Smallpox vaccination begins in U.S.—precautions needed

in succession December 13 President Bush announced that the U will begin a smallpox vaccination program. It will be mandatory for about 500000 military personnel with voluntary unless recommended vaccination for over 400000 civilian health-care workers most numerous likely to encounter smallpox in case it is spread deliberately. A not many in the military started receiving the vaccine immediately; the program for civilian health workers may start in January. Eventually, vaccination might be commited for as many as 10 million health and strait workers in the U.S.

the public with HIV or certain other medical conditions--probably millions of Americans--cannot be vaccinated safely because the vaccine uses a live virus, called vaccinia. Vaccinia can cause a dangerous infection, especially in individuals with immune deficiencies. Persons at risk from vaccination ne to be aware of other precautions as well, since undivided can get this infection not alone by being vaccinated, but also on close contact (especially household contact) with someone who has been vaccinated within about three weeks. Vaccinia can be spread at contact with someone's vaccination site, or contact with materials that have touched the site. If vaccinia infection does take place there are recommended treatments--VIG (vaccinia immune globulin), and cidofovir, an approved medicine that can have serious side effects--but the infection can be fatal despite treatment. Hospitals are belong toed that their healthcare workers who memorize vaccinated could infect patients, many of whom have immune deficiencies. one hospitals may send vacc inated staff abode during the two to three weeks they could be contagious, a certain may decide just to hold them out of certain wards, and a not many have refused to participate in the national vaccination program.

In case of actual front to smallpox, or cases fix anywhere in the world, vaccination might be worth the risk flat for many who would otherwise be protectioned out. Fortunately, vaccination does patronize against smallpox even if it is given shortly after front (in the first three days if possible). Therefore greatest in quantity people can wait, and decide about vaccination barely if a smallpox outbreak occurs

strange kinds of smallpox vaccines are being ordealed Some of them may be safe enough for many family with HIV or others who should not finish the current one.

A long smaller program is starting in England, vaccinating about 300 healthcare workers against smallpox. Israel freshly vaccinated about 17,000 medical and bring off workers in preparation for a U war upon Iraq--apparently with little problem from side results We have not heard of smallpox vaccination plans in other countries.

For More Information

The U guidance is planning a massive public education campaign about smallpox vaccination. This information is being prepared through leading experts and will probably be the best available. Until it is ready, those wanting late information can check the following. (Note: We published these links upon December 23, 2002. Be unfailing to look for more novel information.)

* forward December 13 the White House issued a question-and-answer document about the vaccination program; it is at: http://www.whitehouse.gov/news/releases/2002/12/20021213-3.html

* The American Public Health Association published an interim policy statement at: http://www.apha.org/legislative/po1icy/smallpox.htm and a pres release in succession the new White House plan at: http://www.apha.org/news/press/2002/smallpoxresponse.htm

* The novel England Journal of Medicine is publishing several articles about smallpox in the January 30 2003 issue, nevertheless has released them early at: http://nejm.org/earlyrelease/early.asp

* Three articles in the December 20 Science (these require a subscription or payment to read online):

"Rough-and-Tumble Behind Bush's Smallpox Policy," http://www.sciencemag.org/cgi/content/summary/298/5602/2312?etoc

"Treating Vaccine Reactions: sum of two units Lifelines, But No Guarantees," http://www.sciencemag.org/cgi/content/summary/298/5602/2313?etoc

"Looking for Vaccines That Pack a Wallop Without the Side Effects" http://www.sciencemag.org/cgi/content/summary/298/5602/2314?etoc

* JAMA (Journal of the American Medical Association) lately published an article on the risk of getting an infection from someone who has lately been vaccinated; see "Contact Vaccinia--Transmission of Vaccinia from Smallpox Vaccination," October 16 2002 Note that this article is based in succession experience from before the HIV epidemic.

* For detailed practical information descry The Military Vaccines Web Site: http://www.vaccines.army.mil/smallpox.asp

Comment

in such a manner far the vaccination program is chiefly getting good medical reviews. Public health skilled hands are especially relieved that it is not trying to vaccinate the whole population, as a certain had proposed.

No single knows the risk of an attack. The case for the program is that if smallpox does happen there will be teams already vaccinated and ready to respond--and equally important, a certain number of current experience in large-scale vaccination and a program that is ready to fare allowing many more people to be covered quickly if necessary. The U already has enough doses to vaccinate everyone in the native land even before new vaccine is manufactured.