By RICHARD PÉREZ-PEÑA
Published: October 3, 2003
it was a medical mystery with national policy implications. New York City says it found the solution buried in its archives.
Last spring, the Bush administration's campaign to vaccinate half a million health workers for smallpox hit a new snag. Two civilians and a National Guardsman died of heart attacks shortly after being vaccinated.
Of all the things that could go wrong with the program, this was not supposed to be one of them. The literature on smallpox vaccination pointed to possible complications like brain inflammation, severe lesions in people with certain skin conditions, and uncontrolled spread of vaccinia pox, a related disease. Heart trouble was not on the list, but who knew?
New York City health officials said there was a way to find out. Using their records from a 1947 crash program to inoculate most of the city, they found no evidence of a rise in heart attacks.
"While we cannot be certain that there is no association between smallpox vaccine and the cardiac deaths that occurred nationally in 2003, our data tell us that the likelihood of smallpox vaccination causing cardiac deaths appears to be extremely low," Dr. Thomas R. Frieden, the city health commissioner, said yesterday.
The results, actually compiled in April and presented then to the federal Centers for Disease Control and Prevention and to a conference of health experts, were published this week in the centers' Morbidity and Mortality Weekly Report.
Whether the findings will revive the moribund vaccination program, intended to provide a measure of protection against the potential use of smallpox as a biological weapon by terrorists, is another matter.
Even before news of the heart attack deaths, doctors, nurses, paramedics and others were reluctant to volunteer for the vaccinations, and the program lagged far behind the pace health officials had hoped for. The notion that the vaccine could cause heart problems seemed like the final blow. The pace of vaccinations dropped sharply, then continued to decline, and all but stopped by summer. Half a million military people, who had little choice in the matter, received the vaccine as planned, but fewer than 40,000 civilians did.
No one had ever before detected a link between the vaccine and heart trouble, but neither had researchers looked for one.
Until 1972, smallpox vaccination was routine in this country, but it was done mostly on infants. Mass vaccinations were rare and vaccination of adults was spotty, at best. Then, for three decades, smallpox inoculations dropped nearly to zero. (The disease was declared wiped out in 1980.)
Before this year, the last mass vaccination in the United States took place in New York City in 1947. It was one for the record books. The city experienced the nation's last domestic outbreak of smallpox — defined as one person transmitting the disease to another on American soil, as opposed to someone arriving here already infected. Twelve people developed the disease, and two died.
In a span of just three weeks, the city Department of Health vaccinated 6.3 million people.
"This was the most intensive vaccination campaign in history, anywhere," said Dr. Farzad Mostashari, an assistant health commissioner.
On the day in April when news spread that some people died just after being vaccinated, Dr. Frieden's aides say, he reasoned that if there were a link to cardiac arrest, that 1947 mobilization would hold the proof, with enough inoculations all at once to produce a measurable rise in fatal heart attacks.
He ordered all the death certificates from 1946 through 1948 pulled from the city archives, to compare the year of the smallpox outbreak with the year before and the year after.
There were more than 81,000 such records, all on paper, that had to be reviewed by hand and entered into a computer database.
"We had about 100 people doing data entry, and there was a core group, about five of us, who put together the analysis," Dr. Mostashari said.
By the next week, the city was ready to show the results to the Centers for Disease Control and Prevention. But the news did not spread much beyond the public health field; newspaper articles continued to refer to the suspected link to heart attacks. Some state and local health departments officially dropped a vaccination program they had found to be unpopular, expensive and unsuccessful. Others simply let it wither quietly.
The paradox was that this might have been the safest smallpox vaccination campaign ever conducted. The rate of complications, minor or serious, lagged far behind historical averages, in part because government officials were careful not to inoculate people who were at high risk of having adverse reactions.
Last month a panel of scientists, convened by the Institute of Medicine and advising Congress, said smallpox policy should move from mass vaccination toward alternatives like developing quick responses to an outbreak. The scientists concluded that the risk of an outbreak was too small to justify the vaccination campaign.
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What about the current epidemic of heart disease?
These bureaucrats never find the smoking gun, cause their too busy burying it!
The two civilians and one National Guardsman DOESN'T include, at least, Rachel Lacey, the 21 year old reservist in the midwest that died right after her inocultations, one of which was smallpox.
The first person who died, was, a Native American woman who got the vaccine to commemorate what the Brits did to her people when they slaughtered them with smallpox inoculated blankets.
What a horrible irony.
Of course, the names and stories of these people disappeared from the media just as quickly as they could "kill" them.
Of course, the quoted article fails to mention that just like the Weapons of Mass Destruction that have never been found, NO EVIDENCE of any weapons-grade smallpox has been found either.
But that would possibly lead the masses to the question of what good a run-of-the- mill smallpox vaccine would be against a high-tech weapons-grade smallpox virus.
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