Published Date: 2003-06-20 23:50:00
Subject: PRO> Smallpox vaccination adverse events - USA (11): few
Archive Number: 20030620.1519
SMALLPOX VACCINATION ADVERSE EVENTS - USA (11): FEW
A ProMED-mail post
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International Society for Infectious Diseases
Date: Thu, 19 Jun 2003 12:09:04 +0200
From: Jean Pascal Zanders <email@example.com>
Via: FAS CBW List <firstname.lastname@example.org>
Source: The New York Times 19 Jun 2003 [edited]
US programs to vaccinate for smallpox come to a halt
Government officials said today [18 Jun 2003] that both the civilian and
military smallpox vaccination programs had virtually come to a halt, the
military program because it has vaccinated everyone it can and the civilian
program because few people volunteered for it.
Officials also said that of the 493 000 people who had been vaccinated, the
rate of dangerous side effects was lower than predicted. "I take that as
proof that our screening succeeded marvelously," said Colonel John D
Grabenstein of the United States Army surgeon general's office, who was in
charge of the military's inoculation.
Although 8 people had heart attacks after immunizations and 3 died, it is
unclear whether the deaths were coincidental, said officials at a
conference in Atlanta, GA, today on immunization policy. The conference was
convened by the Centers for Disease Control and Prevention. The heart
attack victims were middle aged, and several had clogged arteries,
diabetes, or other risk factors like smoking. There were no deaths from
encephalitis, eczema vaccinatum, progressive vaccinia, or the other side
effects predicted last year based on studies from smallpox vaccination
drives in the 1960s.
The military has inoculated 454 856 personnel, nearly 90 per cent of them
before the invasion of Iraq, and is now vaccinating about 1000 a week,
which Colonel Grabenstein called "maintenance." State health departments
have inoculated only 37 608 civilian emergency health workers and are
adding about 100 more each week.
President Bush announced last December  that the country would
vaccinate up to 500 000 civilian health workers as a first line of defense
against a terrorist smallpox attack. White House officials said there was
evidence that President Saddam Hussein of Iraq either planned to use
smallpox as a weapon or could have given it to terrorists. But the program
got off to a slow start and Dr Raymond A Strikas, director of smallpox
preparedness in the centers' immunization division, said volunteers dropped
off sharply after late March 2003. Dr Strikas cited several reasons:
*With a quick victory in Iraq, Americans felt the threat had faded.
*The heart attacks and cases of inflamed heart muscle led the centers on 25
Mar 2003 to ban immunization for anyone with heart disease.
*Nurses and others resisted immunization until a law to compensate them if
they were hurt was passed; it was not signed until 30 Apr 2003.
*SARS and monkeypox competed for state health resources and public attention.
"What we are in now is what we call the natural pause between Stage 1 and
Stage 2," Dr Strikas said, with Stage 2 being the 500 000 goal. [Stage 2]
would have extended vaccination to the general public, he said, "but
there's been relatively little clamoring for that." Asked if the centers
were disappointed that so few had volunteered, he said: "We accept where we
are, given the circumstances. We can make this work."
The smallpox vaccine, vaccinia, is the most dangerous vaccine, and health
experts predicted it would cause serious adverse reactions in one in 19 000
to one in 71 000 people and would kill one or 2 in a million. But they
predicted brain inflammations or the uncontrolled spread of vaccinia pox,
not heart attacks. The government ordered large supplies of vaccinia immune
globulin, an antidote for bad reactions. It was needed only 3 times,
instead of the roughly 50 times that the 1960s studies would have predicted.
About 125 women who were pregnant or became pregnant were inadvertently
vaccinated, despite screening, Colonel Grabenstein said. Thus far, there
has been no vaccinia in fetuses, and miscarriage rates have been normal,
though they are still being followed. In the past, there were reports of
myocarditis and pericarditis (inflammation of the heart and the sac
surrounding it) from Australia and Finland, but they used more virulent
vaccinia strains, doctors said. Heart inflammations were not identified in
the 1963 and 1968 American studies that experts consulted last year when
planning the immunization drive, said Dr Juliette Morgan of the National
Immunization Program at the centers. Vaccination did seem to increase the
risk of myocarditis in the military vaccines, Dr Morgan and Colonel
Grabenstein said. Of the 18 cases that have been most studied among 53
possible ones, all were young healthy men who developed chest pains and
abnormal enzyme levels; all seem to have recovered. That was 3.6 times the
number that might have been expected to develop myocarditis [without
vaccination, in that number of people].