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http://www.nytimes.com/2003/02/14/national/14SMAL.html?tntemail0

Military Says Severe Reactions to Smallpox Vaccine Are Few

By THE ASSOCIATED PRESS

ASHINGTON, Feb. 13 — Three serious reactions have been reported among more than 100,000 vaccinations against smallpox given to members of the military, the Army's deputy director for military vaccines said today.

Col. John D. Grabenstein told an Institute of Medicine panel that there have been two cases of encephalitis and one heart infection associated with the vaccinations. All three people have recovered and returned to duty, he said.

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"We're seeing a rash of rashes," Dr. Grabenstein said, but serious reactions are occurring at a lower rate than had been expected.

The civilian smallpox program is off to a slower start, with just 1,043 people vaccinated as of Tuesday, said Dr. Joseph Henderson, associate director for terrorism preparedness at the Centers for Disease Control and Prevention.

He told the institute, an independent panel advising the government on medical issues, that no serious reactions had been reported in this group, mainly public health and safety personnel.

Concerns about liability and compensation for people who suffer reactions have slowed the civilian program, but Dr. Henderson said just one state, Michigan, had declined to take part, and he said he expected the vaccination numbers to climb in coming weeks.

When the smallpox vaccination program was announced, as preparation for a potential attack, the rate of life-threatening complications was estimated at 14 to 52 per million people being vaccinated for the first time, with one or two deaths. If the complication rate reported by Dr. Grabenstein holds steady, about 30 life-threatening complications per million would be expected — in the middle of the range predicted based on vaccinations in the 1960's.

Routine smallpox vaccinations ended in the 1970's. People born before that probably were vaccinated, and are believed less likely to react to revaccination.

Dr. Grabenstein said 63 percent of those in the military program were being vaccinated for the first time.

In addition to the three serious cases, he said there had been seven cases of generalized vaccinia — a widespread rash — and a variety of minor complaints, including fever, malaise and swollen arms and lymph nodes.

Overall, he said, 4 percent to 5 percent of people receiving a first vaccination have missed a day or more of work, compared with 1 percent to 2 percent of those being revaccinated.

Of the serious reactions reported, one encephalitis case and the heart infection were from new vaccinations, both involving people in the United States. The other encephalitis case, treated in Germany, was a revaccination, he said.

Dr. Henderson characterized the civilian program as a success despite the low number vaccinated, noting that the main effort has been in providing vaccine to the states and setting up education programs and infrastructure for the work to proceed.

"We're much better prepared than we were even three weeks ago," he said.

The vaccination uses the live vaccinia virus, a less potent cousin of smallpox, and people receiving it need to keep the site covered until it heals to avoid passing it along to others.

Noting that concern, Dr. Grabenstein said the most commonly asked question among the military receiving the vaccine is whether they can have sex afterward.

The answer? Yes, but "wear a T-shirt," he said.

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