-Caveat Lector-

10/07/2002 - Updated 06:58 AM ET

Smallpox vaccinations: A shot in the dark

By Marilyn Elias, USA TODAY

The threat of bioterrorism is not high enough to justify preventive
smallpox vaccination of children and teenagers, U.S. pediatricians
say in a policy statement today.

[caption] Mass immunizations similar to one during a smallpox
outbreak in New York in April 1947 are once again a real
possibility.

AP file

Vaccinations should be reconsidered if new evidence suggests
bioterrorism is more likely or if safer vaccines are developed, says
the American Academy of Pediatrics (AAP).

Smallpox vaccines "are not nearly as safe as other vaccinations we
routinely use, and they're for diseases that are around, unlike
smallpox," says Robert Baltimore of Yale Medical School, co-author
of the policy.

The influential AAP is weighing in as the federal government
considers who should be vaccinated in anticipation of a bioterrorist
attack.

Top federal scientists Friday recommended making vaccine available
to any American who wants it after medical and emergency workers are
immunized.

The new AAP policy favors a "ring" approach � isolating those who
develop smallpox and immunizing people around them � rather than
giving shots before an attack to anyone who volunteers.

A key concern about a "voluntary," preventive plan is that immunized
people develop a blister that can transmit the virus to others who
haven't volunteered for shots. "There is no such thing as a truly
voluntary plan," Baltimore says.

Routine smallpox vaccination ended in 1972. The disease has been
eradicated, but fears persist that terrorists have obtained stocks
of the virus.

Estimates on adverse reactions from the vaccine, which are based on
studies in the 1960s, could be low because more Americans now have
weak immune systems, Baltimore says. Those with weaker immune
function are most likely to be harmed by the vaccine or from contact
with immunized people.

Children pose special problems. The United States has stored vaccine
that can be diluted and that will work for adults if there's a mass
immunization program. But the diluted dosage needed for children is
unknown, Baltimore says.

The government has plans to test that vaccine on children in the
Cincinnati and Los Angeles areas. But it's unknown when or even if
the study will start, says Anthony Fauci, director of the National
Institute of Allergy and Infectious Diseases. Experts will testify
on the risks and benefits of the study for kids at a public meeting
in November called by the Department of Health and Human Services,
Fauci says. The HHS secretary "will have to approve the trial," he
says.

Although some parents are worried, most aren't clamoring for their
kids to get smallpox shots, according to an informal USA TODAY check
with children's doctors. The scene is nothing like last year's
anthrax scare, when pediatricians were swamped with demands for
antibiotics and smallpox vaccines.

"It's not on their radar screen right now," says pediatrician Garry
Gardner of Darien, Ill.

Loraine Stern, who treats middle-class families in Newhall, Calif.,
says: "Parents are concerned; they're asking about it. But they're
not acting cuckoo like they were last fall."

http://www.usatoday.com/news/health/2002-10-07-smallpox-vaccines_x.htm

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