Doctors Are Ironing Out Details for Giving the Smallpox Vaccine

By DENISE GRADY

With smallpox vaccinations for half a million health and emergency workers scheduled to begin later this month, doctors advising the government were still ironing out details yesterday of who should avoid the vaccine and how it should be given.

In a conference call, the group, the Advisory Committee on Immunization Practices, addressed questions yesterday that had been raised about draft recommendations the committee developed in October. Its final recommendations will be presented to the Centers for Disease Control and Prevention, which usually follows the committee's advice.

One issue was whether people living with infants under a year old should be vaccinated. In its draft, the group said such adults could safely be immunized. But babies that young should not be vaccinated, because they are vulnerable to dangerous reactions. Some experts fear that a vaccinated adult could infect a baby with the vaccine virus, vaccinia, which is related to smallpox and can be shed from the inoculation site.

That concern led Dr. Thomas R. Frieden, the New York City health commissioner, to urge the committee in December to advise people living with infants not to be vaccinated. Dr. Frieden said the infant of a vaccinated health care worker in Israel had recently became infected and that in the 1947 outbreak in New York City two infants died after adults in their homes were vaccinated. But Dr. Seymour Williams of the Centers for Disease Control and Prevention, who participated in the conference call, presented information from studies in the 1960's, when smallpox vaccination was routine, showing that vaccinia transmission from adults to infants was very rare.

The group agreed with Dr. Williams and let its recommendation stand, but it acknowledged that some states or cities might choose to exclude people with infants.

Sandra Mullin, a spokeswoman for New York's health department, said, "While we will not exclude individuals with infants from participating, we will continue to advise against it."

The group also expanded the categories of people who should not be vaccinated. It had already said that people with autoimmune diseases like lupus and rheumatoid arthritis should not be vaccinated if they are taking drugs to suppress the immune system. Yesterday, the group said it would recommend that some people with severe autoimmune diseases, even if they are not taking medication, should also avoid the vaccine.