A disease eradicated a quarter of a century ago seems to have come back to haunt the people of our country with a little help from bio-terrorism. Dr. Elizabeth MacNeill, MD, MPH, Chief Medical Officer of Pima County Health Department (PCHD), recently addressed a group of UBRPers her at UA and discussed the pros and cons of a possible vaccination against the disease.

The cause of the disease, the variola virus causes the distinct progressive skin rash, accompanied by high fever. As of today no proven treatment exists and is known to cause fatality in 20-30% cases. It is considered to be contagious, especially during the onset of lesions to scab separation; but, according to the information available on CDC’s website ‘direct and fairly prolonged face-to-face contact’ is required for the transmission of the disease. Usually the virus is not airborne and as such not as contagious as the common flu or measles. An infected person is usually very sick and not able to move around in the community. This raises the question as to how likely a person would be to avoid detection and carry the disease to the US.

The effects of the vaccine are also questionable. The vaccine, ‘Dryvax’, includes side effects of severe allergic reactions, autoinoculation, generalized vaccinia, axilary adenopathy, eczema vaccinatum, encephalitis and in some cases death. Considering these side effects, the vaccine is not recommended for persons with weakened immune system, with history of eczema/atopic dermatitis, with interrupted skin disease, those with history of cardiomyopathy, heart attack, angina, other coronary artery diseases or with 3 or more major risk factors for CVD, and pregnant or breastfeeding women. This means more than three-quarter of the US population are ruled out from taking the vaccine. Effects on different age groups are not yet fully understood. Liability issues complicate the matter further with health workers not getting compensations for the severities experienced. The initial plan of the government to vaccinate the entire US population is currently stalled after the side effects seen in healthcare workers who were the initially treated. However, the CDC claims it has enough vaccines to vaccinate everyone “who needs it” in the US in the case of an outbreak. In an answer to one of the questions Dr. MacNeill pointed out that in such an event this would probably include all of the population regardless of side effects. Interestingly Arizona was one of states to terminate statewide vaccination of healthcare workers early on. Knowing the side effects the state government officials probably did not have too much trouble making the decisions.

Concerned officials also need to be aware of the costs associated with the preparation, application, follow up and treatment of the side effects before administering the vaccine. Comparing the risks against the benefits of the vaccine, it should be clear why the hospitals are declining to participate in the Federal pre-event vaccination plan. Work is in progress in creating a new vaccine for smallpox, which the government hopes will have reduced side effects. According to Dr. MacNeill the new vaccine would not contain the antibiotic components usually causing allergic reactions.

The talk concluded with questions from students eager to know the reasons for the vaccination plan, the possible measures in the event of an outbreak, and the comparative situations (of vaccination and associated side effects) in the military and the general public. In the end, Dr. MacNeill reminded us the more imminent risks of the American life included obesity, flu, diabetes that need more attention from the government as well as the general public. More information about the smallpox vaccine could be found on CDC’s website www.cdc.gov/smallpox or from the PCHD disease control (740-8315).

Shubin Shahab, Visiting UBRPer from Georgia Institute of Technology, Atlanta, Georgia, working in Dr. Robert Erickson’s lab, Pediatrics