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February 24, 2003

U.S. IMMUNIZATION NEWS

"A Model for a Smallpox-Vaccination Policy"

New England Journal of Medicine (www.nejm.org) (01/30/03) Vol. 348, No. 5, P. 416; Bozzette, Samuel A.; Boer, Rob; Bhatnagar, Vibha

As debate swirls over the appropriateness of administering the smallpox vaccine in response to the threat of bioterrorism, researchers have been investigating a number of scenarios in which vaccination is likely to occur and how those moves would affect the general population.  The authors created fictional smallpox bioterrorist attacks to test probable outcomes of a variety of vaccine initiatives, using outbreaks of the disease in Europe and North America since the 1940s as a guide of how the illness travels through a population.  The results of the research indicate that if the vaccinia virus were released from a laboratory, isolating smallpox victims and vaccinating their contacts would result in seven deaths from either the vaccine or the virus.  The response would result in 19 deaths if bioterrorists infected a human and used that person as a vector for the disease.  In more dangerous bioterrorist actions, if a building were infected with the virus, the illness would cause 300 deaths; a low-impact airport attack, which would infect one airport and its customers alone, would cause 2,735 deaths; and a high-impact airport attack, which would include the infection of several airports, would cause 54,729 deaths. Immediately vaccinating all people near an attack would change little in the number of deaths, and while vaccinating health care personnel before an attack would save lives in large attacks, it would cause the death of 25 workers across the nation from vaccine complications.  Vaccinating the general public before an attack would lead to 482 deaths nationwide.  The research suggests that health care workers should be vaccinated against smallpox before an attack unless the risk of that attack is very low, while the general population should only be vaccinated if the risk of a major attack or multiple attacks is very high.

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