- The Washington Times - Thursday, March 27, 2003

Federal health officials are advising against the smallpox inoculation for those with heart disease until they determine whether the vaccine can contribute to cardiac problems.
The Centers for Disease Control and Prevention in Atlanta issued its "temporary deferral" advisory late Tuesday after a Maryland woman who had been vaccinated died of a heart attack. Six other persons also have experienced coronary problems after their inoculations.
"At this time, we have no cause-and-effect relationship … but we're working with health officials to explore any possibility" of a link between the smallpox vaccine and heart disease, CDC spokeswoman Karen Hunter said in a telephone interview yesterday.
Three women, all health care workers in their 50s, suffered heart attacks. One died, another is on life support and a third is recovering, CDC Director Julie Gerberding said Tuesday night. The condition of the patient on life support was not available yesterday.
Two other persons developed angina, or chest pain, after their vaccinations, and another two experienced inflammation of the membrane surrounding the heart.
Dr. Gerberding said the five persons who suffered heart attacks or angina after volunteering for the smallpox vaccine had prior risk factors for heart disease. The other two patients did not, she said.
Primary risk factors include diabetes, smoking, high blood pressure and obesity.
Ms. Hunter said the smallpox vaccine, which in rare cases is known to cause life-threatening conditions and death, has never been associated with heart problems.
Data collected in the 1960s about the vaccine's side effects primarily involved children, who were required to receive the smallpox inoculation before attending school and who would not be likely to have heart problems, she said.
"But since this is an older population now getting the smallpox vaccine, we'll be looking at any type of health event that follows vaccination … we're erring on the side of caution," Ms. Hunter said.
The Maryland woman who died, a nurse at a Salisbury hospital, was vaccinated March 18. She died five days later while attending a conference in Arlington. Her death prompted the CDC to take its emergency action Tuesday, with the approval of Health and Human Services Secretary Tommy G. Thompson.
Dr. Gerberding said the seven persons became ill five to 17 days after their immunizations.
She told reporters in a telephone briefing Tuesday night that medical specialists did not believe the smallpox vaccinations caused the heart attacks. But she does not rule out that the vaccine, which is made of a live virus that is a cousin to smallpox, can cause inflammation that could have worsened pre-existing medical conditions.
In interviews yesterday, J.B. Hanson, spokesman for the Maryland Department of Health and Mental Hygiene, and Lucy Caldwell, spokeswoman for the Virginia Department of Health, said preliminary evidence did not suggest a correlation between the vaccine and the woman's fatal heart attack.
"The woman clearly died of a heart attack … but there is no reason to believe the vaccine was a major factor," Mrs. Caldwell said. More testing is under way.
Pregnant women, those with suppressed immune systems such as organ transplant recipients and HIV patients, and those with histories of skin disorders should not receive the smallpox vaccine.
Several hundred thousand members of the military have been vaccinated, a Pentagon spokesman said.
"We've encountered a few significant side effects, but all [those affected] have been returned to active duty," said the spokesman, who did not identify the side effects.
No smallpox cases had been reported in the United States since 1949, and routine vaccination ended in 1972.
President Bush in December announced a smallpox vaccination program that was mandatory for the military but voluntary for others including health care workers and emergency responders because of concerns that terrorists could use the deadly virus as a biological weapon.
The goal was to vaccinate 500,000 health care workers.
Because of concerns about the safety of the vaccine, only about 25,000 have volunteered to be immunized.

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