Expanded Vaccination Studied -- Some See Risks to Those With HIV
October 1, 2002
President Bush is considering a plan that would allow most Americans to receive the smallpox vaccine to protect themselves against a bioterrorist attack, but would screen people to avoid giving it to high-risk individuals, such as those with HIV and others with suppressed immune systems.
The administration has already expressed support for a proposal to vaccinate first-responder health care workers, as well as a plan to vaccinate hundreds of thousands of people in any area where an outbreak actually occurs. But the proposal to vaccinate most Americans -- regardless of whether there is an outbreak -- is complicated and controversial.
On Friday, Dr. Fred Rosen, one of the nation's top immunologists, issued a stern warning against making the smallpox vaccine widely available, which he said would be an "irresponsible" measure that could cause death or serious illness to about 1 million Americans with HIV.
The danger, Rosen said, is that the vaccine is composed of vaccinia virus. Vaccinia itself is potentially dangerous to people with depressed immune systems and can be spread from a person's vaccination pock mark to a person who has not been vaccinated. Rosen's concern is that if millions of Americans decide to be vaccinated, they could infect and endanger HIV-infected people and others who are immuno-suppressed.
"There are about a million people with the AIDS virus... and I don't know what is going to happen to them if they get vaccinia virus," Rosen said. "I think they are going to die or have severe complications." It is estimated that up to 950,000 people in the United States have HIV.
"Fred is expressing reasonable concerns, but you have to put it into context of a policy which will be offered on a voluntary basis to people," said Dr. Anthony Fauci, director of the National Institute on Allergy and Infectious Diseases. "There will be very, very explicit recommendations for exclusion -- for example, HIV-infected individuals, transplant recipients, people with immuno-suppressed conditions."
Some believe the administration should also consider preventing the vaccination of anyone with eczema, because those with a history of the skin condition are more likely to have complications from the vaccine. At least 15 million Americans have eczema and related conditions.
09.28.02; Michael Kranish
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.