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Few sickened by smallpox vaccine

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ATLANTA -- Careful screening to avoid giving smallpox vaccine to people at high risk of side effects has kept the number of serious reactions lower than expected, federal health officials said Wednesday.

But the most serious health problem that has emerged, inflammation of the heart tissue, was not among those expected when the national smallpox preparedness program began in December. A panel of vaccine experts is expected to decide today whether to recommend limiting the civilian program to health care workers or to expand it as planned to police and other emergency workers. The unexpected heart problems are cited as a reason for caution.

Since December, about 500,000 civilian and military workers have been vaccinated, and many of the anticipated problems have not happened, Col. John Grabenstein of the Army Surgeon General's Office told the Advisory Committee on Immunization Practices, a panel of experts that advises federal agencies.

Before the program began, it was believed there would be 14 to 52 life-threatening reactions and one to two deaths per 1 million vaccinated. Those figures were based on data from the 1960s, a time when smallpox vaccinations were routine.

Of 454,856 military personnel vaccinated since December, there have been 32 mild skin rashes and one case of encephalitis, which has not been definitely linked to the vaccine, Grabenstein said. About 75 instances of transmission of the vaccine virus to family members or to other parts of the body have been reported, he said.

The only red flag to be raised so far has involved inflammation of the heart muscle or the surrounding tissue, a condition doctor call myopericarditis. Grabenstein said it has been detected in 46 people in the military. All have recovered. The military concluded that the vaccine likely caused the condition.

Juliette Morgan with the Centers for Disease Control and Prevention said that of about 37,000 health care workers immunized, 22 suspected and probable cases of heart tissue inflammation were reported. In addition, there were three heart attack deaths, including two among civilians, but there is no evidence they were caused by the vaccine, she said.

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