THREE months after the US started vaccinating against smallpox, there is still huge opposition to vaccinations among hospitals and health workers. Yet the vaccine is turning out to be far safer than some predicted.
It consists of live vaccinia virus, and can cause potentially fatal complications, including severe skin infections and brain inflammation, especially in people being vaccinated for the first time. So when President Bush announced on 13 December that half a million civilian health workers, as well as half a million troops, would be vaccinated by 15 March, it was feared that side effects would be more common than in the past.
But so far severe reactions have been rare. The first 205,000 military personnel to be vaccinated have now been observed for the three to four weeks in which complications can develop. Only three had serious problems, two of them encephalitis, says Al Zelicoff, a bioweapons expert at Sandia National Laboratories in New Mexico. All recovered.
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The incidence of side effects also seems to be low among troops vaccinated later, even though two-thirds of them are getting the vaccine for the first time, according to Bill Bicknell of Boston University鈥檚 School of Public Health. The Centers for Disease Control and Prevention in Atlanta has reported no serious side effects among more than 12,000 health workers vaccinated so far. And of 17,500 Israeli health workers vaccinated in a similar drive, only one developed serious complications.
These rates are in line with two studies from the 1960s that reported serious complications in 14 and 52 people per million respectively, says Zelicoff. One also reported a death for every million vaccinated, but Bicknell says that all but two of the 12 who died during this study were children, and the two adults had seriously impaired immunity. Since immune-impaired people and children are excluded from the current programme, he sees no reason to expect any deaths.
Whether these findings will help persuade reluctant health workers remains to be seen. The prospects of the US reaching the target of 10 million vaccinated by July look slim. Last week, in a bid to rescue the vaccination drive, the White House proposed a compensation plan for people who get sick or miss work because of side effects.
Side effects are not the only problem, though. Many hospitals across the US are refusing to participate because of fears that vaccinia will spread from vaccinated staff to vulnerable patients. Two civilians have caught vaccinia eye infections from soldiers, and the immunosuppressed wife of a vaccinated surgeon in Israel developed serious complications.
Such infections might be prevented by special dressings, such as a pad that releases iodine over the vaccination site. But these special dressings are not being widely distributed.