Smallpox shots for kids? Not yet, experts advise

In today’s world, parents are faced with protecting their children from growing threats which include biological and nuclear warfare. Some parents have even purchased or created survival kits replete with gas masks, bottled water and iodine pills (to combat radiation) — in case they need to bunker down in the wake of another attack. Others are asking their pediatricians about smallpox shots. But, at this time, the Advisory Committee on Immunization Practices (of the Centers for Disease Control and Prevention) and the American Academy of Pediatrics (AAP) do not recommend smallpox vaccination, saying that the potential benefits of the vaccine do not outweigh its risks. And while threats that terrorists will use smallpox as a biological weapon are real, they are considered remote at this time. That’s why pediatric health experts warn that instead of focusing on smallpox, parents should deal with protecting their kids from diseases that do exist in this country — including influenza, chicken pox, measles, mumps, rubella and a host of other diseases. “Smallpox is the 800-pound gorilla that won’t go away and it colors what people think about other immunizations,” says Philip LaRussa, M.D., professor of clinical pediatrics at Columbia University College of Physicians and Surgeons. “Parents really need to keep up on routine childhood immunization that we are recommending, and separate what goes on with smallpox from other immunizations.” Current recommendations call for all U.S. children to be immunized against 11 diseases: diphtheria, tetanus, pertussis (whooping cough), polio, measles, mumps, rubella (German measles), chicken pox (varicella), hepatitis B, Haemophilus influenzae type B (Hib) disease, and pneumococcal disease. Children in some western states should also be immunized against hepatitis A. This year in particular, some of the nation’s top medical organizations are also recommending that all healthy children ages 6-23 months should get the flu vaccine. The AAP further notes that the shortage of tetanus-diphtheria vaccine is now over. Last month, however, many states began scaling back immunization requirements of children’s vaccines after the General Accounting Office (GAO), an investigative branch of Congress, issued a report warning of future shortages of the nation’s vaccine supply. The office identified five endangered vaccines, which protect children against eight diseases: measles; mumps; rubella; tetanus; diphtheria; pertussis; chicken pox; and pneumococcal disease, which can also trigger pneumonia and meningitis. There is currently no chicken pox vaccine shortage in New York City, according to a spokesperson at the New York City Department of Health. There is, however, a shortage of pneumococcal vaccine for children; this is a separate vaccine from the pneumonoccocal vaccine used in adults. In light of the shortfall, government immunization experts are urging that children at high risk for pneumonia — including those with compromised immune systems — get vaccinated first, receiving a series of three shots and holding off on the fourth. Reasons for the shortages, according to the GAO, include companies leaving the vaccine market, manufacturing or production problems, and insufficient stockpiles. “We have the luxury in the U.S. of being in the position of having all of these diseases go into complete decline because of vaccinations,” Dr. LaRussa says. “In countries where the fear of vaccine has led to a decline in immunization rates, many diseases have come back.” The rates of diphtheria, measles, mumps, pertussis, polio, rubella, tetanus, and invasive Hib disease have all been reduced by 97 percent or more by routine immunization in the U.S, according to the AAP.

