Andrea Deerheart Cornitcher, but she wanted to help. So the registered nurse sidestepped her American Indian ancestors' thorny history with smallpox - a disease that some say was deliberately spread to them in Colonial times through infected blankets - and on March 18 was vaccinated for the disease. Five days later, the 55-year-old Princess Anne resident died of a heart attack. She was the first of three people to have a fatal heart attack after getting the smallpox vaccine through the government's program of voluntary inoculations for health care and emergency workers who would respond to a bioterrorism attack.

WASHINGTON - With recent deaths raising grave questions about the safety of smallpox vaccinations, the House rejected legislation yesterday that would allow compensation for health and emergency workers who become ill or die from the vaccine. The measure was the latest homeland security initiative championed by President Bush to fall victim to partisan disagreement in Congress. Most Democrats opposed the Republican-written bill because they said it would have offered nurses and emergency workers only a modest benefit for taking on a major health risk.

Maryland forged ahead with a slightly modified smallpox vaccination campaign yesterday after two recently inoculated women in the state suffered heart attacks - one of them fatal. Federal officials continued to probe a possible link between the vaccine and heart problems reported in seven inoculated health workers nationwide. Although several experts said it is unlikely the vaccine contributed to the heart ailments, the University of Maryland Medical Center was debating whether to delay its planned vaccination of 40 employees until a connection has been definitively ruled out. "This could be chance.

WASHINGTON - Top government officials implored health-care workers yesterday to volunteer for smallpox vaccinations, telling them that the threat of a bioterrorist attack is real, that it is their public duty to be prepared, and that the government will compensate them for any injuries. "This is an unprecedented time in our history," said Dr. Julie L. Gerberding, head of the Centers for Disease Control and Prevention, referring to the threat of terrorist attacks against the United States and the prospect of a U.S. war against Iraq.

Gov. Robert L. Ehrlich Jr. announced yesterday that the state health department will begin inoculating 6,000 health care workers against smallpox this week in the first phase of a three-pronged strategy for protecting Maryland from a biological attack. The second phase, which could begin this year, involves vaccinating the rest of the health care work force, including doctors and nurses, emergency medical personnel and health department officials. The final phase is to begin next year, when the vaccine will be made available to the public on a voluntary basis.

Sometime early next year, Judy Rudell expects to be vaccinated for smallpox, knowing the vaccine could make her sick, but convinced that it's the right move. "There are some things you can worry about and some things you can't worry about, and this is one of those things you just can't worry about," said Rudell, 51, whose nursing agency routinely places her in the emergency rooms at Good Samaritan and Union Memorial hospitals. Rudell is one of 6,000 health care workers in Maryland who would come into contact with the first victims of a biological attack and who will be vaccinated for smallpox as part of a federal plan to prepare for a terrorist-related outbreak of a disease eradicated in 1980.

PHILADELPHIA - In its eagerness to prepare a plan to vaccinate 500,000 hospital workers against smallpox, the government neglected one thing: Nobody alerted the people who are supposed to get the inoculations. Tomorrow is the deadline for states to submit their smallpox-vaccination plans to Washington. President Bush is expected to approve an inoculation program any day now, and vaccinations are supposed to begin next month. The program is designed to inoculate enough doctors, nurses and other emergency workers to deal with a smallpox outbreak in the United States if the deadly virus becomes a bioterrorist weapon.

Leading medical groups are urging caution in the use of smallpox vaccine, particularly if no cases of the disease occur. Their concerns stem from the risks of the vaccine, which is significantly more likely than any other vaccine to cause serious side effects. On Friday, government health officials said for the first time that they favored offering smallpox vaccine to the public even if no bioterror attack occurred, though only after health workers were immunized and a vaccine was licensed for general use, possibly in 2004.

The fishmeal cakes smell awful, bad enough to nauseate the people who have to ride in helicopters and drop them into the woods. But raccoons gobble them up, and Anne Arundel County health officials hope the vaccine hidden inside the cakes will immunize the wild animals against rabies and help to reduce the disease's threat to county residents and their pets. This morning, weather permitting, two dozen public health employees and volunteers in Arundel -- some on foot and some in the air -- will start scattering more than 17,000 baited vaccine packets across the Annapolis and Broadneck peninsulas.