This Week’s Smallpox News: The paper from this week’s JAMA about the risk of contact vaccinia from smallpox vaccine must be getting a lot of press. I know this because my seven year old daughter, who has eczema, asked me tonight if she’s going to get smallpox. I’d link to the paper, but it requires registration, so here’s the Reuters version instead. The conclusions regarding the risks are sensible:

"A orderly, systematic approach along with careful screening to identify potential vaccinia-susceptible individuals and household contacts and close monitoring for adverse effects are essential to reduce the risk of transmission of vaccinia following smallpox vaccination," the report concludes.

This would seem to argue for voluntary pre-attack vaccination when we have the luxury to screen for contraindications and educate people on the importance of shielding others from their vaccine site. Yet, one of the authors of the paper, a pediatrician, is quoted by Reuters as being against pre-attack vaccination:

"The real question," Neff said, "is why are we cascading into a seemingly unstoppable war scenario that causes us to react in an extreme fashion to a real or imagined fear of a bioterrorism event that otherwise would be highly unlikely.

"If we as health professionals cause serious injury or death as a result of our actions, then if these actions are ill-advised, we stand in danger of losing a very valuable public trust," Neff said.

We stand in even greater danger of losing public trust if we wait until after an outbreak, when many more lives would be at risk, not only from the disease, but from the vaccine, too.

UPDATE: Reuters posted this interesting correction to the above link. The correction says it was posted to make "clear the risk is cowpox," but that was pretty clear in their original story. What this one also makes clear is that Dr. Neff, the doctor they interviewed in the original, isn't the main author of the paper. The corrected version also leaves out his comments about "rushing to a war scenario." I suspect that the real correction is that Dr. Neff's views don't represent the views of his colleagues.

AND ELSEWHERE: Britain is planning to vaccinate key healthcare workers, with plans to expand the program in case of an attack.

Meanwhile, Israel has been conducting vaccinations of healthcare workers and so far there have been no media reports of adverse reactions. Here's a first person account of smallpox vaccination and overall preparedness from an Israeli hematologist :

In the event of an actual attack I will probably be called upon to be a care-giver, although, to be frank, I lack almost any medical training whatsoever. I've been instructed in the art of resuscitation, to substitute for an electronic respirator in the event that the number of victims overwhelms the available equipment resources. I'm unsure of how effective and helpful I'll be, but I know that I will do my best if prevailed upon.

We should take a page from their preparedness manual.