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U.S. Military Official Praises Army Smallpox Vaccination Program By David Ruppe WASHINGTON — The U.S. military’s effort to inoculate more than 500,000 soldiers with the smallpox vaccine — begun last December in anticipation of a war on Iraq — has wound down to where a relatively small number of personnel now receive the vaccine each month, a senior Army official reported yesterday. A low percentage of serious side effects have been reported so far, he said (see GSN, May 7). The vaccinations probably did cause, however, 58 cases of serious heart trouble known as myo-pericarditis, said Army Col. John Grabenstein, the deputy director for military vaccines for the Army Surgeon General. He said no deaths have been attributed to the vaccinations, even after the close investigation of three soldiers who died after receiving the vaccine. About 500,000 soldiers, particularly those deployed in Iraq and neighboring countries, plus up to 5,000 members of smallpox epidemic response teams and up to 25,000 members of medical teams have been vaccinated since U.S. President George W. Bush announced the effort last Dec. 13., according to data presented by Grabenstein (see GSN, Dec. 13, 2002). By Oct. 15, 504,028 personnel had been vaccinated, Grabenstein said in a presentation at Harvard University’s Biosecurity 2003 conference here. A parallel effort to massively vaccinate the civilian population has fallen far short of its goal, with fewer than 40,000 people of a targeted 439,000 volunteering for inoculations. With respect to the military program, the peak rate of vaccinations was 200,000 in February. Since July, though, the Army has averaged about 8,000 per month. Some ComplicationsVaccine recipients are screened to prevent high-risk people, such as those with a weakened immune system, eczema or with serious heart disease, from being vaccinated, but small numbers of the recipients nevertheless suffered side effects, Grabenstein said. He reported that 3 percent of inoculated hospital staffers took sick leave following their vaccination, as did 0.5 percent of deployed troops. The average sick leave lasted 1 1/2 days. He said today that he did not have figures indicating sick-leave rates for other groups of vaccine recipients, but added, “The rates from the three sources were pretty consistent with each other, indicating that they apply to the other settings too.” In his conference presentation, Grabenstein described the “noteworthy” complications from the vaccinations, including one case of encephalitis, 34 mild cases of generalized vaccinia and 90 cases of inadvertent eye or skin infections apparently caused by vaccine recipients touching the post-vaccination scab and transferring the vaccine virus to other areas. As for cardiac complications, Grabenstein reported 56 “probable” cases of myo-pericarditis and two “confirmed” cases. “Smallpox vaccination increases risk of myo-pericarditis” among adult males receiving the vaccination for the first time, he concluded. Earlier this year, Grabenstein coauthored a paper published in the Journal of the American Medical Association on those complications, which were not anticipated by experts (see GSN, May 23). It concluded: “Myo-pericarditis should be considered an expected adverse event associated with smallpox vaccination,” and advised doctors to consider it when diagnosing chest pains within 30 days after a vaccination. Grabenstein said data is still being compiled on how many of those 58 recovered fully. He also reported 18 initial diagnoses of ischemia, which results from an imbalance between oxygen supply and demand and can lead to insufficient oxygen to the heart or brain. Six of those diagnoses were later changed to myo-pericarditis. Of the remaining 12 cases, there was one fatality: a 55-year-old smoker with various heart ailments, he said. He was “waiting for his heart attack to happen,” said Grabenstein. Grabenstein said the number of ischemia cases “did not exceed” the expected level of ischemia for nonvaccinated people in the Defense Department. “Our experience suggests that broad smallpox vaccination programs may be implemented with fewer serious adverse events than previously believed,” Grabenstein wrote in another coauthored article also published in the Journal of the American Medical Association last June.
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