California: Smallpox Vaccinations Trouble Gay Community
January 3, 2003
Plans to initially vaccinate a half million soldiers and a half million health care workers -- and eventually at least 10 million Americans -- against smallpox pose a greater risk to those with compromised immune systems than to healthy people. This disproportionately affects the gay community.Adapted from:
Federal guidelines recommend against giving smallpox vaccination to individuals with compromised immune systems, whether from HIV, cancer chemotherapy, drugs that suppress rejection of transplanted organs, or for other reasons. People who have experienced eczema or atopic dermatitis, even as children, are excluded, as are those with such skin conditions as burns, chickenpox, shingles, impetigo, herpes, severe acne or psoriasis until they are completely healed.
The National Association of People with AIDS wrote a six-page letter to Health and Human Services Secretary Tommy Thompson on December 12, raising 10 specific concerns "that must be considered and addressed as part of any smallpox vaccination policy and program." "A blanket refusal to vaccinate all HIV-positive individuals would be misguided," said Terje Anderson, NAPWA's executive director. Limited data suggest that a person with a relatively intact immune system may be vaccinated safely. Anderson does not want the government to foreclose that option to people who may choose it.
CDC estimates that at least 200,000 people are infected with HIV and do not know it. Those with advanced disease and a greatly compromised immune system may suffer deadly consequences. NAPWA is urging education and appropriate screening for all those considering taking the vaccine.
Furthermore, there are no data on whether people with a weakened immune system face an increased risk of acquiring disease through secondary exposure from the vaccinations of others. Anderson asked Thompson to articulate "the government's view of the degree of risk this possible exposure presents" and the steps it is taking to protect patients from the vaccination of health care workers.
A new smallpox vaccine is in development. It should be safe for people with compromised immune systems, and it will not have the risk of secondary transmission. Dr. Ron D'Amico, an infectious disease specialist with Beth Israel Hospital in New York, hopes to begin safety trials of the vaccine in February through the AIDS Clinical Trials Group.
Bay Area Reporter (San Francisco)
12.19.02; Bob Roehr