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Smallpox vaccinations: A shot in the dark

By Marilyn Elias, USA TODAY

The threat of bioterrorism is not high enough to justify preventive smallpox vaccination of children and teenagers, U.S. pediatricians say in a policy statement today.

		Mass immunizations similar to one during a smallpox outbreak in New York in April 1947 are once again a real possibility.
		AP file

Vaccinations should be reconsidered if new evidence suggests bioterrorism is more likely or if safer vaccines are developed, says the American Academy of Pediatrics (AAP).

Smallpox vaccines "are not nearly as safe as other vaccinations we routinely use, and they're for diseases that are around, unlike smallpox," says Robert Baltimore of Yale Medical School, co-author of the policy.

The influential AAP is weighing in as the federal government considers who should be vaccinated in anticipation of a bioterrorist attack.

Top federal scientists Friday recommended making vaccine available to any American who wants it after medical and emergency workers are immunized.

Smallpox odds 15 per 1,000,000 would develop life-threatening complications, such as encephalitis, after vaccination. 1 to 2 per 1,000,000 would die from complications. 530 per 1,000,000 would develop non-lethal complications from touching the vaccine site. One example: If a newly vaccinated person touches the site and carries the virus on his hand to another part of the body, such as the eye, it can cause blindness. Source: CDC

The new AAP policy favors a "ring" approach — isolating those who develop smallpox and immunizing people around them — rather than giving shots before an attack to anyone who volunteers.

A key concern about a "voluntary," preventive plan is that immunized people develop a blister that can transmit the virus to others who haven't volunteered for shots. "There is no such thing as a truly voluntary plan," Baltimore says.

Routine smallpox vaccination ended in 1972. The disease has been eradicated, but fears persist that terrorists have obtained stocks of the virus.

Estimates on adverse reactions from the vaccine, which are based on studies in the 1960s, could be low because more Americans now have weak immune systems, Baltimore says. Those with weaker immune function are most likely to be harmed by the vaccine or from contact with immunized people.

Children pose special problems. The United States has stored vaccine that can be diluted and that will work for adults if there's a mass immunization program. But the diluted dosage needed for children is unknown, Baltimore says.

The government has plans to test that vaccine on children in the Cincinnati and Los Angeles areas. But it's unknown when or even if the study will start, says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Experts will testify on the risks and benefits of the study for kids at a public meeting in November called by the Department of Health and Human Services, Fauci says. The HHS secretary "will have to approve the trial," he says.

Although some parents are worried, most aren't clamoring for their kids to get smallpox shots, according to an informal USA TODAY check with children's doctors. The scene is nothing like last year's anthrax scare, when pediatricians were swamped with demands for antibiotics and smallpox vaccines.

"It's not on their radar screen right now," says pediatrician Garry Gardner of Darien, Ill.

Loraine Stern, who treats middle-class families in Newhall, Calif., says: "Parents are concerned; they're asking about it. But they're not acting cuckoo like they were last fall."