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Smallpox Vaccine Candidates Narrow After Three Deaths

Mar 31, 2003 | USA TODAY The list of people who can't receive the smallpox vaccine will expand, at least temporarily, to include heart patients and people at risk of heart disease, a panel of medical experts recommended Friday.

The deaths last week of two health care workers, both women in their 50s, who suffered heart attacks after receiving smallpox vaccine prompted the recommendation, approved during a special meeting of the Advisory Committee on Immunization Practices, which advises the Centers for Disease Control and Prevention.

A third heart-attack death was reported Friday at the meeting by Lt. Col. John Gravenstein of the Army Surgeon General's Office, who said a 55-year-old National Guardsman died Wednesday, days after receiving smallpox vaccine. Preliminary autopsy results indicate the man had a prior history of coronary artery disease, so the military believes it is unlikely the vaccine caused the man's death, he said.

Other heart problems have emerged in a small number of health workers and military personnel who have been vaccinated recently. The CDC has reports of another heart attack, in which the patient recovered, two cases of angina, or chest pain, and two of myocarditis or pericarditis, an inflammation of heart tissue that has also been reported in 10 of the more than 350,000 vaccinated military troops. All were mild, but the number of cases has raised a red flag to doctors suggesting that the vaccine, which contains a live virus similar to smallpox, may be causing the inflammation.

Myocarditis, which is often preceded by a viral infection, is usually not serious, cardiologist Joseph Parillo of the Robert Wood Johnson School of Medicine told the committee, but "the danger is that a significant number go on to develop (heart disease)."

The advisory committee rejected proposals to exclude only people with diagnosed heart disease, or to exclude from the voluntary smallpox vaccination program anyone over age 50, which would automatically eliminate 25% of eligible health care workers. Instead, the committee decided that people with known heart disease or who have three or more risk factors such as diabetes, high blood pressure or high cholesterol, should be excluded. The plan will exclude 6.1% of health workers.

Pediatrician Paul Offit of Children's Hospital of Philadelphia proposed a temporary halt to the vaccination program while research on a possible link between the vaccine and heart problems continues. "Many people don't know they have underlying heart disease," Offit said.

Health departments in California, Illinois and New York said they will suspend smallpox vaccination clinics, pending more information and new screening guidelines from the CDC. "This is a prudent and cautious approach that will interrupt our clinics only very briefly," said Kristine Smith of the New York State Department of Health.

The vaccination program, announced in December, is part of a national effort to prepare health and emergency workers to respond to a potential smallpox attack by terrorists. So far, 25,645 health workers and public health officials have been immunized.

The new restrictions will stay in place until the vaccine's role in heart attack, if any, is determined.

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