Officials See No Grounds for Mass Smallpox Effort

[Guest guest]

March 29, 2002

THE VACCINE

Officials See No Grounds for Mass Smallpox Effort

By DENISE GRADY

ven with more abundant supplies of smallpox vaccine expected by the

end of the year, health officials said yesterday that they still would not

recommend mass vaccination to prepare for a possible terrorist attack. But

they left themselves plenty of room to change course, saying repeatedly that

the issue was still open for public discussion.

The vaccine has significant risks and the likelihood of terrorists'

using smallpox is considered low, Tommy G. , the secretary of health

and human services, and Dr. S. Fauci, the head of the National

Institute of Allergy and Infectious Diseases, said at a news conference.

If a smallpox attack does occur, Mr. said, current plans call

for vaccinating only people exposed to the disease and others in contact

with them. That strategy, called " ring containment, " was recommended in

November by the federal Centers for Disease Control and Prevention.

Dr. Fauci said that ring containment was a proven method of halting

smallpox epidemics, and that it was preferable to widespread vaccination

because the smallpox vaccine could have serious side effects. For every

million people vaccinated, one or two have reactions that can be fatal, most

often encephalitis, an inflammation of the brain. Hundreds more may have

other reactions that are not life-threatening but are serious nonetheless,

he said.

Although most healthy people tolerate the smallpox vaccine well,

except for developing a sore at the vaccination site, some get fevers,

headaches or extensive rashes. In a recent study of the vaccine in 680

adults, more than a third had reactions that caused them to miss work,

school or recreational activities, or to lose sleep. Other vaccines now used

to prevent common diseases are much safer, Dr. Fauci said.

" If there was absolutely no toxicity to the smallpox vaccine, there

would be very little debate about having people vaccinated, because you

could essentially eliminate the threat, " Dr. Fauci said. " That,

unfortunately, is not the case. "

People with lowered immunity can become very sick from the smallpox

vaccine, which is made from vaccinia, a virus related to the one that causes

smallpox. If a person's immune system is not working properly, the virus can

multiply explosively and cause a severe infection. People at risk include

those with AIDS or H.I.V., cancer and autoimmune diseases, and those with

organ transplants or health problems that require them to take steroids or

other drugs that suppress the immune system.

People with chronic skin conditions that cause raw patches of skin,

like eczema, even if they occurred in the past, may also develop severe

problems from the smallpox vaccine, said Dr. B. Belshe, a professor

of medicine at Saint Louis University who conducted a recent study of the

vaccine.

Dr. Fauci and Dr. Belshe said that if the vaccine became available to

those who wanted it in the absence of an attack, people with lowered

immunity or skin disorders should avoid it. Very vulnerable people with

immune disorders may even be at risk if they are around others who were

recently vaccinated, though Dr. Belshe said that problem might be solved by

covering the vaccination sites with special bandages that prevent the virus

from spilling out into the environment.

But if people with compromised immune systems were exposed to a

smallpox patient during an outbreak, the risk-benefit picture would change,

and, Dr. Fauci said, they could be vaccinated and then given injections of

vaccinia immune globulin, which can prevent severe reactions. The substance

can also be used to treat extreme reactions in healthy people.

Vaccinia immune globulin is in short supply now, but, Mr.

said, the government has set aside $100 million to make more.

Dr. Fauci said the government's long-term goal was to make a smallpox

vaccine " that induces strong immunity but does not replicate enough to pose

a threat to immunocompromised people. "

Dr. Fauci was asked whether he would take the current vaccine himself

or give it to his family if it were to become widely available. He declined

to answer, saying that although he is normally quite open about his

opinions, in this case he feared that his taking a stand " would put a big

damper on open discussion. "

Mr. said that companies making the vaccine are not free to

sell it. Smallpox vaccine is not licensed now and the government owns all or

most of the existing stocks. It has contracted with a biotechnology company,

Acambis, to provide 54 million doses of a reconfigured vaccine by this

summer.

Meryl W. Dorey,

President

The Australian Vaccination Network, Inc.

PO Box 177 02 6687 1699 Phone

Bangalow NSW 2479 02 6687 2032 FAX

meryl@... http://www.avn.org.au

" All truth goes through three stages. First it is ridiculed. Then it is

violently opposed. Finally, it is accepted as self-evident. " (Schopenhauer)

____________________________________________________________________________

______

Any information obtained here is not to be construed as medical OR legal

advice. The decision to vaccinate and how you implement that decision is

yours and yours alone.