Federal Smallpox Vaccination Programs at Near ‘Halt’
Federal officials attending an immunization policy conference yesterday said the military and civilian smallpox vaccination programs launched by the Bush administration have "virtually come to a halt" -- the military has vaccinated nearly all eligible recipients, while the civilian program has seen dwindling numbers of volunteers, the New York Times reports (McNeil, New York Times, 6/19). Under the civilian plan, which commenced in January, about 500,000 health workers were scheduled to be vaccinated in the program's opening weeks. The second phase of the plan was scheduled to inoculate up to 10 million health workers, firefighters, police and ambulance personnel (California Healthline, 1/30). The military has vaccinated 454,856 personnel, nearly all of those eligible, and continues to vaccinate approximately 1,000 personnel per week as "maintenance," according to Col. John Grabenstein, an official in the Army surgeon general's office, who led the military vaccination program. Meanwhile, state health departments have vaccinated 37,608 civilian health care workers and continue to vaccinate about 100 workers per week, the Times reports. Dr. Raymond Strikas, the CDC's director of smallpox preparedness, said the civilian program "got off to a slow start" and then "dropped off sharply" after March. According to Strikas, there were several reasons for low vaccination rates among civilians: a quick military victory in Iraq, several cases of heart inflammation and three heart attacks that led the CDC to prohibit people with a history of heart disease from being immunized, resistance from health care workers before Bush signed a federal compensation program on April 30 and competition for attention and state resources from SARS and monkeypox. Strikas said, "What we are in now is what we call the natural pause between stage 1 and stage 2." Strikas added that stage 3 would extend the vaccine to the general public, "but there's been relatively little clamoring for that" (New York Times, 6/19).
Some federal officials are concerned that the low vaccination rates could leave the nation unprepared in the event of a smallpox attack, the AP/Las Vegas Sun reports. According to statistics released by the CDC yesterday, 40% of the nation's acute care hospitals have vaccinated at least one worker against smallpox, and about 10% of hospitals nationwide have vaccinated more than 25 staff members. Speaking yesterday at a briefing of the CDC's Advisory Committee on Immunization Practices, CDC National Immunization Program Director Dr. Walter Orenstein said, "If we had an outbreak today, we would clearly need unvaccinated staff to help." Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said, "We are extremely vulnerable right now. If a single case shows up ... we are not prepared for that" (Yee, AP/Las Vegas Sun, 6/18).
CDC officials yesterday said careful screening of potential smallpox vaccine candidates has led to fewer serious adverse reactions than expected, USA Today reports. Of the more than 450,000 military personnel who have received the vaccine, 32 have experienced "mild skin rashes," about 75 have transmitted the vaccine virus to family members or other parts of their body and one has contracted encephalitis. According to CDC officials, the most serious reactions in vaccine recipients were numerous cases of inflammation of the heart tissue. Officials have detected 46 cases of heart inflammation among military personnel. Among about 37,000 civilian recipients, there were approximately 22 suspected or probable cases of heart inflammation (Manning, USA Today, 6/19). In April, a Maryland woman and a Florida woman -- both health workers -- and a 55-year-old National Guard member died of heart attacks after receiving the vaccine (California Healthline, 4/7). However, the CDC's Dr. Juliette Morgan said there is no evidence that the heart attacks were caused by the vaccine. "I take that as proof that our screening succeeded marvelously," Grabenstein said (New York Times, 6/19). The ACIP will meet again today to decide whether to recommend moving on with the second stage of the national smallpox vaccination program, in which police and other emergency workers could volunteer to receive the vaccine (USA Today, 6/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.