World Health Body Rules Outy Mass Smallpox Jabs

GENEVA (Reuters) - The World Health Organisation (WHO) said on Friday it remained opposed to mass inoculations for smallpox despite fears the virus could be used as a weapon of germ warfare.

Smallpox, once among the world's most lethal diseases, was eradicated over 20 years ago, but the recent anthrax attacks in the United States have raised concerns it could reappear.

However, the vaccine itself can have serious side effects and poses a greater health risk while there are no reported cases of smallpox worldwide, the WHO said.

An adverse reaction to the vaccine can kill one person in a million but there has been no incidence of smallpox since 1978.

``The risk of adverse effects is sufficiently high that mass vaccination is not warranted if there is no real risk of exposure,'' the WHO said in a statement.

The United Nations (news - web sites) body said it asked a committee of experts last week to review its policy guidelines and they had recommended no change. Only those at direct risk of contracting the disease, which used to be fatal in some 30% of cases, should be inoculated, the WHO said.

Smallpox is caused by the Variola major virus and its symptoms are fever, headache and widespread blisters. It is on a list of 11 diseases, including anthrax, that the WHO has warned could be used in a biological weapons attack.

So far three people have died and at least 11 others have been infected in the United States by anthrax delivered through the mail. US officials have said there could be a link between the attacks and last month's suicide hijackings in New York and Washington in which some 5,000 people are thought to have died.

Another argument against mass inoculation is that the smallpox vaccine can be administered after the disease has been contracted, provided it is detected quickly, WHO head of communicable diseases David Heymann said.

The incubation period for smallpox is seven to 14 days and the vaccine is effective if given within four days of infection.

Most people over the age of 30 will already be protected because countries did not end inoculation until the 1970s.

``I think we can be confident public health systems would pick up the disease very rapidly,'' Heymann added.

The WHO estimates governments have a stockpile of some 90 million doses of smallpox vaccine but it is not known how much would still be usable. The vaccine is no longer made, but the United States and other governments have announced plans to seek fresh production.

Although the virus has been eradicated as a disease, there are still two high-security research facilities--one in the United States and another in Russia--where it is maintained. There have been reports that Iraq and North Korea (news - web sites) could also have samples

Well stated in #19.

I disagree though.

There was routine immunization for decades, ending in about 1972.

In terms of potential side effects you mention (brain damage, widespread skin necrosis), they can be avoided after vaccination much more readily today with various treatments.

A biological attack would not have the same infectious dynamics as the outbreak of 1947 you mention. It would be much more severe.

I appreciate very much your comments and input.

I have an uncle who is a retired GP who has said (if my mother got the story correctly) that the type of vaccine we received as children might have varying periods of effectiveness--IOW, it might and might not still protect me. Do you know if this is the case?

Immunologists are essentially split on the subject. Some suggest that the immunity imparted by the vaccine will last a lifetime, others suggest that boosters would be required.

One of the unfortunate things (if you can all it that) about the worldwide erradication of smallpox, is that the question regarding the long-term effectiveness of smallpox vaccines remains unanswered, because no one has been exposed to the virus for decades.

An immunologist colleague of mine (whom I respect) suggests that those immunized as children are probably OK. That's the version I choose to believe (perhaps a bit pollyanna of me).

The WHO is lying to avoid public panic. The Yugoslav experience shows that smallpox spreads like wildfire through a previously innoculated population. By the time anyone detects a symptom that can be identified as smallpox, innocilation provides no protection.

Can you provide details of this? Numbers, mortality, morbidity,etc.? This does not square with other data I've come across.

Don't get me wrong, I don't want to start a flame war, and I'm certainly not saying smallpox isn't dangerous. I think, however, that it may not be the millions of dead Americans scenario that is being painted.

The things I've read (see my post above) give me this impression. Person(s) get smallpox, develop symptoms (fever and rash, basically)in 7-17 days. They are not infectious till they develop a rash, or perhaps the day before. Most people, by the time they are infectious, are so sick with fever, malaise, and even delirium, that they are not out and about. Historically, many cases of smallpox were transmitted to those who came to see the victims (family, friends, and medical personnel). In other words, most victims quarantine themselves because they are too sick to go out.

Right now, we have enough vaccine to contain an outbreak in one area. We need more vaccine to contain multiple outbreaks. As to how quickly smallpox would be identified right now, let me say this-I'm a doctor. I guarantee you that every doctor, nurse, hospital, clinic, ER, in America has put smallpox at the top of the list for any case of fever and rash that they see. Believe me.

HarryK

It should be possible to determine who would be most vulnerable to complications -- very young children, pregnant women, people with impaired immune systems, frail elderly, and then not vaccinate them. And the unvaccinated would still have some protection because so many people around them would be immunized. When the children are older, the pregnant women have given birth, then they can be vaccinated.

Mrs VS (one of the pregnant)

Funny how things change. A few months ago FReepers were up in arms because the military required (admittedly imperfect) anthrax shots. It never seemed to occur to anyone that the survival of the country might depend on having some soldiers who could survive a terrorist attack. Or that the risks associated with the vaccine were comparable to other kinds of risks associated with being in the military.

Now there is this rush to vaccinate everyone despite the fact that Smallpox has a well known behavior and has been wiped out once without vaccinating everyone.

Indeed, all of the above are considered to be relative contraindications to vaccination. The data on complications are based on the rate in healthy people. There is no evidence, that I am aware of, that rate of complications from the vaccine would be any lower today, or the treatment any more effective. In fact, the most effective treatment for the lesser complications of vaccine is vaccinia immune globulin (VIG), and the govt. would need to obtain more of that to treat all the complications.

