THE SMALLPOX VACCINE

November 2002
		Is smallpox vaccination an appropriate response to the threat of bioterror? Experts from the Centers for Disease Control and Prevention answer your questions.

Will the vaccine become mandatory? How many people died when the vaccine was last administered to the general public? How long does immunization last? How easily is smallpox spread? How will the vaccine be administered?     Online Special: The Bioterrorism Threat Browse the NewsHour's coverage of health	The smallpox vaccine may soon be administered to a core group of health care workers as part of their voluntary participation in a plan to ready the U.S. for a possible smallpox attack. The Centers for Disease Control and Prevention played a key role in developing the plan, which is being finalized by the Bush administration. Dr. Julie Gerberding, the head of the CDC, told the NewsHour that the pre-attack vaccination plan may eventually be expanded. "We could also consider... including all health care personnel and all first responders such as police and fireman, and hazmat [hazardous material] teams, and so forth in that response group, and that would be up to about 10 million people...," Gerberding said. She also left open the possibility that the vaccine may eventually be made available to the general public on a voluntary basis. While the vaccine is the only means of protection from the disease, it carries its own dangers. The vaccine contains a live virus and can cause a rash, fever and head and body aches. In some cases, these side effects can be severe. Historically, out of 1 million people receiving the vaccine, about 15 will experience life-threatening side effects and one or two will die from adverse reactions to the vaccine. Does the protection the vaccine offers outweigh its risks? Is it fair to expose health care workers to its side effects? Are we doing enough to prepare for the threat of bioterrorist attacks? The CDC provides answers to your questions below.
	Debbie of Indialantic, FL asks: _____________________________________ Do you think this vaccine will stay optional or do you see it becoming mandatory? I work in a hospital in the ER and we are exposed to a lot of diseases already. Based on what I've read, I would not want to have the smallpox vaccine. I have children at home, and I would not want to harm them or their friends and our friends. Medical epidemiologist Dr. Lisa Rotz responds: ___________________________ No vaccine recommended by CDC is mandatory; all are voluntary. The smallpox vaccine is the best protection you can get if you are exposed to the smallpox virus. The smallpox vaccine does not contain smallpox virus and cannot spread or cause smallpox. However the vaccine does contain another virus called vaccinia which is "live" in the vaccine. And it's not just children who should be protected -- but also those who have compromised immune systems or who have skin conditions, such as eczema. Because the virus is live, it can spread to other parts of the body or to other people from the vaccination site. To protect your family and friends, you should carefully take care of the vaccination site. Vaccinia is spread by touching a vaccination site before it has healed or by touching bandages or clothing that have become contaminated with live virus from the site. Vaccinia is not spread through airborne contagion. Vaccinated persons must be very cautious to prevent transmission of the vaccine virus to others. Byron of New York asks: __________________________________ Didn't we all get the smallpox vaccination back in the 1950s and 60s? How many people died from it then? Medical epidemiologist Dr. Lisa Rotz responds: ___________________________ Routine vaccination of the American public against smallpox stopped in 1972 after the disease was eradicated in the United States. In 1968, 572 people in the United States had confirmed vaccine complications and there were nine deaths, according to an article in the New England Journal of Medicine. In the past, between 14 and 52 people per million vaccinated experienced potentially life-threatening reactions. Today it is estimated that between one and two people per million vaccinated will die as a result of life-threatening reactions to the vaccine. Until recently, the U.S. government provided the smallpox vaccine only to a few hundred scientists and medical professionals who work with smallpox and similar viruses in a research setting. After the events of September and October 2001, however, the U.S. Government took further actions to improve its level of preparedness against terrorism. For smallpox, this included updating a response plan and ordering enough of the smallpox vaccine to immunize the American public in the event of a smallpox outbreak. The plans are in place, and there are sufficient amounts of the vaccine available to immunize everyone who might need it in the event of an emergency. Careful screening of potential vaccine recipients is essential to ensure that those at increased risk do not receive the vaccine. P. Dowling of Sydney, Australia asks: __________________________________ If one was vaccinated in 1938, doesn't that provide immunization? I thought vaccination was life long. The CDC responds: ___________________________ Past experience indicates that the first dose of the vaccine offers protection from smallpox for 3 to 5 years, with decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts longer. The CDC provided this information from their Web site. Jodi Barrett of Pomeroy, OH of asks: __________________________________ How does one get smallpox? [Could one catch it by being in the same room with an infected person, or is close contact needed in order to contract the disease?] The CDC responds: ___________________________ Smallpox normally spreads from contact with infected persons. Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Indirect spread is less common. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Smallpox is not known to be transmitted by insects or animals. The CDC provided this information from their Web site. David Snodgrass of Tucson, AZ asks: __________________________________ Is the use of a jet injector gun the best way to administer the vaccination? In 1967, if memory serves, that was the method used to give me the vaccine. Medical epidemiologist Dr. Lisa Rotz responds: ___________________________ The vaccine formulations now available are not formulated for the jet injector gun. Current day problems [with jet injector guns] include concerns about transmission of other infectious diseases such as hepatitis (there have been some outbreaks). The smallpox vaccine is not given with a hypodermic needle. It is not a "shot," like many vaccinations. The vaccine is given using a bifurcated (two-pronged) needle that is dipped into the vaccine solution. When removed, the needle retains a droplet of the vaccine. The needle is then used to quickly prick the skin 15 times in a few seconds. The pricking is not deep, but it will cause a sore spot and one or two drops of blood to form. The vaccine usually is given in the upper arm. If the vaccination is successful, a red and itchy bump develops at the vaccination site in three or four days. In the first week after vaccination, the bump becomes a large blister, fills with pus, and begins to drain. During week two, the blister begins to dry up and a scab forms. The scab falls off in the third week, leaving a small scar. People who are being vaccinated for the first time may have a stronger "take" (a successful reaction) than those who are being revaccinated.