Officials to consider smallpox vaccine risk
By Robbie Dingeman
Advertiser Health Writer
In the debate over whether civilians should be vaccinated against smallpox, local health officials say there will need to be serious discussions over when the danger of the disease outweighs the risks associated with the vaccine.
White House officials said this week President Bush plans to order the inoculation of U.S. troops amid heightened concerns about biological warfare and covert stocks of the smallpox pathogen abroad. But the president will delay ordering the vaccination of civilians because the vaccine has been linked to serious, occasionally fatal, complications in a small percentage of recipients.
Smallpox is a contagious disease that results in fever and a distinctive, progressive skin rash. The disease can be fatal but was declared eradicated in 1980 after a worldwide vaccination program. Since the Sept. 11 terrorist attacks, government authorities have determined that there is a possibility that smallpox could be used as a weapon in a bioterrorist attack because some of the virus still exists in laboratories.
Dr. James Marzolf, chief of the epidemiology division of the state health department, said that when smallpox was a threat to the general community people believed the risk of the vaccine was reasonable.
"The risks then were that you might get smallpox and die versus the risk of the vaccine," Marzolf said. "The risk from the disease itself outweighed the risk of the vaccine."
Marzolf said the current threat comes from "kind of a big unknown." Even if there is an outbreak people could still be immunized to prevent the disease from spreading and to prevent a lot of the really bad complications and deaths associated with the disease.
Smallpox has been around for at least 3,000 years and early epidemics swept across populations. It has the potential to kill 30 percent of those infected and leave survivors scarred or blind.
Dr. Steve Berman, medical director of infection control at St. Francis Medical Center, said after smallpox was eradicated in the United States, routine vaccination for the disease ended in 1972.
Berman said the medical community stopped vaccinating after the threat of smallpox diminished because of the serious and even deadly side effects that can be associated with the immunization. "It's very controversial," he said. "There is a definite risk to immunization."
Berman said countries are weighing the risk for their communities. "Israel is immunizing the civilian population," he said. "Here in this country, people are not convinced."
The Centers for Disease Control and Prevention has required that each state has a plan in place in case widespread immunization is needed after an outbreak.
Marzolf said it's understandable that the military would opt for vaccinations while the civilians would hold off. "They're the front-line folks, the defenders."
He said that the military continued immunization for smallpox for more than a decade after the civilian medical community had stopped the vaccinations.
The smallpox vaccine contains a live virus related to the smallpox virus and can cause rash, fever, chills and body ache.
The CDC estimates that 1,000 people for every 1 million vaccinated experienced serious if not life-threatening reactions. In past instances, between 14 and 52 people per 1 million vaccinated experienced potentially life-threatening reactions and one and two people out of every 1 million vaccinated die because of reactions to the vaccine.
Reach Robbie Dingeman at 535-2429 or rdingeman@honoluluadvertiser.com.
