-Caveat Lector-
"The number of combat troops vaccinated will be reported to civilian public health
authorities, but will not be released to the public, the colonel emphasized
." ???? JR
----- Original Message -----
Sent: Tuesday, February 11, 2003 8:16 AM
Subject: Vaccines Shield People from Germs, Keep Them Healthy, Help Military Mission

By Rudi Williams
American Forces Press Service

WASHINGTON, Feb. 11, 2003 -- Noting that DoD's anthrax and smallpox vaccination plans are
part of the global war on terrorism, Army Col. John D. Grabenstein said vaccines shield
people from dangerous germs, keep them healthy so they can live better lives, and help
them do their military missions and return home healthy.

Vaccines prevent infections such as tetanus, typhoid fever, measles, yellow fever,
smallpox, anthrax and a host of other diseases, according to Grabenstein, 20-year expert
in vaccines. He is deputy director for military vaccines, Office of the Army Surgeon
General. He spoke recently at the 2003 TRICARE Conference here.

"Anthrax and smallpox vaccines are very much alike and, at the same time, very much
different," Grabenstein said during a conference session on DoD vaccination programs
against the two diseases.

The World Health Organization declared smallpox eradicated in 1980. DoD stopped routine
smallpox immunizations in 1990.

Grabenstein said President Bush announced the resumption of smallpox vaccinations on Dec.
13, 2002, and about 2,000 people on epidemic response teams received them shortly after.
The total will climb to about one-half million as hospital and clinic medical teams and
mission-critical military forces are immunized.

The number of combat troops vaccinated will be reported to civilian public health
authorities, but will not be released to the public, the colonel emphasized.

Controversy abounds about the pros and cons of inoculations against anthrax and smallpox,
but Grabenstein assured conferees that whatever DoD medical professionals say or do is
rooted in science.

"We're evidence-based and have a firm foundation for what we do. We acknowledge what we
don't know and try to get that data and proceed accordingly," he said. "The other key
piece is that we're in the care-giving business and operate a no-fault health care
system.

"Is that absolute, definitive proof that the vaccine never causes any harm to anybody?
No. All medications have their side effects," Grabenstein remarked. "We operate a no-
fault system, so if somebody is sick, get them care. It doesn't matter whether the
vaccine did it, get them care and then we'll sort it all out."

He recalled a conversation on a bus en route to the Pentagon when one of the folks in his
office said, "I thought you stopped the program with anthrax vaccinations because of all
the controversy."

"No," he responded, "we almost ran out of vaccine. That's why we slowed down." DoD began
anthrax vaccinations in March 1998, but manufacturer's delays resulted in a slowdown in
2000 and 2001, the colonel noted. DoD reacted in July 2000 by limiting inoculations to
troops in or bound for Korea and Southwest Asia. "That wasn't enough, so we slowed down
twice again," Grabenstein said.

He said Congress directed the National Academy of Sciences Institute of Medicine to start
a thorough study in fall 2000 on "everything known about anthrax vaccine. The academy
concluded in March 2002 that anthrax vaccine effectively protects humans against anthrax,
including inhalation anthrax, "caused by all known or plausible engineered strains of B.
anthracis."

Grabenstein said the Centers for Disease Control and Prevention is coordinating a study
to see if the long-recommended six-shot series is really necessary or whether fewer doses
would protect as well. He said he hopes the CDC data support fewer shots, say, four. The
Food and Drug Administration has the final word, he noted.

As to vaccine safety, Grabenstein said, the National Academy of Sciences investigative
committee listened carefully to naysayers' concerns and allegations but in the end found
that anthrax vaccine has side effects "comparable to those observed with other vaccines
regularly administered to adults. There's no evidence people face increased risks of
life-threatening or permanently disabling adverse events immediately after vaccination
nor any elevated risk of developing adverse health effects over the longer term."

In the lessons-learned category, Grabenstein said DoD has "all sorts of customers, and we
need to work with them. We need to educate them and listen to their concerns and find the
answers that they personally want, not just what we think most people want."

Grabenstein said there's a new resource in the vaccine area. "We started with the vaccine
health care center at Walter Reed Army Medical Center in Washington a year and a half
ago," he noted. "The delightful news is that the Navy is standing up the second vaccine
health care center at Portsmouth, Va. And there's an additional series of sites coming
along in the pipeline."

The Army, DoD's lead agent for vaccines, is using Food and Drug Administration-licensed
doses of the smallpox vaccine, also known as vaccinia vaccine or Dryvax, manufactured by
Wyeth Laboratories. Grabenstein said vaccinia is a weaker virus that has a lower rate of
adverse reactions than the potentially lethal smallpox virus, more properly called
variola virus.

He noted that the smallpox vaccination program is about preparedness. "Contagious, we
know. Deadly, we know. And the effect on a military mission would be enormous," he said.
"With anthrax, we talk about higher threat areas, but it's really a different construct
with smallpox."

Many of the people receiving smallpox vaccinations now are those furthest from medical
reinforcement, he said. "We have great resources in the states. Conditions in Afghanistan
are not like that," he added.

Grabenstein estimated about 65 percent of active duty personnel and 43 percent of
reservists have never been vaccinated against smallpox. Even among those who have been
immunized, he said, their last dose was a long time ago.

Up to 40 percent of any group of people might be exempted from smallpox vaccination to
avoid adverse events. Automatically exempted, for instance, are pregnant women, breast-
feeding mothers, and persons with immune deficiencies, such as HIV infection, or with
certain skin conditions and allergies.

Of the patch of skin that usually serves as a smallpox immunization site, Grabenstein
gave clear warning: "Don't touch it. If you touch it by accident, wash your hands. Don't
let others touch it." He also said to avoid close contact with medically exempt people.
In field situations, don't share mattresses, clothes or towels with them.

_______________________________________________________
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