 February 2003 • Volume 9 • Number 2 |
BY CINDY McCANSE
You'd think that with all the media hubbub surrounding the announcement of President Bush's comprehensive smallpox vaccination plan, few questions would remain. The details have been scrutinized for weeks, the issues debated in both the public forum and the medical literature. What query could possibly have gone unasked?
Here's a biggie: If family physicians are on the front line of bioterrorism defense, shouldn't they be vaccinated against the deadly smallpox virus? In the absence of contraindications, of course.
Not necessarily, according to Jonathan Temte, M.D., Ph.D., of Madison, Wis. Temte is associate professor of family medicine at the University of Wisconsin, Madison, and a researcher and lecturer on bioterrorism.
"As sentinel physicians against bioterrorism, family physicians play a vital role in recognizing aberrant diseases, such as smallpox, and in notifying public health agencies of suspected cases," he noted. That said, however, immunization of all family physicians against the disease is not warranted at this time, Temte added, for the following reasons:
The president's current strategy, Temte explained, is "to create a small cadre of health care workers in each state who are maximally immunized against smallpox. These people will form the core of responders providing care to patients with possible smallpox in designated hospitals and will also conduct case and contact investigations."
All such vaccinations are to be administered on a strictly voluntary basis according to detailed plans submitted by each state to the CDC last year, said Herbert Young, M.D., director of AAFP's Scientific Activities Division.
"Once these initial immunizations have been given, then states can move on to the broader first responder and health care worker groups," he said.
Go to http://www.bt.cdc.gov/agent/smallpox/vaccination/ for more information about both the federal vaccination plan and the vaccine itself.
The Academy has already expressed its concern about use of the live vaccinia virus vaccine used to immunize against smallpox. In a Dec. 17 press statement, AAFP President James Martin, M.D., of San Antonio agreed that voluntary immunization of emergency smallpox response teams was appropriate but cautioned physicians and others who make up those teams to educate themselves about the medical and legal issues involved.
Above all, he advised that the immunization program be closely monitored and that the knowledge gained from it be used to inform future decisions.
FP Steven Marks, M.D., of Eugene, Ore., pointed out a specific aspect of physician vaccination: How should physicians who choose to be vaccinated contend with the risk of spreading live vaccinia to their patients for up to three weeks after vaccination?
Marks is public information officer for the Lane County Medical Reserve Corps, a disaster preparedness task force of the Lane County Medical Society. From his perspective, such practical considerations will continue to generate concern about the immunization strategy until further answers or better solutions are available.
"Given the lack of any evidence that smallpox is an imminent threat and the rates of complications from the vaccine, is it even appropriate to start immunizing large numbers of health care workers or the public?" Marks asked. "The only potential epidemic at this point appears to be fear of smallpox ... not the disease itself. Are we proposing to use immunization to treat the fear?"
Go to http://www.aafp.org/x16645.xml to read the AAFP press statement. AAFP policy statements on smallpox vaccination are available at http://www.aafp.org/x16643.xml and http:// www.aafp.org/x10636.xml.
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More reading on smallpox vaccination For an overview of smallpox vaccination in the
primary care context, consult the following source: Historical data on the adverse effect profile of
the smallpox vaccine Lane JM, Rubin FL, Neff JM, Millar JD. Complications of smallpox vaccination, 1968. National surveillance in the United States. New Engl J Med 1969;281:1201-8. Lane JM, Ruben FL, Neff JM, Millar JD. Complications of smallpox vaccination, 1968: results of ten statewide surveys. J Infect Dis 1970;Sm122:303-9. Data on the adverse effect rates for the oral
polio vaccine and the whole-cell pertussis vaccine Data on the long-term protective effects of
previous immunization with vaccinia vaccine |
Press time updateAt press time, an Institute of Medicine advisory committee had just released a report calling for greater caution in implementing the federal smallpox vaccination program. The report came shortly before vaccination of some 500,000 emergency first responders was scheduled to begin as early as Jan. 24. The report, commissioned by the CDC, listed as concerns the vaccine's high risk profile and the lack of a dedicated compensation fund for those injured by the vaccine. The Homeland Security Act exempted vaccine makers from liability for adverse effects of the vaccine. Vaccinees who suffer adverse effects may be covered by state worker's compensation programs, but those programs are unlikely to pay for all medical expenses or time lost from work. People receiving the vaccine should understand they are doing so for the public good, rather than for any likely personal benefit, said the report. Go to http://www4.nationalacademies.org/news.nsf/isbn/01172003 to read a press release and to access the full report. |
To reach writer Cindy McCanse, e-mail cmccanse@aafp.org.
FP Report is
published by the AAFP News Department.
Copyright © 2003 by American Academy of Family Physicians.