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BMJ 2002;324:1176 ( 11 May )
 

News roundup

US reviews smallpox vaccination policy

Fred Charatan Florida

US public health doctors and preventive medicine specialists met in Atlanta, Georgia, last week to consider whether to continue the policy of prohibiting vaccinations against smallpox unless a smallpox bioterrorist attack takes place or whether to allow smallpox vaccination for anyone who wants it.

The Advisory Committee on Immunization Practices and the National Vaccine Advisory Committee of the Centers for Disease Control and Prevention (CDC) have formed a joint panel which will present recommendations to the full Advisory Committee on Immunization Practices next month.

Routine vaccination against smallpox stopped in the United States in 1972, and the World Health Organization declared the disease eradicated in 1979. It is estimated that a half of the US population is now susceptible to smallpox.

Dr Glen Nowak of the CDC said, "The current knowledge levels of physicians and the public are likely to limit understanding of strategies intended for determining smallpox vaccine use before or after a bioterrorist attack."

Dr D A Henderson, who led the worldwide smallpox eradication programme in the 1970s and is now an adviser to Tommy Thompson, US secretary of health and human services, told the panel that there was no information to suggest that a smallpox attack was likely. However, in the event of a smallpox bioterrorist attack the CDC’s current policy is for vaccination of first responders (doctors, nurses, hospital and clinic personnel, and the fire, police, and ambulance services), isolation of people infected with smallpox in special units, and vaccination of identified contacts.

Dr Henderson and other speakers cited many problems if the smallpox vaccine were to be offered to all Americans who wanted it. People with compromised immune systems, such as people with AIDS, and those with a history of eczema or atopic dermatitis are at risk from vaccination. A recipient of smallpox vaccine can infect another person by transfer of the virus by hand or through bathing. Other complications include post-vaccination encephalitis.

The current classification by the Food and Drug Administration of smallpox vaccine as an investigational drug requires that everyone being vaccinated must give informed consent, but many doctors are concerned about their liability if they were to give the vaccine.

Dr William Bicknell, professor of international health, sociomedical sciences, and community medicine at Boston University’s School of Public Health, emphasised that relying on containment, tracing contacts, and isolation as the primary strategy to manage a malicious release of smallpox virus was very risky. Claiming that there was good reason to believe such a strategy would not work, he urged the CDC to seriously reassess its current policy. He published his views last month in the New England Journal of Medicine (2002;346:1323-5).

The CDC announced that it plans to hold forums in four US cities over the next few weeks to discuss the risks and benefits of reintroducing smallpox vaccination.

For further information see www.cdc.gov
 
 

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