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October 16, 2002

U.S. IMMUNIZATION NEWS

"Big Question About Smallpox:  What if . . . ?"

New York Times (www.nytimes.com) (10/15/02) P. F6; Grady, Denise

Dr. William Schaffner, chairman of the preventive medicine department at Vanderbilt University, has spent much of this year worrying about the fact that the site of a smallpox vaccination can shed live virus and infect others who might be exposed to it. Schaffner is one of the infectious disease experts currently advising the government as it considers the first wave of inoculations of about 500,000 soldiers, along with selected health care workers, against a possible smallpox bioterrorist attack.  The government has suggested that once the vaccine is approved for mass use, it should be offered to the public.  The greatest concern, says Schaffner, is that vaccinated people pose a risk to others who are particularly vulnerable to the vaccine itself, like pregnant women, infants, people with autoimmune disorders, cancer, or new organ recipients, and those with a history of eczema or other skin conditions.  He notes that the program will establish a transmissible infection, and people other than the volunteers could easily acquire the infection from accidental exposure, though studies from the 1960s indicate that transmission rates in this manner were low.  Schaffner points out that 40 years ago, when the vaccine was in routine use, HIV was unknown, organ transplants were rare, and rates of eczema were very much lower than they are today.  Special vaccine bandages are being tested to determine whether their usage will reduce the chance of transmission.  A secondary concern, says Schaffner, is time lost from work by at least 30 percent of health care workers and other first line defenders resulting from their reactions, or the side effects of receiving the vaccine for the first time.

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