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Smallpox: U.S. Medical Groups Urge Caution on Mass Vaccination Several U.S. medical groups have said the United States should be cautious in providing smallpox vaccine to the public, especially before an outbreak has occurred, the New York Times reported today (see GSN, Oct. 7). The American Medical Association said yesterday that it supports the smallpox guidelines that the United States released in June (see GSN, Dec. 5, 2001). The guidelines call for the vaccination of health care workers and the use of the “ring vaccination” strategy — vaccinating those who came into contact with an infected person — in the event of an outbreak. “The need for further voluntary vaccination beyond front-line health care workers is a very complex issue,” the association said in a press statement. Policy-makers must compare the potential health risks of a smallpox outbreak with the side effects of the vaccine, the association said, noting concerns about who would be responsible for deaths or injuries in a mass vaccination campaign. The American Academy of Family Physicians has taken a similar position, according to the Times. The American Academy of Allergy, Asthma and Immunology has also called for caution, said spokesman James Baker. The group is concerned about potential risks that the vaccine poses to people with the skin conditions such as atopic dermatitis and eczema, he said. In their calls for caution, the medical groups have not criticized U.S. smallpox vaccination plans, according to the Times. They also have said that mass vaccination would probably be appropriate in the event of an actual outbreak. The groups’ concerns are based on the potential risks of the smallpox vaccine, which is more likely to cause serious side effects than other vaccines, the Times reported. The rates of complications caused by mass vaccination are expected to be higher now than during vaccination campaigns of the 1960s and 1970s because the number of people at risk from the vaccine’s side effects has increased. People at increased risk from the vaccine include immuno-compromised patients, those on chemotherapy and pregnant women. People who are vaccinated can also endanger those who are especially vulnerable to the vaccine’s side effects, according to the Times (see GSN, Nov. 21, 2001). The vaccine, which uses a live version of the virus, can be shed for up to several weeks from the vaccination site and poses an infection risk to others (Denise Grady, New York Times, Oct. 8). For further information, see: Journal of the American Medical Association Background on Smallpox
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