- Hello Jeff - Below you will find the MD Anderson Cancer
Hospital information regarding contact vaccinia virus infection and the
risk to cancer patients (as well as any of us with autoimmune disease,
eczema, HIV, HCV, etc etc.).
-
- The Anderson concern for contact within 6 FEET tells
me that the risk of transmission IS via aerosol, even limited, so that
even coming within 5 feet of a newly-vaccinated health worker is of serious
concern.
-
- I advise that you first find out if your doctor, dentist,
etc has had smallpox vaccine within the past 21 days before you make an
appointment. Unfortunately, I did not hear MD Anderson offer to give medical
help time off. I would hope that at least 14 days after inoculation would
have been given. Without time off, employees should be STRONGLY urged to
stay at home in quarantine. It would not be of advantage for the newly-vaccinated
to go out to shopping malls, movies, etc and thus put the public at risk.
-
- Bush is making a very, very bad mistake by initiating
smallpox vaccinations at this time. There is simply too much risk to the
public compared to the actual risk of a terrorist event using smallpox.
I have stated that a terrorist would probably choose chemical weapons,
or agraterrorism against livestock and/or crops. If bioterrorism were to
be used, anthrax, plague or tularemia would probably be choices. The delivery
is easy, and if released at rush hour in subway or large office tower ventilation
system, anthrax would kill as many, if not more people, than smallpox.
-
- If 'Homeland Security' would have done its HOMEwork,
they could have learned from the New York City 1948 outbreak. At that time,
the index patient - who reported to an ER - was not diagnosed and he was
sent home. It was after two of the hospital employees took ill, that the
health department figured out it had smallpox to deal with. The index case,
quite ill, reported to a second hospital. Even with the loss of time in
diagnosis, the health department was able to contain the outbreak to 2
deaths and 12 cases in total. Not a big kill rate for a bioterrorist.
-
- Of course, mobilizing for smallpox bioterrorist event
is big news for Homeland Security. Lots of money involved as well...especially
for pharmaceutical industrial complex.
-
- I think, given the stability of anthrax or plague, and
given the ease of distribution and delivery, either would be the choice
of a terrorist...and not smallpox.
-
- Patty
-
-
- Smallpox Vaccination - Request For Information
-
- A ProMED-mail post
- promed@promed.isid.harvard.edu
- ProMED-mail is a program of the
- International Society for Infectious Diseases
- www.isid.org
-
- Date: Fri, 13 Dec 2002 11:12:26 -0600
- From: J Tarrand MD
- jtarrand@mail.mdanderson.org
- M. D. Anderson Cancer Center
-
-
- Re: PRO Smallpox vaccination strategies - USA (08)
- -----------------------------------
- The smallpox vaccine contraindications include close
contacts with
- immunocompromised individuals. Some at our Cancer Center
take this to
- mean anyone who is working directly or may be within
6 feet of our
- cancer patients (i.e., virtually everyone). How have
other centers
- with immunosuppressed populations interpreted this contraindication?
-
- My understanding is that in a 1968 study from 10 state
surveillance,
- only 27 post-vaccination transmissions were documented
per million.
- With better wound care, strict hand-washing, and vaccination
of only
- those with a preexisting scar, shouldn't the risk be
considerably lower?
-
- J Tarrand MD
- MD Anderson cancer center
-
- ______________________
-
- Dr. Tarrand's questions re: smallpox vaccination risks
are
- legitimate ones that face many health care institutions.
This
- moderator chooses to preface a response with an acknowledgement
that
- definitive answers are not easy to come by. Information
and studies
- on the adverse effects of smallpox vaccination are primarily
from
- times of outbreaks and from the era when routine smallpox
vaccination
- was conducted. As routine immunizations were discontinued
in the USA
- in 1972, and worldwide in 1982, the numbers of immunosuppressed
- persons who were potentially exposed to recently vaccinated
- individuals was significantly lower than today (in the
general
- public), and definitely lower than patient populations
in the
- hospital institutional setting.
-
- There is a good summary of the data from Lane's papers
on smallpox
- vaccination adverse effects at:
- http://www.bt.cdc.gov/agent/smallpox/vaccine-safety/adverse-events-chart.asp
-
- 1. Lane JM, Ruben FL, Neff JM, Millar JD. Complications
of smallpox
- vaccinations, 1968: national surveillance in the United
States. New
- Engl J Med 1969;281:1201-1208.
- 2. Lane JM, Ruben FL, Neff JM, Millar JD. Complications
of smallpox
- vaccination, 1968: results of ten statewide surveys.
J Infect Dis
- 1970;122:303-309.
-
- The numbers of inadvertent inoculations per 1,000,000
vaccinees cited
- in the 2 studies were:
- (the primary vaccinees were predominantly infants less
than one year of age):
-
- NATIONAL SURVEY (Ref 1 above)
- All primary (i.e., first-time) vaccinees 25.4
- Vaccinees greater than or equal to 1 year of age 27.1
-
- 10-STATE SURVEY (Ref 2 above)
- All primary (i.e., first-time) vaccinees 529.2
- Vaccinees greater than or equal to 1 year of age 532.0
-
- The last paragraph in the discussion is important: "The
authors of
- the studies state that the national survey statistics
should be
- considered minimal estimates of the risks of smallpox
vaccination.
