Following Death of Third Smallpox Vaccine Recipient, CDC Advisory Panel Recommends Further Limits on Eligibility

The Advisory Committee on Immunization Practices, a panel of experts that advises the CDC, has recommended that the CDC expand its list of people who should not receive the smallpox vaccine to include individuals with three or more "major risk factors" for heart disease, including smoking, diabetes, high blood pressure and high cholesterol, the New York Times reports (Grady, New York Times, 3/29). The proposal goes beyond what CDC officials recommended last week -- that people with a history of heart disease do not receive the vaccine. That recommendation came after a Maryland woman and a Florida woman -- both health workers -- died of heart attacks after receiving the vaccine and several other vaccine recipients experienced heart difficulties (Kaiser Daily Health Policy Report, 3/28). The Defense Department on March 28 announced that an unidentified 55-year-old member of the National Guard died of a heart attack after he received the vaccine (New York Times, 3/29). All three people who died after receiving the vaccine had risk factors for heart disease, the AP/San Francisco Chronicle reports (Meckler, AP/San Francisco Chronicle, 3/29). Health officials said it is not currently known whether the vaccine played a part in the deaths or the other cases, but said that the issue should be studied further (New York Times, 3/29). If the CDC adopts the panel's recommendation, agency officials estimate that approximately 6% of health workers and 10% of the general public would be ineligible to receive the vaccine (AP/San Francisco Chronicle, 3/29). The ACIP rejected the CDC's current guideline to exclude only those people with a history of heart disease and another proposal to exclude anyone over age 50, a plan that would disqualify 25% of all eligible health workers (Manning, USA Today, 3/31).

States Halt Programs
The advisory panel's recommendation could further impede the progress of the national smallpox vaccination program, which already has had a slow start, the AP/Chronicle reports (AP/San Francisco Chronicle, 3/30). In the program's first two months, approximately 25,000 of a planned 450,000 health workers have received the vaccine. Although the smallpox vaccine has not been linked to heart problems in the past, the recent problems relating the vaccine have added to concerns over the lack of a compensation program for people who experience negative reactions to the vaccine and doubts about the risk of an attack (Connolly, Washington Post, 3/29). Three states -- California, Illinois and New York -- have temporarily suspended vaccinations while the link between the vaccine and heart problems is investigated (AP/San Francisco Chronicle, 3/29). Meanwhile, other states, including Florida, have postponed inoculations until state public health officials can update potential volunteers on new safety measures concerning heart problems, according to the Post (Washington Post, 3/29). California Health Director Diana Bonta on Friday notified county officials to immediately suspend their vaccination programs until at least April 7, when the CDC is expected to update its recommendations on who should receive the vaccine (St. John, San Francisco Chronicle, 3/30). Florida officials have begun re-interviewing health workers, inquiring about previous heart problems, before they receive the vaccine (Royse, AP/Tallahassee Democrat, 3/29). However, Florida officials said they would not halt the vaccination program, the Miami Herald reports (Prater, Miami Herald, 3/29). PBS' "NewsHour with Jim Lehrer" on March 28 reported on the third person to die of a heart attack after receiving the smallpox vaccine. The segment includes comments from Walter Orenstein, director of the CDC's National Immunization Program ("NewsHour with Jim Lehrer," PBS, 3/28). A transcript of the show's news update is available online.