E-NEWS FROM THE NATIONAL VACCINE INFORMATION CENTER

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"Protecting the health and informed consent rights of children since 1982."

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NVIC Note: Rebecca Rex represented NVIC and Prove at this meeting in San Antonio. The last meeting is Saturday in Washington DC at the Institute of Medicine. ACIP will meet on June 19-20 to make a final decision.

Metro and State

Smallpox debate hits Alamo City

By Cindy Tumiel

San Antonio Express-News

Web Posted : 06/12/2002 12:00 AM

The ongoing national debate over whether to restart widespread smallpox vaccinations reached San Antonio on Tuesday, as local medical professionals urged federal health authorities to give more people the option of being inoculated against the potentially deadly virus.

San Antonio was the last of four cities around the country in which two Centers for Disease Control and Prevention committees sought public input in order to make recommendations on a national smallpox vaccination policy.

It's been three decades since widespread smallpox immunizations stopped in this country. But the Sept. 11 terror attacks and later anthrax contamination have caused worry about the possibility that terrorists or rogue governments may have obtained the smallpox virus and could turn it into a deadly weapon.

The federal government has begun stockpiling the vaccine, and 286 million doses should be available by the end of next year.

Health authorities are debating what to do with those doses and whether to change the current policies, which recommend vaccines only for laboratory personnel who work with smallpox-related viruses.

Vaccination of the public isn't recommended unless there is a confirmed case of the disease, and the current policy calls for a "ring" strategy of isolating and vaccinating only those closest to the outbreak.

Health officials around the country are split over whether to restart widespread smallpox vaccinations. Several national medical journals have raised the issue, but many public health authorities believe the risk of potentially serious side effects, including death, from the vaccine outweighs the chance of a smallpox terror strike.

Many at Tuesday's CDC hearing said the government should maintain its current policy against widespread inoculations because the vaccine will cause adverse reactions, particularly for those with compromised immune systems.

Scientists estimate that under mass inoculations, 180 to 400 people could die and thousands more could suffer side effects.

About 20 people spoke at the San Antonio hearing, most of them health care professionals or administrators who urged relaxation of the current government policy.

At the very least, emergency responders and health care workers - such as hospital workers, public health and public safety employees - should be given the option of being vaccinated, said Dr. Jan Patterson, a professor at the University of Texas Health Science Center and the infection control director for two local hospital systems.

Otherwise, these workers could be infected, and the result would be a major strain on the health care system, she said

"Some pre-existing immunity would be extremely helpful in containing any outbreak in our communities," Patterson said.

"Voluntary vaccinations of frontline health care workers would strengthen the ability of local nurses, doctors and others in every community throughout the nation to deliver the care that would be needed," said Jana Stonestreet, chief nursing executive for Methodist Healthcare System.

The general population should be educated and screened for risk of adverse reaction, then offered the option of being vaccinated as well, Patterson and others said.

Recent surveys have shown that people are fearful of smallpox and willing to be vaccinated, said Donald Morse, a special operations officer at the San Antonio Metropolitan Health District.

"If we could do 50 percent of the people, we could do a lot to eliminate that fear, and we possibly could also eliminate it as a weapon," Morse said, noting that terrorist groups might not use smallpox if they realized it wouldn't cause widespread harm.

Others urged caution, noting the vaccine being manufactured is the same one used during mass inoculation campaigns of the 1960s. Many suffered serious adverse reactions to the vaccinia virus that is used to help confer immunity.

The immunization forms a lesion on the skin, which still can expose sensitive individuals to the vaccinia virus, said Rebecca Rex, vice president of Parents Requesting Open Vaccine Education of Austin.

"If first responders are offered the vaccine before an actual attack, we demand their quarantine until the scabs from their vaccine lesions have fallen off and they can no longer transmit the vaccinia virus to others," Rex said.

Dr. Fernando Guerra, Metropolitan Health District director, helped preside over the meeting as a member of the National Vaccine Advisory Committee, one of the groups helping the CDC review its smallpox policy.

A number of factors led to selecting San Antonio as a site for the meeting, including its proximity to the border, the research done in the area and the community's level of bioterrorism preparedness.

ctumiel@express-news.net

06/12/2002

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