Smallpox vaccine program evolves: inoculation list expands to more people in 'high threat' areas - Airman Consumer

Airman, June, 2003 by Scott Elliott

America's response to the Sept. 11, 2001, terrorist attacks has been multifaceted and well-documented - the war on al Qaeda, the establishment of the Department of Homeland Security and the 24-7 combat air patrol coverage of Operation Noble Eagle, to name a few.

Most Americans have been affected to some degree by these security measures. Few, however, have been at the same personal level as those who had to receive anthrax and smallpox vaccinations.

Military members have been receiving inoculations against the smallpox virus since December 2002, when President George W. Bush directed people in high-threat areas to be vaccinated.

Initially, the Air Force targeted medical professionals and designated forces in specific mission-critical areas as the first to be vaccinated. Those medics included members of the Smallpox Epidemiological Response Team and those responsible for administering the vaccine to others.

The vaccination program expanded with airmen deployed to high-threat areas, such as those supporting Operations Enduring Freedom and Iraqi Freedom. "Mission essential" civilian employees deployed to selected overseas locations began receiving vaccinations in March.

The latest group to join the inoculation list includes many nonmilitary people living and working in locations the Defense and State departments consider "high-threat." Voluntary smallpox and anthrax vaccinations are now available for the adult family members of service members, all appropriated and nonappropriated fund DOD civilian employees and their adult family members, and civilian contract employees.

Civilian contractor family members are not authorized the vaccine. Employees who volunteer for the vaccination must be authorized by their employers.

Old vaccine, new process

The United States routinely inoculated children against smallpox until 1972 and, in 1980, the World Health Organization declared smallpox eradicated worldwide. As a result, the remaining small supply of vaccine was more than two decades old.

"I think we ought to take some comfort in that," said Brig. Gen. Robert Smolen, director of nuclear and counter-proliferation at the Pentagon. "While the vaccine may be old, this is the vaccine that was proven successful. The supply has been tested, and there's been no degradation to quality."

One of the program's early goals was an aggressive public education program. Patients selected for inoculation were provided smallpox information from a variety of sources, including handouts, commander's calls, talking to health care professionals and access to the DOD smallpox Web site at www.vaccines.army.mil.

Before receiving the vaccine, patients undergo a thorough prescreening process, because the vaccine has unique "contraindications," or reasons to avoid it, medical officials said.

"Contraindications in either the individual receiving the vaccine or the person's household contacts will preclude a nonemergency vaccination," said Lt. Col. (Dr.) Kelly Woodward, chief of preventive medicine at the Air Force Medical Operations Agency, Boiling Air Force Base, D.C.

The service adopted a new set of items to its prescreening program after the Center for Disease Control and Prevention report on an investigation of whether a sequence of cardiac deaths was associated with the vaccine.

"It's not known whether the heart attacks were causal or a coincidental association with smallpox vaccination," said Maj. (Dr.) Mylene Huynh, deputy chief of the operational prevention division of the medical operations agency.

The CDC recommended not to inoculate people with conditions such as prior heart attack, angina, congestive heart failure, stroke or other cardio conditions currently being evaluated by a physician, Huynh said.

In addition, people with three or more of the following cardiac risk factors are being exempted from smallpox vaccination: hypertension, high blood pressure, high cholesterol, diabetes, a family history of heart disease and current smokers.

Protecting the force

More than 350,000 service members have been vaccinated since the program began six months ago. Although the smallpox vaccine does have some well-documented side effects, only 10 Air Force members suffered serious adverse reactions.

"Many people can expect to have minor side effects, such as feeling achy, low-grade fever, headache and itching at the injection site," Woodward said. "Those are minor reactions and resolve on their own."

The smallpox vaccine is a "live-virus" vaccine that uses vaccinia virus; however, people cannot contract smallpox from the vaccine, Woodward said,

People who were inoculated prior to 1972 will have to be revaccinated if they're selected to deploy to one of the high-threat areas, Woodward said.

"We know that, over time, the body's defenses against smallpox -- those gained through vaccination -- decrease," he said, "People need to be revaccinated every 10 years."

A potential benefit for being one of those being revaccinated is that the threat of serious side effects is lower than for those getting the shot for the first time, Woodward said.