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Smallpox vaccine: Balancing the benefits and the risks

Despite increased public demand, the potential for severe reactions must be weighed against the threat of the disease before beginning widespread inoculations.

By Susan J. Landers, amednews staff. Nov. 12, 2001.

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Washington -- In recent weeks, the world has become a different place -- one in which fears of smallpox have re-emerged for the first time in decades.

Parents are calling pediatricians asking if their children could be vaccinated against the feared disease. But, of course, they can't be. There are reported to be only about 15 million doses of the vaccine in the nation -- vaccine that was basically left over from 1972, when the country's mass vaccination program ended.

In addition, physicians are cautioning those eager to receive the vaccine for themselves or their family members that the live-virus preparation of infectious vaccinia virus that is used to inoculate people against smallpox carries its own risks.

"This is not an innocuous vaccine," said Donald Henderson, MD, director of the Center for Civilian Biodefense Studies at John Hopkins University in Baltimore. He was recently named head of a federal advisory committee to assist the government in deciding when and if to begin another widespread smallpox vaccination program. Dr. Henderson is also known for his work in helping to rid the world of smallpox years ago.

"Before a recommendation could come forward to use smallpox vaccine, I think there would have to be a demonstrated risk," said Timothy Flaherty, MD, chair of the AMA Board of Trustees. "And right now, without having had a case of smallpox in the world since the early 1980s, there is no reason to use smallpox vaccine."

Side effects and adverse reactions from the smallpox vaccine range from fever to tissue necrosis and extensive lesions to encephalitis. A death rate of one per 1 million vaccinations is noted by the Centers for Disease Control and Prevention. [...]