-
- The authors assert, on the other hand, that a small number
of
- patients included in the 10-state survey may have been
vaccinated
- prior to or after 1968. Those rates, therefore, may overestimate
- slightly the true incidence of complications. Thus, when
describing
- rates of the more severe smallpox vaccine adverse events
in 1968
- (vaccinial encephalitis, vaccinia necrosum, and eczema
vaccinatum),
- it appears to be preferable to use the range presented
by the 2
- studies. The 10-state survey data may present a better
estimate of
- less severe adverse event rates from 1968 (generalized
vaccinia and
- accidental autoinoculation)."
-
- Yes, there is a reported shorter duration of inoculation
site
- infection in those with pre-existing immunity. However,
the current
- body of literature is unclear on the duration of immunity;
the
- commonly accepted duration is 10 years, but current studies
are few.
-
- Frelinger and Garba (ref 1 below) reported that 13/14
subjects
- studied had detectable antibody 35 or more years after
last known
- exposure to smallpox vaccine. A study by Suari et al.
in Maryland
- involved 621 subjects and concluded that approximately
75 percent of
- his population had no evidence of residual immunity as
defined by
- "take rate" following revaccination (ref 3
below). A study by Frey
- et al. (ref 2 below) of 680 never-vaccinated individuals,
while
- addressing the issue of dilution of vaccine dose, noted
that 5.7
- percent (37) of vaccinees had rashes at sites other than
the
- vaccination site on days 7,8, and 9 and 10.1 percent
(67) on day
- 10,11, or 12 with an overall 14.3 percent (95) having
a rash at a
- site other than the vaccination site.
-
- This moderator cannot address the question of how other
centers with
- immunosuppressed populations are interpreting this contraindication
- but can only guess that there are significant concerns,
especially
- given the high level of "unknowns" at present.
ProMED-mail would be
- very interested in hearing how other institutions are
interpreting
- this contraindication to vaccination in light of the
planned
- vaccination activities.
-
- 1: Frelinger JA, Garba ML. Responses to smallpox vaccine.
N Engl J
- Med. 2002 Aug 29;347(9):689-90; discussion 689-90.
-
- 2: Frey SE, Couch RB, Tacket CO, Treanor JJ, Wolff M,
Newman FK,
- Atmar RL, Edelman R, Nolan CM, Belshe RB. Clinical responses
to
- undiluted and diluted smallpox vaccine. N Engl J Med.
2002 Apr
- 25;346(17):1265-74.
-
- 3: Sauri MA. Responses to smallpox vaccine. N Engl J
Med. 2002 Aug
- 29;347(9):689-90; discussion 689-90.
-
- 4: Sauri M, Sibley C, Monk B, Nichols M, Lai S. Durability
of
- vaccinia immunization based on reaction at the rechallenge
site. Md
- Med. 2002 Spring;3(2):44-51.
-
- 5: Arita I. Duration of immunity after smallpox vaccination:
a study
- on vaccination policy against smallpox bioterrorism in
Japan. Jpn J
- Infect Dis. 2002 Aug;55(4):112-6.
- <http://www.nih.go.jp/JJID/55/112.pdf> Mod.MPP]
-
- [see also:
- Smallpox vaccination strategies - USA (08) 20021112.5785
- Smallpox vaccination strategies - USA (07) 20021018.5591
- Smallpox vaccination hazards (03) 20021017.5571
- Smallpox vaccine hazards (02) 20021015.5559
- Smallpox vaccination strategies - USA (06) 20021006.5479
- Smallpox vaccination strategies - USA (05) 20020924.5390
- Smallpox vaccination strategies - USA (04) 20020923.5383
- Smallpox vaccination strategies - USA (03) 20020915.5312
- Smallpox vaccination strategy - Israel 20020820.5095
- Smallpox vaccine hazards 20020817.5080
- Smallpox vaccination strategies - USA (02) 20020726.4868
- Smallpox containment strategies - USA 20020711.4725
- Smallpox vaccination (02) 20020710.4715
- Smallpox vaccination strategies - USA 20020709.4710
- Smallpox vaccine, ACIP recommendations - USA (02) 20020621.4560
- Smallpox vaccine, ACIP recommendations - USA 20020620.4542
- Smallpox vaccination 20020611.4468
- Smallpox, diluted vaccine trial (05) 20020219.3587
- Smallpox, diluted vaccine trial (06) 20020304.3685
- Smallpox, diluted vaccine trial (07) 20020307.3707
- Smallpox, diluted vaccine trial (08) 20020329.3841
- Smallpox, diluted vaccine trial (09) 20020331.3849
- Smallpox, diluted vaccine trial (10) 20020404.3876
- Smallpox, diluted vaccine trial (11) 20020404.3880
- Smallpox, diluted vaccine trial (12) 20020408.3904
- Smallpox, diluted vaccine trial (13) 20020409.3919
- 2001
- ----
- Smallpox, diluted vaccine trial 20011117.2827
- Smallpox, diluted vaccine trial (02) 20011119.2844
- Smallpox, diluted vaccine trial (03) 20011121.2850
- Smallpox, diluted vaccine trial (04) 20011123.2870
- Smallpox, re-vaccination & immunity 20011029.2672
- Smallpox, re-vaccination & immunity (02) 20011101.2700
- Smallpox, re-vaccination & immunity (03) 20011102.2718
- Smallpox vaccine, ACIP recommendations 2001 20010623.1190
- Smallpox vaccine, WHO statement 20011025.2641
- Smallpox vaccine, WHO statement (02) 20011027.2649]
- ..........................mpp/pg/lm
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