BACKGROUND:
By October 24, 2003, 38,577 out of 500,000 targeted civilians had been vaccinated against smallpox as part of Phase I of the Pre-Event Smallpox Vaccination Campaign. Reasons that individuals accepted or refused the vaccine are largely unknown.

OBJECTIVE:
This study investigates the attitudes towards smallpox vaccine (SPV) among a convenience sample of health care personnel (HCP) in Virginia during this vaccination campaign.

METHOD:
In May 2004, we conducted a cross-sectional anonymous study of 225 HCP, who were offered the SPV in January 2003 when they were identified as possible members of smallpox response teams. The questionnaire covered factors such as contraindication to vaccine, perceptions of vaccine safety, concerns about bioterrorism threat, and influence of workplace and demographics.

RESULT:
185 participants returned the questionnaire (response rate 82%). Overall, 93% were female nurses, aged 27 to 67, (median 53). Among non-vaccinees (n=44), 70% had a contraindication to the SPV compared to 8% among vaccinees (n=132). Helping prepare America in case of a bioterrorist attack (OR:17.7, 95%CI: 3.6-85.9) and joining a response team (OR:7.9, 95%CI: 3.2-19.3) appear to be major determinants of acceptance of SPV. This remains true in both groups after stratification for contraindication. Belief that a terrorist attack might occur was associated with vaccination. Vaccinees with contraindication were more likely to have been asked by their immediate supervisor to be vaccinated (OR:5, 95%CI: 1.1-22.1) and to have been concerned that their decision about the vaccine would affect positively their job evaluation (OR:11, 95%CI: 1.6-81.1).

CONCLUSION:
Motivating reasons for SPV included fear of bioterrorism, and willingness to help in the preparedness effort. Having a contraindication was the main deterrent. The study limitations are the uncertain generalizability of these findings and the small sample size. Further studies of attitudes towards SPV in a nationwide representative sample of HCP are warranted.

LEARNING OBJECTIVES:
To determine attitudes of health care personnel towards smallpox vaccination.