WASHINGTON (Reuters Health) - More needs to be known about the safety of smallpox vaccination before states begin offering the shot to fire and police personnel, a federal advisory panel said in a report issued Tuesday.

In a multi-page letter to the Centers for Disease Control and Prevention (CDC), the Institute of Medicine's Committee on Smallpox Vaccine Implementation said that in addition to concerns about side effects, it thinks the government needs to design educational materials targeted to the new group of potential vaccinees, and should better define what it takes for each locality to be declared "prepared" for a smallpox attack.

Overall, despite not coming close to reaching the oft-cited target of 500,000 vaccinees, the program has gone well, said committee chairman Brian Strom, a professor at the University of Pennsylvania School of Medicine.

"They vaccinated 40,000 people with a toxic vaccine that has not been used for decades, and they did it amazingly safely, very quickly," he told Reuters Health.

As of early May, 36,217 mostly health care workers had been immunized, and about 400,000 military personnel.

But Strom noted that the committee is concerned that so far, information about side effects has been collected for only about a third of the civilians. Some of the rare, serious problems, such as heart inflammation, were expected. However, it is still not clear whether some reported heart attacks might be linked to the vaccine, and whether other side effects might show up.

"It is certainly very possible that there are other side effects that we don't know about yet," said Strom.

The CDC is collecting and analyzing side effect data. That analysis should be done before states begin vaccinating volunteer fire, police and other so-called first responder personnel, said the IOM panel. Most states are expected to start the next round of vaccination in late August or early September.

The IOM panel also suggested that educational materials, currently geared for health care workers, be reworked so they are more understandable by the general public. The CDC is working on that now, Strom said.

There has been much debate about whether enough people have been vaccinated to ensure that the country is prepared for a smallpox attack. Numbers alone won't mean that a particular area is ready, said the panel.

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