PANEL ADVISES SMALLPOX VACCINATION OF 510,000



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Last Updated

17 Oct 2002

Source:  Wall Street Journal, October 17, 2002.

HEALTH

Panel Advises Vaccination Of 510,000 Against Smallpox

By CHAD TERHUNE. Staff Reporter of THE WALL STREET JOURNAL

ATLANTA -- A federal advisory panel recommended that an estimated 510,000 hospital physicians, nurses and other staff be vaccinated against smallpox as preparation against any outbreak. But the panel rejected, for now, a much wider vaccination of as many as 10 million health-care workers and other "first responders" such as paramedics, firefighters and police officers.

The Advisory Committee on Immunization Practices, in a meeting here attended by researchers and health and government officials from across the country, voted 9-1 in favor of the recommendation; two members abstained due to a conflict of interest with Wyeth, a drug maker in Madison, N.J., and one of the manufacturers of the smallpox vaccine.

The White House will consider the recommendation in its final decision on smallpox vaccinations. D.A. Henderson, an adviser to Health and Human Services Secretary Tommy Thompson and leader of the smallpox-eradication effort in the 1970s, said in an interview that he expects the Bush administration to announce its smallpox-vaccination policy in coming weeks. He said preparations on vaccinating selected health-care workers could proceed in the meantime and may begin as soon as early next year.

Serving as Guideline

The panel's recommendation calls on nearly all of the nation's 5,000 hospitals to have, on average, about 100 of their staff members vaccinated.

One reason the panel adopted a policy involving so many hospitals is that so few medical centers had volunteered to be the designated smallpox-treatment facility in their area.

The public-health officials, physicians and researchers on the panel said vaccination of about 815,000 emergency-response workers across the country wasn't warranted during this first phase because smallpox patients with a fever or rash could get to an emergency room on their own.

The panel's recommendation would serve as the guideline for state and local health departments, which would administer the vaccinations as part of their broader bioterrorism response efforts. It would be left up to health departments and hospitals as to which specific personnel should be offered the vaccine. For instance, panel members discussed whether hospital housekeepers should be vaccinated or whether doctors and nurses could handle those chores during the early days of an outbreak.

Risk of Complications

The federal Centers for Disease Control and Prevention already has issued guidelines to state health departments on how to vaccinate all Americans within five to 10 days in the event of an outbreak. There has been greater debate, though, over what to do in advance of a possible smallpox outbreak.

Some at the panel meeting were against any advance vaccination, given the risk of serious complications from the vaccine and the absence of clear evidence of a threat. Health officials estimate two to three deaths per one million people vaccinated.

"If there is no case of smallpox, we will be doing more harm than good," said Paul Offit, a panel member and chief of the infectious-diseases section at the Children's Hospital of Philadelphia. Dr. Offit voted against vaccinating health-care workers before an outbreak.

However, most health officials backed some pre-event vaccination to ensure proper treatment of smallpox cases and to avoid overwhelming the public-health system at the onset of any outbreak.

Some panel members also reiterated their opposition to offering voluntary vaccination to the general public before an outbreak. The Bush administration and CDC officials have discussed offering that option.