WASHINGTON - Federal officials said yesterday that they were preparing to expand the government's smallpox vaccination program, even as a second inoculated worker died and an expert panel encouraged health departments to ensure they are prepared to respond to a bioterrorist attack rather than simply vaccinate.
The death Wednesday of a Florida nurse's aide, from a heart attack 17 days after she was vaccinated, came just three days after a vaccinated Maryland nurse had a heart attack and died.
Five other civilians who developed heart problems after being inoculated, as well as 10 vaccinated military personnel who suffered heart inflammation, have fully recovered.
The vaccine probably caused the cases of heart inflammation, or myopericarditis, said physicians at the Pentagon and the Centers for Disease Control and Prevention. But they remain unconvinced that the vaccine is linked to three post-inoculation heart attacks, including the two fatal ones.
The CDC and outside experts will begin a formal investigation of the cardiac cases today. Until their work is done, people with heart problems will not be vaccinated.
Yet federal officials say they have no plans to extend the temporary inoculation restrictions to all volunteers who have risk factors for heart disease - including high blood pressure and a history of smoking.
"If you looked at all known risk factors ... it would be very difficult to enhance our preparedness," says Dr. Walter Orenstein, director of the CDC's national immunization program. "We are not recommending a pause because of concern for the need to get prepared, especially with events going on around the world."
Orenstein also dismissed yesterday's recommendation by an Institute of Medicine committee that the CDC and state and local health departments stop, evaluate the program's progress and figure out exactly how to prepare to respond to a smallpox attack before continuing to vaccinate greater numbers and additional groups of people.
"The focus should be not on fixed numbers ... but on their distribution and the ability to mobilize them" to isolate and treat smallpox victims and prevent the spread of the deadly virus, said Dr. Brian Strom. He is chairman of the institute's committee on the smallpox program, which was created at the CDC's request.
"It is important to define the goal of the program as preparedness and to avoid exposing more people than necessary to the vaccine's risks," he said.
But within two or three weeks, the CDC plans to tell states they can go ahead with Phase 2 of the program and begin vaccinating police, fire and emergency personnel in addition to frontline health workers.
The program, which began Jan. 24, was designed to vaccinate up to 450,000 frontline health-care workers within a month or so. Then, in a distinct second phase, as many as 10 million police, fire and emergency medical personnel were to be inoculated.
By last Friday, just 25,645 people, almost all of them public health or hospital workers, had been vaccinated.
Concerns about the vaccine's risks, uncertainty about the threat level and the lack of guaranteed compensation for people injured by the vaccination have dampened participation.
This week's news that two vaccinated health workers have died and several others experienced heart problems has only heightened such concerns.
Bush administration officials presented their proposal for a compensation fund this month, hoping it would jump-start the stalled program. But the legislation, which they predicted would move quickly through Congress, is instead stalled in both the Senate and House.
The Institute of Medicine report yesterday said the federal government must provide money to the states and compensation to people injured by the vaccine in order to run a successful program.
In its report, the institute also said lack of federal dollars to run the vaccination program is producing financial worries among states, local health departments and hospitals.
Local departments appear to have shifted money from other important tasks, including areas related to bioterrorism and to other disease prevention, to focus on this one, the report said.
Vicki Kemper writes for the Los Angeles Times, a Tribune Publishing newspaper. The Associated Press contributed to this article.