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By Steve Vogel
Washington Post Staff Writer
Saturday, January 11, 2003; Page A07

None of the more than 170 military personnel vaccinated for smallpox at Walter Reed Army Medical Center more than three weeks ago has experienced serious complications or caused secondary infections in others, according to Army officials.

Walter Reed doctors overseeing use of the live virus vaccine say their experience -- the first of any hospital -- should offer reassurance to nervous officials at civilian hospitals. They are being encouraged by the Bush administration to begin inoculating medical workers who would respond to a smallpox outbreak. The voluntary civilian program, ordered by the president to help guard the nation against a potential terrorist attack, is tentatively scheduled to start this month.

Walter Reed completed a second major round of vaccinations this week, inoculating more than 250 military medical workers on Thursday.

During the first round of inoculations, conducted Dec. 16-18, "the complaints were much less than I expected," said Army Lt. Col. Lisa A. Black, chief of occupational health at Walter Reed. "We really didn't see any major problems."

The personnel who have been inoculated are military health care providers based in the Washington area. Under Department of Defense rules, their identities and their units cannot be disclosed.

"These are the folks who would be treating a true case of smallpox," Black said.

One of the biggest concerns of health officials is that workers inoculated with the live virus used in the smallpox vaccine would inadvertently infect others, including family members or hospital patients.

In the case of Walter Reed, there have not been any incidents in which the inoculated medical workers have infected other people with whom they have been in contact, which include seriously ill patients with immune deficiencies, officials said.

The medical workers have not had to be put on leave or otherwise kept from sick patients "like some facilities are concerned," Black said.

Some of the inoculated personnel have missed work, suffering headaches, rashes and sore arms, doctors said, describing the overall phenomenon as "the yucks" or "feeling punk."

"A few people had very robust reactions," said Col. Renata Engler, chief of the Walter Reed clinic administering the shots.

Walter Reed conducted lengthy briefings and individual health screening to ensure that the inoculation was not given to medical workers who have conditions that would put them at risk, including eczema.

To prevent the spread of the virus, a strict series of precautions has been instituted. Medical workers who have received the inoculation are required to have daily evaluations of their condition before being allowed contact with patients. The monitoring continues until the scab left by the vaccination falls off.

On Thursday, more than 30 health care workers sat in chairs waiting for the vaccination in a line that snaked around the corner. Some waited up to 90 minutes.

Army Sgt. Mark Dearlove, an immunization technician wearing a blue medical smock over his camouflage uniform, stuck his head out the door. "Next patient!" he called.

"You mean, 'Next victim,' " grumbled the next man in line, an Army sergeant.

The patient rolled up his T-shirt to expose his left shoulder. Dearlove, donning a fresh pair of medical gloves, used a blue permanent marker to place four dots in a small diamond shape on the man's arm, identifying the area where the inoculation would be given. Dearlove lowered safety glasses over his eyes, took a bifurcated needle and dipped into a small vial of the smallpox vaccine sitting on a table.

Holding the man's arm with one hand, Dearlove jabbed the area within the diamond with the needle 15 times in rapid-fire motion. "There is trace blood," he told a nurse -- a sign that the skin had been penetrated.

Among those administering the shots was Air Force Master Sgt. Ray Anspach, a senior immunization technician and instructor at Walter Reed.

Anspach, 40, has been giving inoculations for 22 years, administering "probably millions" of shots. He was a bit bemused by all the fuss surrounding the smallpox inoculation, which he gave often during his first years in the service. "When we were giving it in the '80s, it was a routine immunization," said Anspach, a resident of Columbia.

Some of those waiting for their vaccination Thursday were relatively senior officers, but that was nothing new for Anspach. On a Saturday last month, Anspach was sent to the White House to inoculate the commander in chief.

President Bush, wearing a white T-shirt and shorts after a workout, was relaxed about the vaccination, Anspach said. Bush offered some locker room humor, expressing where he would like an onlooking member of the White House medical staff to be given the smallpox vaccine, according to the sergeant. "He made a little joke about getting it in the butt," Anspach said.

Bush showed no reaction as he was given the inoculation, Anspach said, but like many who take the shot, "he looked away."

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