In the wake of the terrorist acts on September 11, questions about smallpox and anthrax vaccines have come from members who are concerned about preparing for possible attacks with biologic agents.

The last known case of smallpox occurred in Somalia in 1977, and in 1980 the World Health Organization certified that smallpox has been eradicated from the planet. The only known remaining samples of smallpox virus are held in secure facilities in the Centers for Disease Control and Prevention (CDC) in Atlanta, and the Institute for Viral Preparations in Koltsovo, Russia.

Smallpox vaccine is no longer licensed and is not available commercially in the United States, because there is no current need for its use. The U.S. Public Health Service does maintain an emergency stockpile of smallpox vaccine. At the present time, smallpox vaccine is released only under an Investigational New Drug (IND) permit from the Food and Drug Administration (FDA) for vaccination of certain laboratory workers who may be at occupational risk of infection with smallpox-like viruses. The IND does not permit release of the vaccine for any other persons or reasons.

Anthrax vaccine is not recommended for people younger than 18 years of age and currently is administered only to people in the military service. Dispensing antibiotics or prescriptions for doxycycline or ciprofloxacin in anticipation of a possible anthrax outbreak is not recommended. If an outbreak occurs, antibiotics will be dispensed through a coordinated effort by the CDC and other appropriate healthcare organizations.

The Academy is aware that plans are being made by the Department of Health and Human Services, the CDC and other parts of the Federal Government to respond to bioterrorism. These plans do not include widespread use of smallpox or anthrax vaccines. The benefit and risk of re-introduction of smallpox vaccine will continue to be examined both by the PHS Advisory Committee on Immunization Practices (ACIP) and by the AAP Committees on Infectious Diseases (COID) and Environmental Health as the situation dictates.

Our COID remains in close contact with the CDC and other federal agencies and will continue to monitor these vaccine issues and keep AAP members apprised.

You may wish to consult the following for more detailed information:

• Anthrax/Bioterrorism Q and A (Updated: 10/26/01)

   

• The AAP Subject Review, "Chemical-Biological Terrorism and Its Impact on Children," published in Pediatrics, March 2000; 105:662-670 and available at: http://www.aap.org/policy/re9959.html

   

• The AAP 2000 Red Book, pp. 84-87, 168-170.

   

• The US Public Health ServiceAdvisory Committee on Immunization Practice recommendations on smallpox vaccination at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm or http://www.cdc.gov/mmwr/PDF/RR/RR5010.pdf (PDF Format)

   

• The U.S. Public Health Service Advisory Committee on Immunization Practice recommendations on anthrax vaccination at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm or http://www.cdc.gov/mmwr/PDF/RR/RR4915.pdf (PDF Format)

   

• CDC Web sites on bioterrorism and preparedness efforts at: http://www.bt.cdc.gov/ and http://www.bt.cdc.gov/Agent/Agentlist.asp