Feb. 13, 2003 (Washington) -- As states begin the initial stage of smallpox vaccinations amid concerns about the vaccine's potential side effects, they may be able to take heart from results in the military. It has so far inoculated more than 100,000 soldiers, with no deaths and only a handful of serious side effects, says a military official.
About twelve of every 1,000 recipients developed a well known and treatable -- but potentially contagious -- rash, according to Colonel John Grabenstein, RPh, PhD, deputy director for military vaccines at the Army Surgeon General's Office. He presented the data at a smallpox vaccination meeting held at the National Academy of Sciences.
Overall, the number of side effects is lower than historical numbers, possibly because 10-40% (varying with location) of potential vaccine recipients were ruled ineligible due to various conditions. "Presumably education is working. A little fear is a good thing," Grabenstein says.
States are proceeding in several stages to implement President Bush's plan to prepare the nation for a potential bioterrorist attack.
Stage 1, begun by some but delayed in others, involves inoculation of a limited number of public health personnel that could mobilize quickly in the event of an attack. Stage 2 will expand the operation to emergency medical response teams, police and fire departments, and other public health officials. Later stages could involve inoculation of the general public.
The voluntary vaccine has sparked concern among many because of potential side effects, including a contagious rash that has healthcare workers worried they might put other patients at risk. Historically, about one in every 1,000 vaccine recipients develops serious skin reactions and a brain infection (encephalitis), and one to two of every million will die.
Some states have received criticism for slow progress. Those efforts have been "slow and steady," says Eddy Bresnitz, MD, state epidemiologist and the Smallpox Vaccination Program coordinator for New Jersey, which has so far vaccinated about 150 healthcare workers. That is enough to respond to an attack, he says, and new vaccinators can be trained very quickly in the event of a widespread outbreak.
And the number of vaccinations is not the only indicator of success. The state programs are also building infrastructure, so that hospitals have a better idea of how they'll respond to an attack, for example, and much of the infrastructure can be adapted to surveillance for other diseases, such as flu outbreaks. "We've educated a lot of people," Bresnitz tells WebMD.
"We're much better prepared than we were even three weeks ago," adds Joe Henderson, associate director of Terrorism Preparedness and Response at the CDC.
Still, Bresnitz and others are cautious about the next stage of the vaccination program. Moving into a larger group of healthcare workers and emergency responders in stage 2 will pose very different problems, and New Jersey will pause before entering stage 2 so that it can learn from its experience and that of other states. "It's an issue of language [in consent forms] and education. It's a hospital worker versus an 18-year-old EMT [emergency medical technician]. It's not the same level of medical knowledge."