- The Washington Times - Thursday, March 11, 2004

Although the president’s plan to inoculate Americans against a smallpox attack has faltered, other preparations against that ancient scourge have been stepped up, making the nation somewhat better prepared than it was before the war on terrorism started.

More than 200 million doses of smallpox vaccine already have been stockpiled. Almost 300,000 doses had been shipped to states as of Jan. 31, according to the Centers for Disease Control and Prevention (CDC). Unfortunately, fewer than 40,000 individuals had been inoculated as of that date — including just over 1,700 in the District, Maryland and Virginia combined.

Concerns over the vaccine’s safety have made many reluctant to volunteer. No civilian vaccines have inadvertently transmitted the virus to others, but a small number of people have experienced adverse side-effects. Since the vaccinations began, 21 individuals experienced either inflammation of the heart or the membrane around the heart, three people experienced a widespread rash, and one person experienced postvaccinal encephalitis (swelling of the brain). As a consequence, the CDC has recommended that people with a variety of conditions — including skin infections, weakened immune systems and heart problems — not receive the vaccine unless they have been exposed to smallpox.

More might be willing if the results of separate animal studies published in the journal Nature and in the Proceedings of the National Academy of Sciences continue to hold for humans. The two papers show that another vaccine — the modified vaccinia virus Ankara (MVA) — was safely administered to about 100,000 Germans in the mid-1970s, but because smallpox was not endemic in the area, its effectiveness was not fully evaluated. The authors of the Nature paper tested both the MVA vaccine and the currently licensed Dryvax vaccine on a group of monkeys exposed to monkeypox, the primate analog of smallpox. Researchers found that MVA was as effective as Dryvax in preventing infections, and that a combination of the two — an inoculation with MVA followed by an inoculation with Dryvax — was even better.

The other paper showed similar results for mice exposed to a slightly different poxvirus. The researchers also tested MVA on mice with significantly compromised immune systems and found that immunocompromised mice suffered few ill effects from even high levels of the vaccine. They also had significant protection from the poxvirus. The results suggest that MVA might be given to smallpox volunteers with compromised immune systems. Considering the sorry state of the vaccination campaign, administrators have been wise to follow other avenues of preparedness.

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