While medical personnel are the first ones who will receive the smallpox vaccine, persons with whom they come in contact could be vulnerable to disease transmission from those who are vaccinated.

CHICAGO -- Before fall, hundreds of Illinois medical and emergency personnel will be given the smallpox vaccine as a "first line of defense" against a disease-bioterrorism attack. Critics are very concerned that forcing medical personnel to have the smallpox vaccine could cause a massive outbreak of the disease.

The Illinois Immunization Advisory Committee (IAC) received a report on the state's plans to upgrade Illinois' capability to respond to a bioterrorism threat with a five-year grant from the Center for Disease Contol (CDC).

In the report to the IAC, Dr. Mark S. Dworkin, State Epidemiologist, described the emerging plan for fighting Category A organisms that pose a risk to national security, such as anthrax, plague, smallpox and botulism. While Dr. John Lumpkin, Director of Illinois Department of Public Health made no request for advice from the committee on immunization policy specifically on the bioterrorism issue, the agenda topic was relevant to what is being planned at the national level.

In late June, the national Advisory Committee on Immunization Practices (ACIP) recommended vaccination for two teams of designated health workers in each state: the "first responders" (i.e. medical investigators, infectious disease specialists) to a smallpox outbreak and hospital personnel stationed in government-designated facilities. The number mentioned in June by ACIP was 15,000. Now the number is estimated to be more like half a million persons to receive the smallpox vaccine.

The ACIP panel recommended against a mass vaccine distribution program because: 1. The smallpox vaccine itself has been found to produce serious side effects and 2. Persons immunized carry the live virus, that could transmit the disease to vulnerable, unvaccinated persons.

The smallpox vaccine is classified by the government as "investigational," therefore, the person receiving the shot will be required to sign a written consent.

Up to 50% of those receiving the current vaccine reported symptoms such as sore arms, fever and swollen lymph nodes. And about 1 in 100,000 persons have suffered brain damage from vaccine-induced encephalitis and 1 in a million persons have died from serious side effects of the vaccine itself.

The June 21, 2002 edition of the New York Times reports

when about 125 health workers were vaccinated at the disease centers last fall, doctors who gave the injections were surprised by the number and severity of adverse reactions. Many recipients were treated with antibiotics in the erroneous belief that the site of vaccination had become infected. Older doctors who had given smallpox vaccine in decades past told their younger colleagues that the skin reactions were from the vaccine. Doctors who conducted recent trials to test the safety and effectiveness of diluting the vaccine had a similar experience.

But the symptoms are not what concerns federal officials and informed citizens as deeply as the fact that a person who is immunized may transmit the smallpox to unvaccinated persons.

Barbara Mullarkey, spokeswoman for the Illinois Vaccine Awareness Coalition, voiced her concern about this to the IAC recently. While the concern was raised during the public comment period, her questions were not addressed by committee members. Mullarkey cited quotes to the committee from the new head of the Centers for Disease Control in Atlanta, Dr. Julie L. Gerberding.

Gerberding, the Deputy Director of the Center for Disease Control, reported to the ACIP panel in Atlanta, "If you get immunized with vaccinia, you can infect people around you from your vaccina scab so while you may accept the risk for yourself, you would be imparting a risk to your contacts."

Mullarkey asked whether this issue was a concern to the members of the committee, who had just received a report on Illinois' emerging program to fight bio-terrorist attacks from the state's Department of Public Health.

"Is there any concern that the very health workers that should be responding to disease outbreaks could be the ones who could actually start a serious outbreak by exposing these vaccinated persons to unvaccinated people whose natural immunities are in question?" Mullarkey asked.

"As a member of the committee, I can tell you that I am very troubled about the reported danger of the smallpox vaccine for persons with immune problems. If being exposed to medical personnel who have had the smallpox vaccination endangers the citizens of Illinois, this must be considered when making public policy decisions," said Fran Eaton, a 3-year member of the IAC, the only member who voted against the chicken pox mandate last year. "We must not over-react and over-compensate to these threats of bioterrorism. When we over-react, based on fear, the terrorists win. We can't let that happen."

Reports over the weekend are that the actual number of persons who are expected to receive the smallpox vaccine is much higher than originally estimated. While the CDC originally estimated the number of vaccine recipients to be 15,000, the number who will receive the vaccine may be closer to 500,000.