Pregnant Women Need Smallpox Vaccine During Attack
Mon Jul 8, 2:38 PM ET

By Alison McCook

NEW YORK (Reuters Health) - The smallpox vaccine can hurt a fetus, so pregnant women are normally not vaccinated against the disease. But if smallpox is ever intentionally released by bioterrorists, Texas researchers say, pregnant women exposed to the virus should be given the vaccine to protect them from the disease that can kill both mother and child.

"In the event of a woman being at risk from smallpox...the risks to the mother and fetus from experiencing clinical smallpox, especially hemorrhagic smallpox, substantially outweigh any potential risks regarding vaccination," lead author Dr. Victor R. Suarez of the University of Texas Medical Branch at Galveston told Reuters Health.

Hemorrhagic smallpox is a relatively rare form of smallpox that is especially deadly, killing 99% of infected people who have not been vaccinated. It also disproportionately infects pregnant women, but the reason why is unclear.

Suarez and his co-author, Dr. Gary D.V. Hankins, base their recommendation on a review of literature concerning the risks of smallpox and its vaccine for pregnant women. They report their findings in the July issue of Obstetrics & Gynecology.

The disease--a deadly blistering of the skin accompanied by pain and fever--was wiped out in 1979 after a worldwide public health effort, but military strategists are concerned that virus samples produced in the Soviet Union during the Cold War could fall into the hands of militant groups or rogue states.

In the event of an outbreak, current US policy calls for isolation of victims and vaccination of anyone suspected to have come into contact with infected patients. There is currently no specific treatment for smallpox.

The smallpox vaccine is now offered to laboratory workers who handle the deadly virus. Calls for a broader vaccination program escalated after the Sept. 11 attacks and a subsequent outbreak of anthrax, which killed five people in the US.

In October 2001, the US government ordered the production of more than 200 million doses of smallpox vaccine and expects to have enough stockpiled by 2003 to protect every citizen from a biological attack.

Side effects from vaccination include death in about 0.5 to 5 per 1 million people who receive it, a potentially lethal inflammation of brain tissue known as encephalitis, infections, and moderate to severe lesions at or away from the site of vaccination. In addition, a fetus can develop complications from the vaccine that can result in miscarriage or stillbirth.

Consequently, current vaccination policy suggests that certain people should not be vaccinated against smallpox, including pregnant women, people with weak immune systems and those who are allergic to the vaccine ingredients.

However, a previous study of pregnant women exposed to smallpox found that they were seven times more likely to acquire hemorrhagic smallpox than their peers, and all of them died from the disease.

As such, the effects of the disease far outweigh the possible risks of the vaccine for pregnant women, causing Suarez and Hankins to recommend pregnant women opt for vaccination in the event of an outbreak.

The doctors also urged their colleagues to learn to recognize the early symptoms of smallpox in their female patients, whether pregnant or not. "Our degree of preparedness and quickness to diagnose and respond to a bioterrorism attack are extremely important to avert a great tragedy," they write.

SOURCE: Obstetrics & Gynecology 2002;100:87-93.

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