US decision on smallpox shots seen in days

Last Updated: 2002-07-26 10:00:53 -0400 (Reuters Health)

WASHINGTON (Reuters) - US officials are putting the final touches on a strategy to combat smallpox in case of a biological attack and promised on Thursday to deliver a plan in a few days or 2 weeks at most.

They are weighing the risks of vaccinating large numbers of people with a vaccine that is relatively dangerous, versus the theoretical but serious danger of a biological attack.

They also worry that legal action may result if people develop complications as a result of smallpox vaccinations.

"The threat of smallpox is small, but it's not zero,'' said Dr. Donald Henderson, a chief adviser to the federal government on bioterrorism. "If indeed smallpox were to be released, it would be very serious...potentially a global catastrophe.''

There is no question of vaccinating the general population. Rather, health experts are trying to decide whether emergency department workers, firefighters and others who may have to help in case of an attack or outbreak should get immunizations.

And if so, the question is how many of them, and where, and whether family members should also be vaccinated. Then the government is dealing with the question of what kind of action to take should there be an outbreak.

"We will have a policy in days, or 2 weeks at the most,'' Henderson told a briefing for legislative and other staff sponsored by the Alliance for Health Reform, a nonprofit group that runs forums on health policy.

Smallpox was declared eradicated worldwide in 1980 and routine vaccination stopped in the United States in 1972. Most, if not all, of the population is considered vulnerable.

The former Soviet Union is known to have experimented with smallpox as a potential biological weapon, and the fear is that extremists or even governments may be planning to use it.

Smallpox covers its victims with pustules and one third of patients die. It is a prime candidate for use as a biological weapon.

The Health and Human Services Department and the White House are considering recommendations made by experts who were studying the issue even before the September 11 attacks and the anthrax-laced letters in October that killed five people in the US.

But it takes years to develop a new vaccine and the United States is stuck with 77 million doses of the old DryVax vaccine and 75 million doses of vaccine that maker Aventis Pasteur had in its freezers and donated.

By the end of the year, 209 million more doses based on the old formula but made under cleaner laboratory conditions should be available. But it may not be any safer.

"Smallpox vaccine is probably the least safe human vaccine,'' Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told the briefing.

Complications include a skin infection called eczema vaccinatum. People with eczema who touch a recently vaccinated person can develop this potentially fatal complication.

HIV infections, cancer treatments that can suppress the immune system, and people with transplanted organs all are more susceptible to complications from smallpox vaccines.

That raises the question of lawsuits, and Henderson said his team is thinking seriously about that.

"To me, it looks like this is going to be a great place for a trial lawyer to go to make a lot of money,'' Tennessee Republican Senator Bill Frist, a doctor, told the briefing.

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