Smallpox vaccine: Whatever happened to primum non nocere?

This morning's LA Times describes the sad case of Cory Belken, a 20 year old marine, who in January was given the smallpox vaccine while having undiagnosed acute leukemia. Two weeks after vaccination the diagnosis of leukemia was made and he underwent induction chemotherapy. Approximately 1 month later, he developed progressive vaccinia (details of his case along with photos have been published in the MMWR). Treating his progressive vaccinia has required nearly 300 vials of vaccinia immune globulin (a dosage that would typically treat 30 patients).

A military physician describes Lance Cpl. Belken as a victim of bad timing. Actually the young marine is a victim of bad policy. The last naturally occurring case of smallpox occurred over 30 years ago, and smallpox is the only infectious disease to have been eradicated. Because of fears that the virus could be used as an agent of bioterror, vaccination resumed in 2002 in the military. A campaign to vaccinate 400,000 civilians failed miserably, achieving 10% of its target. Our hospital was the first to refuse to vaccinate healthcare workers because we felt the live virus vaccine was too dangerous for our healthcare workers and because of the concern that a healthcare worker could potentially transmit the vaccine infection to a patient.

As of October 30, 2004, 822 adverse events associated with smallpox vaccination were reported. This resulted in 85 hospitalizations, 2 permanent disabilities, 10 life threatening illnesses and 3 deaths. And as the LA Times article demonstrates, the adverse events continue to occur.

Smallpox vaccine is the most dangerous vaccine in use today. Given the lack of any cases of smallpox anywhere in the world for the last 3 decades, the risks of this vaccine simply can't be justified.


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