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Second heart attack death after smallpox shot reported

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Under the new, temporary guidelines, people who have been diagnosed with serious heart disease such as coronary artery disease, congestive heart failure, previous heart attack and angina are being told not to get the vaccine.

ATLANTA, Georgia (CNN) -- Federal health authorities Thursday announced that a second health-care worker who had recently been inoculated against smallpox has died, but they said they were not sure whether the vaccination played any role.

Officials from the Centers for Disease Control and Prevention identified the fatality as a 57-year-old woman who died Wednesday -- 10 days after suffering a heart attack, and 17 days after being inoculated against smallpox.

The woman, who had a history of heart disease and high blood pressure, developed difficulty breathing and dehydration six days after receiving a smallpox vaccination, said Dr. Walter Orenstein, director of the CDC's National Immunization Program.

The first fatality was a Maryland health care worker in her 50s who had received the smallpox vaccine and died Sunday, five days after receiving her inoculation.

That woman also had a history of heart problems.

In addition to the two fatalities, five other cases of heart problems have been reported among people shortly after they were inoculated: one other person suffered a heart attack, two suffered mild pericarditis -- an inflammation of the heart or its membranes -- and two suffered angina, Orenstein said.

Earlier this week, after the first death was reported, the CDC asked people diagnosed with heart disease not to be vaccinated against smallpox until it can be determined whether there is a causal link.

According the CDC, 25,645 individuals in the United States have been vaccinated between January 24 and March 21.

They participated in the civilian smallpox vaccination program, which is part of the nation's bioterrorism preparedness plan.

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In addition to the reports of possible vaccine side effects among civilians, 10 cases of mild pericarditis were reported among the 500,000 military personnel who have received the vaccination since early January, Orenstein said. All of these patients have recovered and returned to duty. "They were not that sick," Orenstein said.

"While the available evidence suggests that the vaccine may be playing a causal role in inflammation of the heart, around the heart, it is not clear whether the other cardiac events are causally related or coincidental," Orenstein said.

According to Orenstein, two-thirds of the civilian smallpox vaccination program participants are over the age of 45, and most of them are women.

The CDC's Advisory Committee on Immunization Practices is to meet Friday to determine which groups should be deferred for vaccination and to devise guidelines for clinics to use in screening potential vaccine recipients.

Cardiac side effects were not considered a risk during the years when smallpox was routinely administered to Americans prior to its eradication worldwide during the 1970s, Orenstein said.

At that time, health officials estimated that the vaccine killed one or two of every million recipients, which health officials deemed acceptable since the disease has a 30 percent mortality rate. But its use now, at a time when it is not clear whether would-be terrorists even have stockpiles of the virus, has stirred controversy.

The CDC recommends many people -- including pregnant women and those with weakened immune systems, such as HIV patients and some people with cancer and those with certain skin conditions like eczema -- not be given the vaccine.

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