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Smallpox Vaccine: Risks v. Benefits

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If the threat of bioterrorist attack with smallpox is real, and if there's enough vaccine to go around, is it time to start mass vaccinations across the U.S?

This week's issue of the New England Journal of Medicine is all about smallpox. There are eight different articles dealing with the topic.

Should the U.S. take precautions against a potential bioterrorist attack with smallpox? It's a topic that's led to a heated debate in the medical community. The real issue is safety.

What are the risks of getting the vaccine, and whqat are the risks of someone who has been vaccinated passing infection to someone else at home, or worse yet, at the hospital, where many patients are immunosuppressed.

To help weight the potential risks and benefits, researchers from the Rand Corp. developed scenarios of smallpox attacks ranging from a laboratory release, to human transmission, or an attack at a busy airport.

As reported in the New England Journal of Medicine, their analysis favors vaccination of health care workers unless the risk of attack is very low.

As for vaccinating the public at large, they say that would only be appropriate if the likelihood of a national attack, or multiple attacks, is high.

Another article in the same Journal highlights the need for public education about smallpox. Researchers from Harvard surveyed 1,000 adults and found many misconceptions. Most believed there had been cases of smallpox in the last five years, that there's an effective treatment, and that there is not enough vaccine to treat everyone in the U.S.

What's more, 30% believed vaccines they got as a child would still protect them from getting smallpox.

Much has changed since the 1950's, when mass vaccinations against smallpox were last used.

Back then, few patients were immunosuppressed, we didn't have chemotherapy, organ transplants, or HIV-AIDS. So the risks to the public are greater today, and that makes the decision about mass vaccinations all the more complex.

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