Groups call for caution in using smallpox vaccine

It's more likely than others to have bad side effects


Leading medical groups are urging caution in the use of smallpox vaccine, particularly if no cases of the disease occur. Their concerns stem from the risks of the vaccine, which is significantly more likely than any other vaccine to cause serious side effects.

On Friday, government health officials said for the first time that they favored offering smallpox vaccine to the public even if no bioterror attack occurred, though only after health workers were immunized and a vaccine was licensed for general use, possibly in 2004. President Bush will review the guidelines.

The American Medical Association said Monday that it endorsed government recommendations issued in June. Those called for immunizing health workers and, if an outbreak occurred, using a strategy called "ring vaccination," which seeks to control an outbreak by isolating infected people and vaccinating a ring of contacts around each infected person.

The American Academy of Pediatrics also said it favored ring vaccination in the event of an attack. Dr. Robert Baltimore, professor of pediatrics and epidemiology at Yale University and lead author of a policy statement by the group in the journal Pediatrics, said the academy was concerned that the public was uninformed about the vaccine's dangers.

A co-author of the statement, Dr. Julia A. McMillan, a professor of pediatrics at the Johns Hopkins School of Medicine, said: "If enough people are vaccinated with this vaccine, people will die. And it's important to keep in mind that this is a disease we haven't seen since the 1970s. To have people die preventing a disease that doesn't exist is a difficult concept. The problem is, we don't know that it doesn't exist. There is some potential that it could exist, and so we're in a difficult quandary."

The group's statement, based in part on studies from the 1960s when smallpox vaccination was routine, reports that for every million people more than a year old who were vaccinated, one or two died. Nine suffered brain infections, and more than 100 developed eczema vaccinatum, a severe illness and skin rash that can leave deep scars and can occasionally turn fatal.

Today, complication rates are expected to be higher because, for a variety of reasons, many more people have weakened immune systems.

In Maryland, health officials are making plans to respond to a smallpox attack should one occur.

Baltimore Health Commissioner Peter L. Beilenson said that, in the event of a smallpox outbreak, the city would set up 15 vaccination centers where people who are not sick would get the vaccine on a voluntary basis. People who have been exposed to someone with smallpox would be urged to report to the center or risk being quarantined for 18 days, one day longer than the virus' incubation period. The city would open seven or eight centers where people who have symptoms would be evaluated and treated.

The Baltimore County Health Department plans within the next six weeks to train staff to administer smallpox vaccine.

Larry L. Leitch, Carroll County's health officer, said he worries that he wouldn't have enough qualified people to vaccinate the county's 157,000 residents.

Sun staff writer Erika Niedowski contributed to this article.

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