Expert: 'Not a safe vaccine'Smallpox inoculation still too risky for public, doctor says

Rocky Mountain News ^ | January 6, 2003 | Jim Erickson

[heyhey]

Expert: 'Not a safe vaccine'

Smallpox inoculation still too risky for public, doctor says

By Jim Erickson, Rocky Mountain News January 6, 2003

President Bush shouldn't have offered the smallpox vaccine to the American public last month because it's still too risky, a leading authority on adverse reactions to the inoculation says.

"President Bush said that any civilian who wanted it could have it. I think that was a mistake, frankly," Dr. Vincent A. Fulginiti said Friday. He spoke at Children's Hospital in Denver.

"This is not a safe vaccine for the general public because of all the complications," Fulginiti said during an interview before his lecture. "This is not the measles vaccine."

Most U.S. physicians have never witnessed the rare but sometimes gruesome side effects the smallpox vaccine can trigger. And few have treated more of the severe complications than the 71-year-old Fulginiti.

In 1961, he joined renowned pediatrician Dr. Henry Kempe at Colorado General Hospital in Denver, now known as University of Colorado Hospital.

Kempe, who died in 1984, pioneered treatments for the vaccine's sometimes-fatal side effects. In the 1950s, he developed what is still the main defense against vaccine-induced disease: vaccinia immune globulin, which is made from the blood of recently vaccinated people.

In the 1960s, hundreds of children from across the country - and a few from as far away as Europe and South America - were sent to Denver for help.

"This was the place, and they were sent strictly because Henry and Vince Fulginiti were doing the research on treatments for those reactions," said Dr. Richard D. Krugman, dean of the University of Colorado medical school. Krugman worked with Kempe and Fulginiti as a resident in the 1960s.

The stricken infants often arrived on military aircraft because civilian airlines refused to take them, Fulginiti said.

At the time, smallpox vaccinations were mandatory in the United States, and infants usually received the inoculation eight to 12 months after birth.

The smallpox vaccine is made from a live, replicating virus called vaccinia. It helps the body develop immunity to the closely related smallpox virus.

But in rare cases, the vaccinia virus spreads from the shoulder inoculation site to other parts of the body. Life-threatening reactions can include an inflammation of the brain called postvaccinal encephalitis, and an uncontrollable and usually fatal flesh-devouring infection called progressive vaccinia.

Kempe and Fulginiti treated 23 children with progressive vaccinia at Colorado General in the 1960s. Only two of them survived, said Fulginiti, who retired last year and now lives in Arizona.

"It was disturbing to lose so many children," he said. "Henry was profoundly disturbed, so much so that he wanted vaccination stopped. But it took several years before people would listen to him."

At a meeting of the American Pediatric Society in Philadelphia in 1965, Kempe stood before his peers and said U.S. smallpox vaccinations should be halted because they killed more children than they protected.

A debate ensued, with Dr. Saul Krugman of New York University and several others firing verbal volleys back at Kempe.

"If we accept Dr. Kempe's proposal, we are likely to revert to the 1920 to 1930 prevalence of smallpox," said Krugman, according to a June 1965 article in Medical World News.

Kempe is best known to most Coloradans for his later studies of child neglect and abuse. He coined the term "battered child syndrome," and Denver's Kempe Children's Center is named for him.

In 1984, he was nominated for the Nobel Peace Prize by former Rep. Patricia Schroeder, a Colorado Democrat.

Today, the Centers for Disease Control and Prevention estimates that for every 1 million people vaccinated against smallpox for the first time, at least 1,000 will suffer serious but nonlife-threatening reactions; between 14 and 52 will experience potentially life-threatening reactions; and one or two will die.

On Dec. 13, President Bush announced that 500,000 military personnel will be vaccinated against smallpox immediately.

Those vaccinations will be followed by a voluntary program to inoculate about 450,000 doctors, nurses and emergency workers who would be the first to respond if terrorists use smallpox as a weapon against the United States.

Then the vaccine will be offered to as many as 10 million health care workers, police, firefighters, paramedics and other emergency workers.

Finally, the federal government would "work to accommodate" members of the public who insist on being inoculated, Bush said. But he stressed there is no evidence that a smallpox attack is imminent.

"If there's an attack, there's plenty of time to immunize the population," Fulginiti said. "So unless there's a real threat, I don't think civilians should be vaccinated

[demosthenes the elder]

this is really odd.
I was innoculated against smallpox as an infant - the same as everyone else who bears the quarter-sized scar on their left shoulder.
My mother is a physician. She says the new vaccine is no more dangerous than the old one. She says that anyone who was successfully innoculated in their youth should be able to handle a booster shot at no risk.
What is the big deal about this?

[Sacajaweau]

He treated 23 children and only 2 survived. These children already HAD smallpox.

Statistically, of one million people proposed to be vaccinated, 1 will die.

Correct me if I'm reading this wrong.

