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Experts: Many Are Too Vulnerable for Smallpox Vaccine

Pregnant women, HIV and skin patients shouldn't get pre-attack vaccine

THURSDAY, Oct. 17, 2002 (HealthDayNews) -- Pregnant women, people with HIV and AIDS, and those with certain skin conditions shouldn't be given the smallpox vaccine in a pre-attack inoculation program, a panel of immunization experts recommended today.

Evidence from the 1960s showed that side effects of the smallpox vaccine caused about one death per 1 million recipients. Officials said that number could be higher today because of the greater number of people with weakened immune systems, such as AIDS and cancer patients, in the population. The vaccinia virus used in the vaccine can also trigger fatal reactions in those with atopic dermatitis or other forms of eczema as well as other skin diseases.

"The concern is that with smallpox vaccine they can get total body involvement," said Dr. Walter Orenstein, director of the U.S. Centers for Disease Control and Prevention's National Immunization Program. "That's the group we're most concerned about, that's the most severe consequence."

Officials estimate that between 2 to 5 percent of adults may have atopic dermatitis or have a history of the condition. Some people have skin disorders nearly indistinguishable from atopic dermatitis, and the committee discouraged vaccination in this group, too. Nor should it be given to people with household members with any of the restrictions.

Officials said aggressive screening before vaccination could eliminate half to two-thirds of severe adverse reactions. However, some problems are impossible to prevent with screening, they added.

The recommendations, from the Advisory Committee on Immunization Practices, refine earlier guidelines from the group, whose advice will help shape the government's smallpox vaccination policy.

On Wednesday, the advisory committee recommended offering smallpox vaccines to roughly 500,000 emergency and hospital workers -- including doctors, nurses, lung therapists, and emergency room personnel -- who would be the first to see cases of the infection in the event of an attack with the deadly virus. Earlier this year, the panel had suggested that only about 10,000 to 15,000 of these "first responders" would need the inoculation up front.

The latest estimate is based on the number of acute care hospitals nationwide, about 5,100, and a rough figure of 100 personnel per hospital who would need the vaccine to provide adequate coverage at each facility, said Dr. John Modlin, chairman of the advisory panel. "They know their staff far better than we do," said Modlin.

The doctors, who spoke at a news teleconference today, did not address why pregnant women shouldn't get inoculated. However, the vaccination has been known to cause fetal infections.

"The goal is a cadre of people who could care for the first several patients in the first seven to 10 days" after a case of smallpox appears, Orenstein added. "We would vaccinate other staff as soon as a case hit" to broaden the number available to care for patients.

For people who have come into contact with smallpox, all restrictions are lifted, Orenstein said, since the disease has a fatality rate of 30 percent.

The Bush administration has yet to declare its intentions regarding smallpox vaccination. However, health officials have been considering a policy of immunizing 10 million first responders, or possibly even every American, as a precaution against a bioterror attack.

The United States abandoned routine immunization against the virus in 1972, and the World Health Organization declared the infection eradicated in 1980. Both the United States and Russia have preserved samples of the virus, and intelligence experts fear that terrorists or renegade states like Iraq and North Korea may have obtained supplies of it to use as a bio-weapon.

The advisory panel also stated that smallpox vaccine could safely be administered at or around the time of most other shots, such as influenza. But it should not be given along with the chicken pox vaccine, which is a live-virus shot.

The committee also said people who will be giving the smallpox vaccine should themselves be vaccinated and that those recently immunized may still work without posing a risk to others. Modlin called the odds of transmission of vaccinia in the health-care setting "extremely low." The larger problem would be a health-care worker passing it to a household member, he added.

Whether the recommendations are adopted still depends on several layers of review and, ultimately, the White House. One option being debated is that no pre-attack vaccinations would be administered, Orenstein said.

What To Do

For more on the smallpox vaccine, go to Stanford University or the Centers for Disease Control and Prevention.

SOURCES: John Modlin, M.D., chair, Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, Atlanta; Walter Orenstein, M.D., director, National Immunization Program, Centers for Disease Control and Prevention
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