Dec 14, 2002
Hi Dr. Wohl,
We are now living with an ever increasing possibility of a Chemical or Biological terrorist attack. Great Britain (where I live) has stockpiled over 30 million Smallpox and Anthrax vaccines with another 30 million on order!
If we were to get into a situation where a Country introduces a wide spread vaccination programme - how safe would it be for those of us with HIV or anybody with immune compromised illnesses to have these live vaccinations?
Are there any official guidelines around about whether people with High or Low CD4 counts should or should not have these vaccines or is it a 'one size fits all' situation and no-one with HIV should have them?
Your thoughts and advice would be greatly appreciated. Its a Scary world out there....
Response from Dr. Wohl
The US Centers for Disease Control and Prvention (CDC) recommend that persons with a "weakened immune system. (Cancer treatment, an organ transplant, HIV, or medications to treat autoimmune disorders and other illnesses can weaken the immune system.)" should NOT receive the small pox vaccine UNLESS they have been exposed to the smallpox virus. This is because the smallpox virus uses a live strain of a related virus called Vaccinia. In some people, Vaccinia can cause problems, even death, and people with certain immune dysfunction, seem to be at greater risk for serious adverse events to the vaccine.
Therefore, if an HIV infected person was exposed to someone with actual smallpox during a biological weapon attack, they can receive the vaccine as the risks of the vaccine no longer out weigh its potential benefits.
Whether someone with a CD4 cell count of 900 and an undetectable viral load is at any greater risk of side effects from the smallpox vaccine compared to a healthy person without HIV is not known. Additionally, whether an HIV infected individual will respond as well to the vaccine is unclear.
There is much we do not know about the current smallpox vaccine, which is a diluted version of previous smallpox vaccines, or the smallpox that may be weaponized.
For now, and under the current circumstances, I'd recommend HIV infected persons to not be the first on their block to get the smallpox vaccine. Time and experience may help clarify just who should and shouldnot receive this vaccine in the absence of exposure. DW
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