Emergency Physicians' Current Attitudes Toward Smallpox Vaccination

The Journal of Emergency Medicine

503

e EMERGENCY PHYSICIANS’ CURRENT ATTITUDES TOWARD SMALLPOX VACCINATION e To the Editor: Since September 11, 2001, many terrorist threats and attacks have occurred in the United States as well as globally that may affect individuals’ perceptions of terrorism and the need to protect against it when the means exist. The ability to protect ourselves against a terrorist attack is especially relevant if smallpox were the agent. Smallpox vaccination is currently available, and production has been increased so that enough is available to vaccinate the nation if needed. Presumably, the public’s anxiety over terrorism peaked after September 11, and health care workers may have been more likely to get vaccinated in the months after the World Trade Center attacks than in the years following, based on perception of risk. In an initial study that we conducted after the September 11 terrorist attacks, emergency physicians (EPs) who perceived a significant risk of a bioterrorist attack were 2.7 times more likely to volunteer for smallpox vaccination compared with those who thought the risk was minimal (1). When we conducted the survey again on a sample of 20 Emergency Medicine programs from the original sample of 45 programs, our present study showed that EPs’ perceptions toward smallpox vaccination are likely a dynamic issue. EPs were less willing to get vaccinated in 2005 than 2003. Although there was no difference in the perception of smallpox vaccine risk, fewer EPs felt that the benefits of the vaccine outweighed the risk in 2005 than 2003. In addition, EPs felt that a bioterrorist attack using smallpox in 2005 was less likely than in 2003 (Table 1). The results from this study suggest that factors such as perception of the risk of a bioterrorist attack on the

United States, and perception of risk-to-benefit ratio of the smallpox vaccine, are dynamic issues for EPs and may affect their willingness to get vaccinated. As EPs will be front-line personnel in the event of a bioterrorist attack utilizing smallpox, their perceptions about vaccination should continue to be evaluated. Nancy S. Kwon, MD, MPA Elizabeth C. Moore, BA William K. Chiang, MD Bellevue Hospital Center/NYU Medical Center Emergency Medicine New York, New York Gregory J. Moran, MD EMERGEncy ID Net Study Group UCLA/Olive View-UCLA Emergency Medicine Los Angeles, California EMERGEncy ID Net Study Group, USA doi:10.1016/j.jemermed.2008.03.009

REFERENCE 1. Kwon N, Raven MC, Chiang WK, et al. EMERGEncy ID Net Study Group. Emergency physicians’ perspectives on smallpox vaccination. Acad Emerg Med 2003;10:599 – 605.

e MASSIVE PULMONARY EMBOLISM ALGORITHM e To the Editor: We would like to report the development of a protocol for the management of patients with massive pulmo-

Table 1. Smallpox Vaccination and Risk of Bioterrorism

Willingness to receive smallpox vaccination Risks outweigh benefits of smallpox vaccination Risk of bioterrorism utilizing smallpox

Risk of receiving smallpox vaccination

Y ⫽ yes; N ⫽ no; U ⫽ unsure.

2005

2003

p Value

Odds Ratio

95% CI

Y 49 (14.7%) N 199 (60.0%) U 84 (25.3%) N 186 (55.0%) U 72 (21.3%) Y 80 (23.7%) Large/moderate 81 (24.3%) Minimum/none 253 (75.7%) Large/moderate 136 (40.6%) Minimum/none 199 (59.4%)

Y 301 (43.4%) N 227 (24.5%) U 297 (32.1%) N 309 (33.4%) U 300 (32.4%) Y 317 (34.2%) 412 (45.7%)

⬍0.001

4.6 (Y vs. others)

3.50–6.06

⬍0.001

1.68 (N vs. others)

1.25–2.25

⬍0.001

0.38

0.28–0.51

0.150

1.22

0.93–1.59

489 (54.3%) 333 (36.0%) 593 (64.0%)