Adults who were vaccinated against smallpox as children can be successfully revaccinated by using diluted doses of the vaccine and with fewer side effects, according to research published by Saint Louis University this week in the Journal of the American Medical Association. “We saw fewer adverse reactions in the participants who had been vaccinated before,” said Sharon Frey, M.D., the lead author of the study and an associate professor at Saint Louis University School of Medicine. “Our study included healthy adult volunteers between the ages of 32 and 60 who previously had been vaccinated. Our comparison group consisted of individuals who were otherwise healthy and between the ages of 18 and 31, who had never received a smallpox vaccination.”
The U.S. government today proposed a plan to create a smallpox vaccination compensation program to provide benefits to public health and medical response team members who are injured as a result of receiving the smallpox vaccine. It is based on a similar compensation package that is currently available to police officers and firefighters.
The current smallpox vaccination policy of vaccinating a very limited number of first responders to a potential smallpox outbreak and avoiding mass vaccination is the best vaccination strategy, say two smallpox experts in an article in Annals of Internal Medicine. The article is released today online at www.annals.org and will be published in the March 18, 2003, hard copy edition of the journal. In the absence of a known threat of smallpox exposure, mass vaccination of the entire population or selective or voluntary vaccination would be dangerous to many who might get the vaccine, their contacts and the public health initiative, say J. Michael Lane, MD, MPH and Joel Goldstein, MD, in the article.
Healthy adults ages 18 to 29 are needed for a research study comparing the safety and effectiveness of two different vaccines for the prevention of the smallpox disease. The study will compare three dose levels of a new vaccine with the current, approved smallpox vaccine that was provided to all U.S. residents during the period of routine smallpox vaccination. The effectiveness of these trial vaccinations will be measured by observing whether or not there is a skin reaction, such as a blister, at the sight of the vaccination. A skin reaction is a typical response to smallpox vaccination. The response also will be measured by examining the size of the skin reaction and the time it takes for the blister to heal. Participants may become immune to smallpox, which would reduce or prevent infection with smallpox.
Researchers say they’ve found that people with atopic dermatitis, a.k.a. eczema, are susceptible to bacterial infections in their skin because their bodies don’t produce enough of two antimicrobial peptides. The findings show that while an allergic reaction can cause a rash, true eczema is all about infection. And medicines containing or inducing the peptides could be used to fight the disorder, which affects millions worldwide.
With all the discussion about possible smallpox bioterrorism attacks in the U.S., has the dermatology world begun to address the cosmetic implications that an outbreak would entail? Sure, it sounds petty when lives are at stake. But if thousands of people stand to potentially become infected, has medicine developed any better means of preventing disfigurement? Drainage? Lots and lots of aloe gel? Sedatives to keep people doped until the pustules pass?
A new reports says that up to half of all U.S. residents may be ineligible for smallpox vaccination because of the growing incidence of eczema. In a report appearing in the September issue of the Journal of Allergy and Clinical Immunology, Dr. Renata J.M. Engler from the Walter Reed Army Medical Center in Washington, DC, and colleagues note that in people with eczema, exposure to vaccinia — a relative of smallpox used to inoculate people — or even contact with someone who was recently vaccinated can cause a condition that can lead to scarring, blindness and even death. “A major challenge lies in the ability to protect the population from the disease while minimizing the considerable side effects from the vaccine,” Reuters quotes from their report. The researchers say more studies should be conducted to help identify people who are prone to side vaccinia effects. Others who should avoid smallpox vaccination include people with immune deficiency diseases such as AIDS, and those on immune system-suppressing drugs, such as transplant patients.
Vaccinating hundreds of thousands of Americans would be more effective in the case of an intentional or accidental outbreak of smallpox than a more limited “ring” plan endorsed by the Centers for Disease Control and Prevention, some specialists believe. “Mass vaccination really leads to fewer deaths than the CDC interim plan,” Lawrence Wein of the Massachusetts Institute of Technology told Reuters. Besides, he said, if there were a smallpox attack, “I think it highly likely that people would take to the streets to demand vaccination, or would flee.” Of course, the smallpox vaccine could be fatal or severely debilitating for many people, including those with common skin conditions like eczema and psoriasis.