Pentagon Faces Difficulties in Smallpox Shots for Troops

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http://www.nytimes.com/2002/12/17/health/17TROO.html?tntemail1

BIOLOGICAL DEFENSES

Pentagon Faces Difficulties in Smallpox Shots for Troops

By DENISE GRADY

s the government begins its program to inoculate half a million troops

against smallpox, it is engaged in a delicate balancing act between the

military's need for discipline and efficiency and its obligation to protect

vulnerable recruits from an unusually risky vaccine.

Military personnel with medical conditions that increase their risk of

being harmed by the smallpox vaccine will not be immunized, but may still

be deployed anywhere, even to regions where it is feared that smallpox

could be used as a weapon, the Department of Defense said in a memorandum

dated last Friday.

The memorandum, signed by S. C. Chu, under secretary of defense for

personnel and readiness, said deployment decisions would be left to

individual commanders.

But if unvaccinated troops are sent to areas where an attack with smallpox

is launched, they will then be inoculated in the field, because at that

point the risk of the disease will outweigh those of the vaccine, said

, a spokesman for the Defense Department.

It is not known how many military personnel will be exempted from the

vaccine for medical reasons. Among those at increased risk are people with

skin rashes like eczema and atopic dermatitis or a history of those

conditions, which affect about 15 percent of Americans. They are advised to

avoid the vaccine, as are people with burns, certain skin infections,

chickenpox, psoriasis and severe or uncontrolled acne.

" I think the number of people with these skin conditions is a minority, "

Mr. said.

But the presence of people in the military who must avoid the vaccine may

pose logistical difficulties. Such people must also avoid close contact

with others who have been recently vaccinated, because for two to three

weeks the vaccination site can shed the live virus, vaccinia, used in the

vaccine. Vaccinia, a relative of smallpox, can infect others, and can cause

serious illnesses in pregnant women, babies under a year old, and people

with immune problems or skin disorders. People who live with someone in a

high-risk group are also advised to avoid the smallpox vaccine, to avoid

transmitting vaccinia to the vulnerable person.

What does this mean on a military base or a ship, where personnel live in

tight quarters and share showers, and those who should not be vaccinated

could be surrounded by those shedding vaccinia?

Another Defense Department memorandum, dated Nov. 26, notes the need for

caution, and says, " Exempt individuals should be physically separated and

exempt from duties that pose the likelihood of contact with potentially

infectious materials (e.g., clothing, towels, linen) from recently

vaccinated people. "

The memorandum says that vaccinated and unvaccinated people should not take

turns sleeping in the same cots, bunks or berths, which is sometimes done

on ships.

Asked how the separation might be accomplished on ships or military bases,

Mr. said, " Right now I'm not prepared to get into that level of

detail. "

" It will be interpreted by the services depending upon their unique

situations, " he said.

Mr. also declined to say whether the military would alter training

programs or routines for military personnel who get flu-like illnesses from

the vaccine, which has more side effects than most other immunizations.

Young people who have not had the smallpox vaccine, the vast majority of

military personnel, are more likely than those who were vaccinated as

children to have reactions like fever, aches and pains, headaches, swollen

lymph nodes and sore arms. In previous studies, about 30 percent of

participants have felt sick enough to miss a few days of work or school.

" We give a lot of vaccines to our troops, " Mr. said, " and a lot of

these vaccines I'm sure cause similar side effects, and we deal with it. "

If service members who do not quality for a medical exemption decline the

vaccine, they may be disciplined by their commanders, Mr. said.

" We're not expecting that because of events last year and the actual use of

anthrax, " he said.

During the 1990's, several hundred service members refused to be vaccinated

against anthrax, which had been ordered for all military personnel. Some

were court-martialed or discharged; others resigned.

--------------------------------------------------------

Sheri Nakken, R.N., MA

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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