A blast from the past

Don’t you hate it when you’re rooting through your storage closet, looking for some old high school yearbooks, and you stumble across a few vials of smallpox you forgot to destroy? Yes, smallpox—declared eradicated 34 years ago—is serious. But there is irony here. Recall the year 2002, when our political leaders used the threat of “hostile groups or governments” in order to implement a smallpox vaccination campaign (one that failed miserably, achieving vaccination of only 10% of its stated target). Alas, Saddam didn’t have smallpox, but he might have stood a chance to procure it if he had only befriended the night janitor at a certain lab in Bethesda.

I’ll use this opportunity to highlight the 2002 NY Times editorial that called out Mike and his hospital for refusing to implement this misguided vaccine campaign. In retrospect, quite a badge of honor to have been deemed “deplorable” in the paper-of-record, for making a reasoned decision to protect patient and healthcare worker safety.

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.