By GIDEON GIL
ggil@courier-journal.com
The Courier-Journal

Kentucky's bioterrorism preparedness plans for the next year include vaccinating emergency workers against smallpox, though a panel of medical experts last month advised against giving the vaccine to this group.

Concerned about unexpected heart problems suffered by a small number of vaccinated health-care workers and military personnel, the Advisory Committee on Immunization Practices recommended that the federal government not expand the inoculation campaign to "first responders," which include paramedics, police and firefighters.

In a June 18 statement, the committee advised the federal Centers for Disease Control and Prevention that it was unwise to expand the vaccination program at this time "because of the new and unanticipated safety concerns." The committee said the extent and severity of heart inflammation and the long-term effects "are not yet known."

In May, the Institute of Medicine, which advises the federal government, came to a similar conclusion after the CDC reported that 21 civilian health-care workers and 37 military personnel, out of 485,000 vaccinated, had developed inflammation of the heart or the heart's lining after their inoculations.

At least six vaccinated civilians have suffered heart attacks, and two died, but it has not been determined whether they were related to the vaccine or were coincidental.

"We agree with the concern," Dr. Raymond Strikas, director of smallpox preparedness and response for the CDC's National Immunization Program, said in an interview. "How we proceed from here is still to be decided."

He said the medical concerns must be balanced against the fact that the vaccination program is also a biodefense and national security issue.

The CDC will officially respond to the committee's recommendation in the next few weeks, Strikas said, but at this point it is leaving it up to the states to decide whether to vaccinate first responders.

Some, including Tennessee and New Jersey, have decided not to offer the vaccine to emergency workers, while others, including Florida, are doing so, he said.

In Kentucky, Dr. Steven Englander, the state epidemiologist, said that after the heart problems were first reported in March, people with known heart conditions or at risk for heart disease were disqualified from receiving the vaccine and that no heart attacks have been reported since.

"I am comfortable, if we screen properly, we have all but eliminated the serious consequences," he said, adding that all recipients who developed heart inflammation have recovered fully.

Some local health departments already have begun vaccinating first responders. The 798 Kentuckians vaccinated against smallpox include 22 emergency workers — 13 EMTs and paramedics, seven firefighters and two law enforcement officers — said Doug Thoroughman, a CDC epidemiologist assigned to Kentucky for bioterrorism preparedness. None is from Jefferson County.

"We don't expect a huge number of first responders to get vaccinated, but we're making it available to them," Thoroughman said.

He said the state recently asked the 55 county and regional health departments how many first responders in their areas were willing to be vaccinated, and the responses varied from none to one or two, to 150 cited by one department.

All states were required by the end of last month to send bioterrorism plans to the CDC for the 12 months beginning in September. While vaccinations will continue to be available, the emphasis of Kentucky's smallpox plan is training health-care workers to administer the vaccine; conducting a statewide smallpox response exercise and one local exercise; and completing response plans for each health department and acute-care hospital, Thoroughman said.

The initial response plans, which outline the steps to be taken in the event of a smallpox outbreak, have to be revised in part because far fewer public health and hospital workers volunteered to be vaccinated in advance of an outbreak than expected.

Kentucky had estimated that as many as 6,000 would be vaccinated. Nationally, fewer than 10 percent of the anticipated number have been inoculated.

Bush administration officials said in December that they hoped to vaccinate nearly half a million public health and hospital workers within a few months, and as many as 10 million first responders later this year, to prepare for a possible bioterrorism attack.

Highly contagious and often fatal, smallpox was considered to be wiped out in the 1970s, but the administration said there was a risk that terrorists or hostile nations had obtained the virus and could use it as a weapon.