Looks like nothing more than anti-Bush rhetoric.

[altayann]

The big deal is that immune systems of infants are generally pretty weak. Since the smallpox is a live virus, you're essentially illness into their bodies.

So your mother is correct, in one sense. Those who were successfully inoculated in their youth can be re-inoculated without trouble.

It's the segment of the population that was literally born yesterday (or within the last year) that's the problem. Add to that that recently innoculated individuals can infect others who haven't recieved the vaccine and it means that you can't vaccinate families with very young children.

I'm surprised your mother didn't point this out to you.

[JeeperFreeper]

Thanks for post.
I agree with Demosthenes the Elder. If the shots are so bad, why did I get one as as kid?
Some question I'd like answered are: 1)what happens if small pox is reintroduced in the U.S., 2)how fast would it spread, 3) how many would die as opposed to deaths and injuries from a preventative inoculation program? I've tried to find out but about all I get are agenda -driven responses.

[demosthenes the elder]

re-read the article more closely. The vaccine against the smallpox virus uses a live-virus culture of a different and far less harmful virus which has a protein coat similar enough to that of the smallpox virus that an immune system exposed to the one can detect and attack the other.

[altayann]

The other problem is that health workers tend to work with a lot of people who have comprimised or weakened immune system. If they were to be innoculated, they could potentially end up anyone in a hospital environment who:

-Had AIDS
-Was undergoing chemotherapy
-had a skin condition
-was born within the last year

[altayann]

I know that. That's the not the problem: the problem is that the vaccine (vaccinia virus) is still a live virus. In someone with a weak immune system, that's going to cause problems.

[Snowy]

Some question I'd like answered are: 1)what happens if small pox is reintroduced in the U.S., 2)how fast would it spread, 3) how many would die as opposed to deaths and injuries from a preventative inoculation program? I've tried to find out but about all I get are agenda -driven responses.

Read the book, "The Demon in the Freezer" by Richard Preston. I'm half way through it. That will tell you what you want to know, and a lot of stuff you would prefer not to know. :(

[woofie]

ping

[Snowy]

I know that. That's the not the problem: the problem is that the vaccine (vaccinia virus) is still a live virus. In someone with a weak immune system, that's going to cause problems.

Then wouldn't the doctor of such a person advise that person not to get the vaccine?

[demosthenes the elder]

and so, for the sake of people so frail that they should have been drowned at birth (slight hyperbole), you support leaving a population of some 280 millions exposed to lethal weaponized bioagents?
There is such a thing as acceptable losses.
One out of one million seems more than fair to me.

[altayann]

I've worked with one of those people you consider so frail that they should have been 'drowned at birth'.

For the record, this person was an officer in the Navy who later in life developed cancer and is currently undergoing chemotherapy. Meaning that their immune system has been weakened.

I would suggest you consider editing your comments.

[KarlInOhio]

One out of one million seems more than fair to me.

The odds of an American being killed by terrorists on 9/11/01 was 1 in 100,000, or ten times the danger of the small pox vaccine.

If our enemies do have smallpox available and our population isn't vaccinated, I expect that the 3000 killed that day will be remembered as just the small attack at the beginning of the war.

[demosthenes the elder]

and I'd suggest learning how to read.
what part of "(slight hyperbole)" did you NOT understand?

[.38sw]

Since the smallpox is a live virus

The small pox vaccine does not use the smallpox virus; it uses vaccinia. It works because the protein signature is similar enough to smallpox that the antibodies produced by your immune system also attack the smallpox virus. You cannot get smallpox from the smallpox vaccine.

[altayann]

The part I didn't understand? The part where you even 'slightly' suggested it in the first place.

[.38sw]

Oh, sorry. I didn't read far enough. I think the point is that someone with a weak immune system shouldn't get the vaccine. Sounds like it may not be a good idea to vaccinate infants.

[altayann]

D'oh ! #@#$#$!!@@. Sorry, I dropped 'vaccine' from the 'smallpox vaccine'.

[Cicero]

Over a considerable period of time this center treated children from all over the world who had adverse reactions. It sounds as if one in a million is probably a high number. And without doubt millions of children were saved from an unpleasant death from smallpox. Working with sick and dying children isn't pleasant, but a doctor should also consider how many others benefited from the vaccine over the years.

As for people who have weak immune systems (notably those with AIDS), they will be much safer in case of a smallpox attack if most of their neighbors have been vaccinated. The more people who have been vaccinated, the less quickly and widely an epidemic would spread.

If someone was living in the same house as an AIDS patient, they might want to take the precaution of keeping them away from each other for a period of time, to prevent any chance of transmitting the virus. But even for the sake of AIDS victims, vaccinating the general population would be beneficial if, as seems likely, smallpox is still in the secret weapons arsenals of Russia, China, the US, and any countries or persons who may have managed to get their hands on it. Iraq is a likely country.