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Smallpox: To vaccinate or not?

Infectious disease expert Dr. Paul Offit does not recommend the smallpox vaccine for the general public because of its dangers.
Infectious disease expert Dr. Paul Offit does not recommend the smallpox vaccine for the general public because of its dangers.

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(CNN) -- Hundreds of thousands of Americans will soon be getting smallpox vaccinations as part of the Bush administration's plan to protect against a bioterror attack.

Military personnel will be the first to receive the shots, in addition to President Bush himself. Medical and emergency response workers will be able to get the shots on a voluntary basis, Bush said Friday in announcing his plan.

The inoculations have not been recommended for the general public, but will be made available to people who want them, Bush said. The question of whether to get vaccinated is a serious one, however, because the smallpox vaccine can have severe and potentially fatal side effects.

CNN anchor Leon Harris and medical correspondent Dr. Sanjay Gupta discussed the vaccine with Dr. Paul Offit, chairman of infectious diseases at Children's Hospital in Philadelphia, Pennsylvania.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: This is the announcement that we've been waiting for quite some time. It is a controversial vaccine... because the fact [is] this is a dangerous vaccine. One to two out of a million people will likely die from that. If you vaccinate the entire country, that's about 250 to 500 people would actually die from this.

One thing that comes up over and over again is kids. Should these kids be getting vaccinated? Dr. Offit, I'm kind of curious what some of your thoughts are, especially in your position?

DR. PAUL OFFIT, INFECTIOUS DISEASE EXPERT: Well, I think that the recommendation by the Advisory Committee of Immunization Practices, which is the committee that recommends vaccine usage to the Centers for Disease Control, has said both in June of this year as well as October of this year, is that we do not recommend it be distributed to the general public, and the reason for that is remember, there is right now no disease that has occurred on the face of this Earth in 25 years, and as you said... it is a vaccine which has severe and occasionally fatal side effects.

So I think right now, certainly for the general public, the feeling is that the risks of the vaccine outweigh its benefits.

LEON HARRIS, CNN ANCHOR: Let's get right to the e-mails. The first one comes to us from Romeo, Michigan. Gerard writes, "I have read that smallpox is not very communicable at all, and that conditions in which it's spread are usually classified as prolonged, intense contact with an infected individual. Is that true?"

GUPTA: Well, this is actually a very contagious disease, which is precisely the reason that people are so scared of it. This is a disease that can be spread by people actually coughing on one another in the late stages of the disease. This is not something that you could have -- be actually spreading -- without knowing that you're spreading.

You're going to be pretty sick if you're going to be contagious. But once you are sick, you can be very contagious, Leon. There are stories about people being able to spread this to 17 people just with a cough. But again, I want to reinforce again, by the point you get contagious, you're very sick, you're not out flying on airplanes, you're not at the shopping malls; you're home in bed.

HARRIS: Let's get to the next e-mail we have... from Rob in Richmond, Virginia: "I had a smallpox vaccination as a child some 35 years ago. I've heard that I may have some protection now, but probably not complete protection. If I want to be revaccinated, does that mean I won't have an adverse reaction since I didn't have an adverse reaction as a child?" How about that one, Dr. Offit?

OFFIT: Well, there are two parts to that question. I think that it's very clear that if you've already received a vaccine, your chance of having a serious, adverse or fatal reaction from the vaccine is at least tenfold lower. So that's true, and that should be reassuring.

The first part of that question is one of duration of immunity, and it's hard to know the answer. There was one study done in the early 1900s in Liverpool, England, and they looked at an outbreak of smallpox and tried to answer the question, if you were vaccinated, were you protected, and if so, how long before you had been vaccinated did that protection last? What they found was 50 years after vaccination, the protection was at least tenfold as compared to a non- vaccinated group. That's reassuring.

But remember, those were back in the days when people often received, you know, one or two or three doses of the vaccine in childhood, not just the one we typically received when we were younger. So I think the answer is, there probably is some protection, but it's likely that for people that got a single dose, the protection wanes.

GUPTA: We've got phone calls coming in as well. Chris from Scarborough Maine is on the phone. Chris, go ahead with your question please.

CALLER: Yes, what is the difference between the side effects from a smallpox vaccine and side effects from regular childhood vaccines?

OFFIT: I think that's a really important question. We're so used to modern vaccines, which were developed all, for the most part, within the last 60 years, which have excellent safety profiles. The fact of the matter is, 3 1/2 million to 4 million children every year get vaccines, and they don't cause permanent harm, and they certainly don't cause death. I mean, we're really fortunate to have modern vaccines. It's really wiped out much of the scourges of childhood.

But that's not this vaccine. The smallpox vaccine is not a modern vaccine. It was developed by Edward Jenner in the late 1700s, and the vaccine that we have today is essentially the same vaccine.

Now you could ask, wouldn't it be possible to use modern technology and make a better vaccine, and I think the answer to that question is yes, but it's going to take several years for that to happen, and then the question becomes, can we wait that long?

HARRIS: Let's get to the next e-mail. Next one is from Emilio in Caguas, Puerto Rico. "Can you tell me which is the most effective treatment for smallpox?"

GUPTA: This is a fascinating question, because there really aren't good treatments for smallpox, and one of the things we've talked about a lot is, in order to develop a good treatment for smallpox, Leon, you'd have to knowingly actually infect human beings to be able to test whether or not that treatment was actually a good treatment. No one's going to knowingly infect themselves with smallpox to be able to test that.

There are some good what are called antiviral medications. There is one antiviral medication that seemed to have some promise, at least in laboratories, especially in monkeys in laboratories, but it's really hard to know in human beings, and as Dr. Offit pointed out, we haven't seen this in almost 25 years.

HARRIS: You can't test on an animal to find out about humans. That's a tough one.

Next e-mail is from A.M. in Branson, Missouri, who writes, "Why is smallpox vaccination considered so dangerous due to possible side effects when as children we were all forced to be inculcated in order to be allowed to enter school? Are the dangerous greater in this new vaccine?"

Good question.

GUPTA: Maybe we both can take a stab, because this is an important point and worth reinforcing. It's the same vaccine as the doctor just pointed out, Jenner in 1796 developed this vaccine, 200 years later, we have the same vaccine. It was just as dangerous as it is today. A couple things have changed. One thing is there are more cases of HIV and chemotherapy than there were before, so more people are at risk, and also the virus doesn't exist like it did before, wouldn't you agree, Dr. Offit?

OFFIT: I think that's exactly right. When you assess the safety of a vaccine, you obviously compare the risks of the vaccine with the risk of the disease. Well, the fact is, is that 50, 60 years ago, the disease still did exist -- I mean, to a lesser extent in this country, but certainly in the world. Now the disease is gone. So therefore, one focus largely just on the risks of the vaccine, and we've made the decision for the last 25 years or so that the risks of the vaccine outweigh its benefits. That's why we haven't been giving it.

HARRIS: I got a phone call the last time you were on to talk about this, [from] a man who has eczema, who was wondering about the particular risks for those with eczema and this vaccine.

GUPTA: Huge topic, eczema affects about 10 percent of the population, 28 to 30 million people. Basically, eczema is a condition of the skin. If you get this vaccine, you have a higher likelihood of spreading the vaccine, this little scar blister thing, all over your entire body, a condition know as eczema vaccinatum. This is a condition that if you see the pictures ... just terrible pictures, rashes all over the body, and it can potentially be deadly as well. That's why people are very concerned, if you've had eczema ever, if you have it now, or if you live with someone with eczema, this vaccine is probably not a good idea for you.

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