Smallpox Vaccination For Everyone?
Many Factors Will Influence A Decision
On Monday February 10 our county health department led a nine county effort aimed at creating a regional smallpox response teams. Statewide, over five hundred were inoculated against the disease on that day, a number that had reached nearly eight hundred by the end of the week.
Now that inoculations have begun, our residents, like millions nationwide, are becoming increasingly interested in the disease, the vaccination, and the consequences of both. Smallpox last occurred in the United States in April of 1947; in that outbreak, nearly six and a half million received vaccinations, twelve people were diagnosed with smallpox, two died of the disease - and eight died from the vaccine.
“This is a disease that does not exist in nature,” explains Dr. Judith Hartner, director of the Lee County Health Department. The last natural case of smallpox on earth occurred in 1977. Officially, it was considered to be eradicated on May 8, 1980 by the World Health Organization (WHO); the United States had stopped routine childhood inoculations in 1972. Now only two locations worldwide are verified as having samples of the organism.
“Horrendous” is not an unfair description to use when discussing smallpox: the effects on the body were devastating and survival marked by horrible, lifelong scarring. When smallpox remained a scourge, the death rate was approximately thirty percent. There’s absolutely no debating its terror - anyone with any sense fears it, and will do anything necessary to avoid it. But, “For all practical purposes, most Americans do not know smallpox, have never experienced it, and those of us who’ve been inoculated in the past no longer have protection,” says Robert South, an epidemiologist at the Lee County Health Department who chose to receive the new vaccination.
|
An expected 286 million doses of vaccinia will be available by year’s end. |
|
Our present challenge becomes, as individuals and as a nation, to keep perspective during emotional times with emotional subjects, when there appears to be honest differences of opinion even among those in charge of planning for our welfare. “In doing this, I accept a risk for myself and my family by getting the vaccine today,” acknowledged Hartner, the health department leader. An expected 286 million doses of vaccinia will be available by year’s end, and a recent Harvard University poll found that three in five Americans say they would get vaccinated if possible as a precaution. So the question becomes: why not just immunize the entire population?
To answer that question, many points must be considered:
-
Since smallpox no longer occurs in nature, should we create a public health policy, in Florida or nationwide, to immunize against something that in theory at least, doesn’t exist?
-
Some people will die from the vaccination itself. This is a fact. An estimated 280 – 300 people will die if the entire country is given the immunization. Proportionately, southwest Florida could expect one death.
-
Side Effects. Bearing in mind that smallpox is a terrible disease, with a death rate of about thirty percent, side effects must still be considered. The Centers for Disease Control and Prevention (CDC) states that although risks of serious complications of smallpox vaccination are low, they can and do occur. Encephalitis (brain inflammation) occurs in about one in 300,000 doses in children, and one in 200,000 adults.
-
Vaccination is not recommended for people with HIV infection, AIDS, those undergoing chemotherapy, and those with eczema or other chronic skin disorder. In all, the CDC estimates that vaccinating everyone in the nation between the ages of one and sixty-five would result in 4,600 “adverse events” and 285 deaths.
-
Unfortunately, we also have to add to this mix the realities of both politics and a media that at times values sound bites, “instant analysis” and headlines over medical and scientific thought and deliberation.
At this time, voluntary vaccination of the general public is not expected to occur until at least 2004. When and if the need or policy ever does occur, some factors each of us muct consider include:
-
Our own personal risk. Eczema, pregnancy, chemotherapy and HIV and AIDS infection all impact on risk.
-
Close contact with someone with HIV or other disease.
-
Our willingness to accept the possibility of “minor” side effects, which could include, among other things, sore arms, fever, a missed day or two from work or school, and a scar at the site of vaccination.
-
Our willingness to accept the possibility of “major” side effects. Though rare, the two most serious are postvaccinal encephalitis and progressive vaccinia. Postvaccinal encephalitis occurs at a rate of 3 per million primary vaccinees; 40% of the cases are fatal, and some patients are left with permanent neurologic damage. Progressive vaccinia occurs among those who are immunosuppressed because of a congenital defect, malignancy, radiation therapy, or AIDS.
A good source for learning more can be found online at the Centers for Disease Control’s smallpox website at http://www.bt.cdc.gov.
