AS MONKEYPOX RISES, SMALLPOX VACCINES TO BE OFFERED
11 Jun 2003
Source: New York Times, June 11, 2003
As Monkeypox Rises, Smallpox Vaccines to Be Offered
By LAWRENCE K. ALTMAN
Federal health officials are expected to announce today that smallpox vaccinations will be made available to certain people who have been exposed to prairie dogs and other animals infected with monkeypox in recent days.
Smallpox vaccine is considered the most dangerous of human immunizations, but it can protect against monkeypox.
The Centers for Disease Control and Prevention is expected to make the vaccinations available as an option to highly selected groups like health workers who care for patients with monkeypox, people who have been exposed to animals sick with monkeypox, veterinarians who care for animals suspected of having it and scientists investigating monkeypox.
The investigation of human monkeypox cases expanded to a fourth state, northern New Jersey, yesterday as the number of suspected monkeypox cases rose to 50: 23 in Indiana, 20 in Wisconsin, 6 in Illinois and 1 in New Jersey. No one has died.
The total is more than double the 23 cases reported in three states when the disease centers urgently announced the outbreak over the weekend. The increase in cases under investigation has resulted largely from widespread publicity that led people to report rashes and illness to health officials, officials of the centers in Atlanta said.
The monkeypox cases are the first detected in the Americas. Most suspected cases had direct contact with prairie dogs or at work in veterinarian offices and pet shops.
Monkeypox patients typically fall ill with signs and symptoms like fever, headaches, dry cough, swollen lymph nodes, chills and drenching sweats.
One to 10 days later, patients develop rashes consisting of blisterlike pimples that filled with pus, broke open and produced scabs.
The rash often erupts in different stages, or crops, as it appeared on the head, trunk and arms and legs.
The Centers for Disease Control and Prevention is also expected today to announce a definition of human monkeypox, which would be critical in determining who would be eligible for smallpox vaccinations as well as investigating the outbreak.
United States officials stopped routine smallpox vaccinations in 1970, about a decade before eradication of smallpox from the world.
On Monday, a subgroup of a national panel of immunization experts appointed by the Centers for Disease Control and Prevention to serve on its Advisory Committee on Immunization Practices began discussions on whether and how the smallpox vaccine might be used.
Discussions focused on the benefits and risks of smallpox vaccine for monkeypox, a viral disease that can be fatal in 10 percent of human cases. The death rate for smallpox was about 30 percent.
But smallpox vaccination can also be fatal. Studies from the 1960's, when smallpox vaccinations were routine, found that for every million people older than 1 year old who were vaccinated, 1 or 2 died, 9 suffered from brain infection and more than 100 developed eczema vaccinatum, a severe illness and skin rash that can leave deep scars and can occasionally be life-threatening.
The government owns all the smallpox vaccine in the United States. This year, the government began offering it to health care workers to protect against any cases that might result from an attack in which terrorists released the virus.
The only known stocks of smallpox virus are kept at the Centers for Disease Control and Prevention and in Russia, both with the approval of the World Health Organization.
But the Bush administration has warned that Iraq as well as other countries and rogue groups might have obtained smallpox virus from the official stores in Russia and begun a program to vaccinate health care workers before the war began against Iraq.
The number of people for whom smallpox vaccine might be offered to protect against monkeypox would be small, the panel's chairman, Dr. John F. Modlin, said in an interview before the panel's meeting.