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Last Updated

04 Jan 2003

Source: Salt Lake Tribune, January 4, 2003

Utahns a Crucial Weapon in U.S. Smallpox Defenses


How close can Utahns get to protecting America from bioterrorism? Roll up your sleeve and find out.

Smallpox vaccinations are now available to hundreds of residents willing to sign up for a government-run program to extract human plasma containing antibodies to the virus. But to have the antibodies, program participants must be freshly vaccinated for smallpox.

So far, more than 500 Utahns are walking around with new vaccination marks on their upper left arm -- the first time fresh smallpox vaccine scars have appeared on nonmilitary personnel in 30 years.

Participants, who receive between $500 to $1,000 for their service, began receiving the vaccinations in May, according to vaccination provider Serologicals Corp. Few serious side effects have been reported.

"We've had a couple of participants end up in the emergency room after they reported pain in the lymph nodes . . . so we sent them to get checked out," said Jolette Franco, Serologicals' administrator for plasma-donor operations in Utah. The Atlanta-based company has two plasma centers in Utah, one in Salt Lake City and one in Provo, where the smallpox vaccinations are being given.

All of those who were hospitalized have been treated and released, Franco said. No other serious smallpox-vaccine side effects have been reported in Utah or in Serologicals' 11 other clinics in a half-dozen states.

The company is using the plasma to create a drug to treat those who suffer adverse reactions to the vaccine.

The federal Centers for Disease Control and Prevention, through the direction of President Bush, has been working with state and local health departments and hospitals to further develop their smallpox response plans. Up to now, this included identifying health care workers and emergency responders to serve on Smallpox Response Teams who will be given pre-bioterrorism-attack vaccinations. The inoculations could begin as early as this month; they are likely to be performed on 500,000 health workers and 500,000 military personnel during 2003.

But those smallpox vaccinations cannot go forward until the CDC produces enough antidote to the vaccine's side effects. That's where Serologicals and Utah comes in; the company has the go-ahead to inoculate area residents and then collect their antibody-filled plasma to make vaccinia immune globulin, or VIG. The antidote must be made from the plasma of people vaccinated in the last two months, when the antibodies are strongest in the bloodstream.

Routine smallpox vaccinations for children ceased in 1972 and the military stopped doing it to troops in the 1980s. Those who now have the vaccination scar, a button-sized skin indention on the upper arm, lost the vaccination protection about five years after they got it -- usually while they were still children.

Donors are usually paid $50 for each time their plasma is drawn, which is approved after a screening interview and a physical with a Serologicals staffer. After a two-week post-vaccination wait period, donor plasma is drawn twice a week for about eight weeks, which means donors can earn upward of $1,000.

The CDC said Friday its VIG stockpile is larger than 2,700 doses, enough to cover adverse reactions in 27 million inoculations. Another drug called cidofovir also is being stockpiled to treat vaccine complications, but only the most severe reactions. Production of both drugs continues today, the CDC said.

Serologicals (through the Canadian company Cangene) and the Maryland-based DynPort Vaccine Company were given stocks of smallpox vaccine to help make VIG.

The most typical risks from smallpox vaccine, which is made from a cousin virus to smallpox and harvested from livestock, include some soreness or swelling of the upper arm and a mild fever and nausea.

The vaccine-related symptoms usually subside within a week or two and can be treated with over-the-counter painkillers. Among adults who are vaccinated, one in three people will feel nauseated or feverish enough to miss work or maybe have trouble sleeping, according to CDC statistics. Deaths from vaccinations are rare: about one person per 1 million inoculations.

Infection with the smallpox virus itself is fatal in 30 percent of cases.

Franco said the criteria for being a VIG donor are strict: Volunteers must be in good health, weigh at least 110 pounds and must be able to pass blood tests for communicable diseases like hepatitis, HIV or other conditions.

Sufferers of the skin disease eczema are being excluded.

And since touching the vaccination site or the bandage can infect someone else with the vaccine virus, potential VIG donors cannot live with anyone at high risk for complications: pregnant friends or family members, children under 1 or people with unexplained rashes or weakened immune systems.

"If you're under a doctor's care for any reason, donors also have to have a note" from the physician to pass the donor screening process, Franco said.

For more information about the smallpox vaccine program, log on to www.cdc.gov or call Serologicals in Utah at 801-583-0488.