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Smallpox: U.S. Health Officials Support Public Access to Vaccine The United States should conduct a voluntary smallpox vaccination campaign to first vaccinate 500,000 health care workers and 10 million first responders and then make the vaccine publicly available as early as 2004, U.S. public health officials said Friday (see GSN, Sept. 27). “We live in a society that values individual choice,” said Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention. “If we have vaccine and we have data to accurately assess the safety, one school of thought is that informed people may want to have the choice of getting vaccine or not.” White House biological terrorism advisers have recommended giving the public “ever-expanding access to vaccine” as more doses pass Food and Drug Administration requirements. The agency will probably approve the first batches of vaccine by next month, according to the Washington Post. To apply the ever-expanding access approach, officials would first vaccinate those considered to be at the greatest risk in the event of a smallpox outbreak, for example, public health investigators, emergency room personnel and hospital support staff, the Post reported. The goal is “is to maximize our ability to respond to an attack should one occur,” Gerberding said. In the second stage, officials would offer vaccine to 7.5 million health care workers and 3 million first responders, said Jerome Hauer, assistant Health and Human Services secretary for emergency preparedness. Bush could also choose to combine both stages and vaccinate the bulk of U.S first responders at one time, the Post reported. After these two stages, the vaccine could be made available to U.S. residents as early as 2004, according to officials. “Right now, our thinking is in favor of making vaccine available to the general public,” Gerberding said. Bush has yet to decide who should be vaccinated and when vaccinations should begin, according to the Post. Vice President Dick Cheney has advocated a broad U.S. vaccination plan, sources said. The policy is “under review,” said White House spokesman Scott McClellan (Washington Post, Oct. 5). Senator Urges Public Vaccination Senator Judd Gregg (R-N.H.), ranking member on the Senate Health, Education Labor and Pensions Committee, argued in a commentary in yesterday’s Washington Post that U.S. residents should be given access to smallpox vaccine and should be allowed to choose to be vaccinated. The panic and confusion likely to result from a smallpox outbreak would make it difficult for the U.S. Centers for Disease Control and Prevention to implement a policy to begin mass vaccinations within 10 days, Gregg wrote (see GSN, Sept. 23). The vaccine must also be administered within four days to be effective, and the flulike symptoms of smallpox could mean it could take weeks to detect an outbreak, he wrote (Judd Gregg, Washington Post, Oct. 6). Pediatricians Advocate Limited Vaccination The American Academy of Pediatrics said today that the U.S. smallpox vaccination plan should involve only limited vaccinations in the event of an outbreak. The potential side effects of the vaccine are too serious, and it has not been tested on children, the academy said in a policy statement (see GSN, Sept. 25). Instead, the academy supports a “ring vaccination” strategy — vaccinating those who came into contact with an infected person. “We’re talking about a disease that hasn’t existed in the world since the 1970s and a vaccine that we know can cause death,” said Julia McMillan, a Johns Hopkins medical school pediatrics professor and coauthor of the policy (Lindsey Tanner, Associated Press/Boston Globe, Oct. 7). Risks The smallpox vaccine poses several potential health risks, including complications for as many as 50 million U.S. residents at special risk, according to the Washington Post (see GSN, Sept. 24). U.S. Department of Health and Human Services experts have estimated that for every 1 million people who are vaccinated, 15 would suffer life-threatening side effects such as encephalitis, and one or two might die. More people could experience other serious side effects such as blindness, but most of them could probably recover, the Post reported. If 200 million U.S. residents were to take the vaccine, 200 to 400 would probably die, as many as 3,000 would probably suffer life-threatening side effects and 160,000 would probably suffer other serious side effects, according to the Post. A large number of vaccine recipients would be expected to suffer mild side effects such as fever, and 15 to 20 percent of vaccinated children would probably be sick enough to miss school for several days (Washington Post, Oct. 5). Israelis Hospitalized Meanwhile, two Israeli health care workers have been hospitalized due to complications from the smallpox vaccine, Ha’aretz reported today (see GSN, Aug. 21). An employee at a public health office in Jerusalem was hospitalized after contracting a rash but was released two days later. An employee at a public health office in Safed was hospitalized after experiencing headaches and fever. Doctors initially suspected meningitis, but the symptoms were later diagnosed as the flu, according to Ha’aretz. About 6,000 Israeli first responders and health care workers have so far undergone voluntary vaccinations. The Israeli Fire Department is expected to begin vaccinations next week, according to a department spokesman (see GSN, Sept. 18). Most Israeli ambulance crews have also agreed to be vaccinated, said a spokesman for Magen David Adom, Israel’s emergency response service. The majority of employees at hospitals and health maintenance organizations, however, have refused to be vaccinated, Ha’aretz reported. Israeli Environmental Ministry staff members have said they would be vaccinated, but only if they receive extra pay (Haim Shadmi, Ha’aretz, Oct. 7). For further information, see: Journal of the American Medical Association Background on Smallpox
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