Question of the Week

March 17, 2003

Three decades ago, health officials in the United States were so confident that smallpox had been erased as a concern that they stopped routine vaccinations. While children and young adults throughout the country have never been vaccinated, others received the vaccine over 30 years ago.

" now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention."

Not having to worry about smallpox (or the vaccine), many today know little about it.

"There are two clinical forms of smallpox. Variola major is the severe and most common form of smallpox, with a more extensive rash and higher fever. There are four types of variola major smallpox: ordinary (the most frequent type, accounting for 90% or more of cases); modified (mild and occurring in previously vaccinated persons); flat; and hemorrhagic (both rare and very severe). Historically, variola major has an overall fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal. Variola minor is a less common presentation of smallpox, and a much less severe disease, with death rates historically of 1% or less."

It is fairly safe to say that no one wants a smallpox outbreak. So doctors and health officials around the country are being asked to prepare to helpanyone who might get infected.

"SPRINGFIELD, IL  Dr. John R. Lumpkin, state public health director, today [January 24, 2003] announced Illinois has ordered 10,000 doses of smallpox vaccine from the Centers for Disease Control and Prevention (CDC) in preparation for the start of a voluntary program to protect public health and hospital workers who would be called on to respond to an outbreak of smallpox."

So, does this vaccine solve the problem?

"The smallpox vaccine helps the body develop immunity to smallpox.... Currently, the United States has a big enough stockpile of smallpox vaccine to vaccinate everyone in the country who might need it in the event of an emergency. Production of new vaccine is underway....the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated. In addition, the vaccine was proven to prevent or substantially lessen infection when given within a few days of exposure."

However, this vaccine is not for everyone; and nothing is perfect, including this vaccine.

"Children younger than 12 months of age should not get the vaccine. Also, the Advisory Committee on Immunization Practices (ACIP) advises against non-emergency use of smallpox vaccine in children younger than 18 years of age. In addition, those allergic to the vaccine or any of its components should not receive the vaccine."

"Some people are at greater risk for serious side effects from the smallpox vaccine. Individuals who have any of the following conditions, or live with someone who does, should NOT get the smallpox vaccine unless they have been exposed to the smallpox virus..."

"As a result of these precautions, the U-M [University of Michigan] researchers estimate that 25 percent of the U.S. population would need to be excluded from any smallpox vaccination campaign because they are high-risk for a side effect or have close contact with someone who is at high-risk."

"Tuesday, February 25, 2003 WASHINGTON (Reuters) - Citing the need for its smallpox vaccination program to include pregnant women, people with weakened immune systems and other vulnerable groups, the US government on Tuesday announced contracts with a Danish and a British company to make a safer vaccine.... 'To protect ourselves from the remote, but extremely grave, threat of a deliberate release of smallpox virus, we need a vaccine that can be safely given to all Americans, including individuals with weakened immune systems, children and pregnant women,' Health and Human Service Secretary Tommy Thompson said in a statement."

So, what could go wrong? Why is there such cause for concern?

"It is estimated that for every one million people who are vaccinated, there would be:
* One or two deaths,
* Between 14 and 52 people would have a potentially life-threatening reaction,
* inflammation of the brain (encephalitis)
* progressive vaccinia, an ongoing infection that destroys skin tissue
* eczema vaccinatum, skin rashes caused by infections such as eczema
* About 1,000 people would have serious but not life-threatening reactions. These include a toxic or allergic reaction at the inoculation site and spread of the vaccinia virus to other parts of the body and to other people.

"The smallpox vaccine also causes milder reactions that usually go away without treatment:
* The arm receiving the vaccination may be sore and red where the vaccine was given.
* The glands in the armpits may become large and sore.
* The vaccinated person may run a low fever.
* An estimated one-third of vaccinated workers would miss work from one to a few days."

Smallpox is bad. While the vaccine can be harmful to some, it can save the lives of many more.

Question of the Week:
Everyone has a different background and medical history. What information should people have in order to make an educated decision about whether or not getting the smallpox vaccine would be the best choice for them. For more smallpox information, try:

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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