Military Smallpox Vaccination Going Well
Success Encouraging For State Plans To Inoculate Healthcare Workers
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
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
"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