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During a smallpox outbreak, vaccinated health care workers would run the local hospital: caring for patients and immunizing area residents. If an outbreak occurred in the Paynesville area, patients first would be transported to the designated trauma center in central Minnesota, the St. Cloud Hospital, one of eight centers in the state. If regional trauma centers were at capacity, PAHCS would need portable ventilation systems to treat smallpox patients here.

ÒVaccinated medical staff would be isolated along with patients at the hospital,Ó said Bev Mueller, acute care administrator at PAHCS, Òand expected to stay at the hospital in shifts for the 10- to 14-day duration of treatment.Ó

Vaccinations at the St. Cloud Hospital, part of phase one of the smallpox plan, should begin in January. Vaccinations at PAHCS are part of phase two, which could start in March.

Phase three Ð making the vaccine available to the general public Ð is not expected until 2004. Because inoculation within three days of contracting smallpox offers full protection and inoculation within seven days lessens the severity of the illness, the vaccine wonÕt be recommended to the public unless a smallpox threat is imminent.

When weighing their decision, PAHCS staff members will have to balance the risk of an outbreak against the risks involved in inoculation, since the vaccine is actually a live virus. According to the Center for Disease Control (CDC), roughly one third of those inoculated will become sick enough with flu-like symptoms to miss a few days of work. This is why healthcare workers Ð who will be needed if there is an outbreak Ð need to be vaccinated in advance.

Because the United States ceased smallpox vaccinations over 30 years ago, a great deal is uncertain regarding the risks of the smallpox vaccine. Health care workers risk an adverse reaction; short-term illness; and potentially exposing family to the vaccine for the first three weeks after inoculation.

Staff choosing to be inoculated would also have to make provisions for the care of children or dependent family members if called upon to be quarantined at the hospital for up to two weeks away during an outbreak.

The last study on the smallpox vaccine was done in 1968, according to the CDC. Information is constantly changing, according to Chuck Schmidt, chairman of the Risk Management Committee for PAHCS. Though at least four staff members have currently agreed to volunteer for the vaccine, Schmidt remains undecided himself.

Even if PAHCS staff members agree to volunteer, they may still be ruled out in the screening process if a family member has a high risk factor. Rated as the highest risks are people with weakened immune systems, people with certain skin conditions such as eczema, and women who are pregnant or plan to be pregnant. The Minnesota Department of Health (MDH) estimates that up to a third of the population may be ineligible for the vaccine as a result of these risk factors or due to proximity to someone within that group.

PAHCS staff have been asked to make an initial decision by the first part of January. Optimally, PAHCS would like all eligible staff to volunteer, but many will be screened out or opt not to participate. If they choose to volunteer, they can reconsider until taking the vaccine.