No, the unfortunate reality is that mass vaccination of all, or most all Americans, would result in a couple hundred deaths and several thousand serious injuries. If we know an attack is inevitable, it may be worth it. If we are not sure anyone hostile even has the virus, it may not be.

HarryK

Frist was the Senator on Imus. The only doctor in the Senate.

The problem with smallpox is that there is likely no cure. Although Frist mentioned there is hope in some AIDS realted drugs and som newer experimental drugs ... Vaccination is a necessity to avoid it right now. Else once caught, you die.

You need to check your facts. The mortality rate in past outbreaks of smallpox has been about 30%, not 100%.

Agreed. There is no magic bullet for this disease; the vaccination can have serious side effects, up to and including death. There is a risk-reward trade-off here and to say we should get everyone vaccinated is irresponsible.

The threat is very real and immunization needs to take place again.

We did it for decades and it works and is safe.

To say that it is safe is not true; there is a significant risk. Safe means that it "does no harm". Anything outside of that definition calls for some wisdom and sound judgement, not wishful thinking that this one shot will solve all our troubles.

I have litte patience for the likes of you.

I was vaccinated, just about everyone I know and you know of a certain age (30 or more) were vaccinated.

These vaccinations were as universal as exists in human society and that is what erradicated small pox.

If you do not want to be vaccinated, that's up to you.

But your superstition and pseudoscience are luxeries we cannot afford to waste time discussing now.

An immunologist colleague of mine (whom I respect) suggests that those immunized as children are probably OK.

Yeah. I just asked that question of an MD where I work, and the answer is "it depends on the individual," but that for a healthy individual and casual exposure no booster is necessary. For an immune-challenged individual (very old, or under medication for something else such as cancer, AIDS, etc) or for a health-care professional under acute and constant exposure, a booster is advisable. She isn't bothering, being in research now, but she said if she were a schoolteacher she'd consider it, children being "sinks of infection."

I have litte patience for the likes of you. I was vaccinated, just about everyone I know and you know of a certain age (30 or more) were vaccinated. These vaccinations were as universal as exists in human society and that is what erradicated small pox. If you do not want to be vaccinated, that's up to you. But your superstition and pseudoscience are luxeries we cannot afford to waste time discussing now.

I was vaccinated, also, when I was young.

But you are the one spreading pseudoscience and hyperbole when you say that everyone who gets the disease, dies. Get your facts straight before you tell everyone that we should trust in something that is not a perfect solution.

This post by HarryK(who says he is a doctor, and I believe him) is much more accurate than your fearmongering:

Actually, this is more complicated than it seems There is a 1 in a million death rate from small pox vaccine. Thus, vaccinating all 280 million Americans would kill about 280 people. In addition, there would be 10-100 times as many serious reactions (brain damage, widespread skin necrosis, etc). If Al-Qaeda, or Iraq or whoever truly has the means to use smallpox, then perhaps 280 deaths and several thousands serious casualties are worth it. How sure are we that they have it? Additionally, with all due respect, there is a cure for smallpox--it is the vaccine. Those who receive the vaccine within 4 days of exposure, are likely to survive. See this thread to see how a potential outbreak in New York was treated in 1947 by mass vaccination--which wasn't started till after the initial case had died. We need more vaccine--to treat an outbreak. I think mass vaccination of everyone right now is questionable, at best. HarryK

I dont agree and I'm a nurse. It's funny that you use the word "cure" and you're a doctor? There is no "cure" for smallpox--Giving the vaccine to someone exposed to it (before you even show symptoms) "MAY" lessen the effects of smallpox, but you cannot say with any certainty that it will "cure" the disease. (Check those facts with the CDC and John Hopkins study on smallpox.)

I would most certainly take the vaccine--if I had the opportunity (which we don't at this time.) The mortality rate of smallpox is 30%.In a population of 280 million, a vaccinated public would have a death rate of 280 people from reaction to the vaccine--compare those stats with 30% of 280 million--which means 84 MILLION people would die in a widespread outbreak of smallpox.

This isnt a trick question--280 deaths next to 84 MILLION deaths--which one do you choose?

Those arent my figures--argue with the CDC.

FAQ'S about Smallpox (from the CDC)

Is smallpox fatal?

The majority of patients with smallpox recover, but death may occur in up to 30% of cases.

Is there any treatment for smallpox? br>
There is no proven treatment for smallpox, but research to evaluate new antiviral agents is ongoing. Patients with smallpox can benefit from supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

If people got the vaccination in the past when it was used routinely, will they be immune?

Not necessarily. Routine vaccination against smallpox ended in 1972. The level of immunity, if any, among persons who were vaccinated before 1972 is uncertain; therefore, these persons are assumed to be susceptible. For those who were vaccinated, it is not known how long immunity lasts. Most estimates suggest immunity from the vaccination lasts 3 to 5 years. This means that nearly the entire U.S. population has partial immunity at best. Immunity can be boosted effectively with a single revaccination. Prior infection with the disease grants lifelong immunity.

How safe is the smallpox vaccine?

Smallpox vaccine is considered very safe. However, some people with pre-existing conditions such as eczema or immune system disorders have a higher risk for having complications from the vaccine. Adverse reactions have been known to occur that range from mild rashes to rare fatal encephalitis and disseminated vaccina. Smallpox vaccine should not be administered to persons with a history or presence of eczema or other skin conditions, pregnant women, or persons with immunodeficiency diseases and among those with suppressed immune systems as occurs with leukemia, lymphoma, generalized malignancy, or solid organ transplantation. Is it possible for people to get smallpox from the vaccination?

No, smallpox vaccine does not contain smallpox virus but another live virus called vaccinia virus. Since this virus is related to smallpox virus, vaccination with vaccina provides immunity against infection from smallpox virus

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