No broad smallpox vaccination

A CDC advisory panel weighs risks against likelihood of infection and recommends that only medical personnel, expected to be first responders to an outbreak, be vaccinated.

By Susan J. Landers, amednews staff. July 8/15, 2002.

An influential Centers for Disease Control and Prevention committee has recommended against administering the smallpox vaccine to the majority of the population at the present time.

Instead, it suggested that the Dept. of Health and Human Services develop a new policy that limits the use of the vaccine to those likely to be first on the scene of suspected outbreaks in each state -- primarily physicians and nurses. Most policemen and firemen would not be included in this first group.

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Topic: Vaccine supply

The committee predicted that states would be ready to oversee the administration of the vaccine to the initial group by next fall.

The recommendation by the 14-member Advisory Committee on Immunization Practices would limit the vaccine to about 10,000 to 20,000 individuals, said John Modlin, MD, committee chair.

The committee ruled that the threat of a bioterrorist attack using smallpox as a weapon is still sufficiently small while the risk of deaths and serious adverse reactions to the vaccine was sufficiently large to advise against mounting a broader vaccination campaign.

However, if the risk of an outbreak of the lethal disease should increase, the committee could quickly change its advice to HHS Secretary Tommy Thompson, noted Dr. Modlin.

10,000 to 20,000 physicians and nurses will be vaccinated for smallpox.

"While the threat of a smallpox attack is believed to be low," said Thompson upon receiving the recommendation, "it is indeed possible, and unfortunately we now live in a world where we need to be prepared for the possibility of such a biological attack." There is expected to be enough vaccine in stock by the end of this year to be able to vaccinate everyone in America, he said.

Other groups, including the AMA and the Infectious Diseases Society of America, also favor a limited immunization campaign at the present time.

HHS will now review the recommendation in establishing a new national policy. Current policy calls for vaccination only of lab workers who may be handling the virus.

Dr. Modlin asked that physicians explain to patients the complex issues debated by the panel during their two-day deliberations in June. Prime among those issues was the danger posed by the smallpox vaccine itself.

The risk of death from the vaccine is thought to be in the range of one in a million with the risk of serious adverse reactions ranging from several hundred to several thousand per million, said Dr. Modlin. However, those numbers are based on the U.S. population as it looked about 40 years ago when the vaccine was still routinely administered.

Today's population has a greater proportion of immunocompromised, Dr. Modlin pointed out, and is in greater danger of serious reactions to the vaccine.