So why not small pox? One of the problems with the smallpox vaccine is that exposure to the severe side-effects from the vaccine is not warranted when there is no known immediate danger of a smallpox outbreak. About one in 1,000 people who get the smallpox vaccine have some sort of significant adverse event. What’s more, smallpox vaccine isn't currently available to any physicians and hasn't been tested yet for use in children. In the U.S., routine vaccination against smallpox ended in 1972. The last naturally acquired case of smallpox in the world occurred in 1977. The last cases of smallpox, from laboratory exposure, occurred in 1978. Until early this year, the only known cache of smallpox vaccine was 15 million doses left over from 20 years ago; by diluting it, scientists determined that 75 million doses could be rendered. Then, last spring, a small pharmaceutical firm in Pennsylvania uncovered 86 million doses stashed in a walk-in freezer at a remote mountainside lab. Health officials later announced that the long-stored doses could yield enough watered-down doses to offer a potent vaccine to all American adults; but the decision on how many people to vaccinate became complicated and contentious not only because the vaccine is dangerous, but also because the treat of a bioterrorism attack is unknown. Furthermore, to date, no clinical trials have yet been conducted on children. A panel of specialists advising the government on smallpox vaccinations last month recommended offering the immunization only to the estimated half-million emergency room and other hospital workers, due to the possibility of a bioterrorist attack. The government has predictably followed the panel’s vaccine recommendations in the past; however, President Bush is expected to make the final decision on eligibility, and a number of proposals have been put before him, including the possibility of vaccinating an estimated 10 million health and emergency workers, or vaccinating all Americans. “The threat of the introduction of smallpox in this country, while real, is quite remote,” says Gil Ross, M.D., medical director of the American Council on Science and Health in New York City. “On the other hand, the risk of commonly seen childhood infectious diseases are very real. That’s why parents should be concerned about making sure their children get the recommended doses of childhood vaccinations.” He points out that, last fall, the U.S. had a few cases of anthrax introduced by person or persons still unknown that caused widespread hysteria about an anthrax epidemic. “The rush to buy and stockpile antibiotics proved to be a fruitless endeavor and it may well be the same situation with smallpox vaccines,” he says. Leading medical groups such as the American Medical Association, the American Academy of Family Physicians, and the American Academy of Pediatrics are recommending the ring vaccination strategy for smallpox rather than universal or voluntary immunization, citing serious health risks from the vaccine. Ring vaccination controls an outbreak by literally vaccinating and monitoring a ring of people around each infected individual with the idea of forming a buffer of immune people to prevent the spread of the disease if an outbreak should occur. The AAP also is pushing for the vaccine to be tested on children before any immunizations occur. At a recent meeting of the Healthcare Public Relations and Marketing Society of Greater New York, Thomas R. Frieden, M.D., M.P.H., the Commissioner of the New York City Department of Health and Mental Hygiene, said: “For the past five to 10 years, we have not worried if there will be a bioterror incident, but when [it would occur]. New York City is the capital of the world and is a symbol, and potentially, as such, is a target.” In the anthrax scare, one-third of the cases occurred in New York City, Dr. Frieden points out. “We hope it won’t happen but we plan for the fact that it might,” he says. New York City is currently stepping up efforts to be prepared in case the unthinkable occurs, he adds. Such efforts include tracking emergency room visits and developing plans to implement mass vaccinations if the need should arise. For more info on smallpox, go to and click on “Children, Bioterrorism and Disasters”. For other vaccine info, click on: “Important Info about Immunizations”.

What about the Other Pox?

Editor’s Note: Although shortages of vaccine supplies to immunize children against childhood diseases such as chicken pox returned to near-normal levels last summer for the first time in two years, the government is still concerned that the supply remains vulnerable to an array of manufacturing disruptions that could occur in the future, including those that contributed to previous shortages. In fact, the report issued by the Congress’s General Accounting Office last month further suggests that deferring immunizations could increase the risk of outbreaks of childhood disease, and undermines the government’s lengthy campaign effort to alert parents to the importance of vaccinating their children. While smallpox may be on a lot of parents’ minds, many are reluctant to vaccinate against another pox — chicken pox, according to a new nationwide survey. Many parents have misperceptions about the potential seriousness of chicken pox that may contribute to their apathy, the survey, of 1,011 parents, conducted for the National Association of Pediatric Nurse Practitioners (NAPNAP) and Merck & Co. Inc., suggests. While 97 percent of parents were aware that chickenpox vaccine is available, less than two-thirds had taken action to vaccinate their child, the survey showed. “Chicken pox is a current threat and we need to address it,” says Mary Beth Koslap-Petraco, M.S., C.P.N.P., the chair of the NAPNAP Immunization Special Interest Group and the coordinator for child health for Suffolk County Department of Health Services in Hauppauge, N.Y. “A lot of parents don’t think chicken pox is a serious disease and are not aware that children can die from it,” Koslap-Petraco says. These same parents reported 90-percent vaccination rates for measles, mumps, and rubella, and diphtheria, tetanus and pertussis. Fifty-one percent of parents who had a child at risk for chicken pox said they were unlikely to vaccinate their child against the disease in the future; 57 percent of parents who did not vaccinate their child for chicken pox had not discussed the vaccine with their health care provider; and 48 percent were not likely to vaccinate their children because they don’t believe that chicken pox is a serious disease, according to the survey. “Chicken pox is worse the older the children get,” Koslap-Petraco says, adding that 40 percent of people who get chicken pox at 13 years of age or older will develop pneumonia. Chicken pox can lead to pneumonia, encephelatis, skin infections, scarring or death.

Editor KIRSTEN MATTHEW contributed to this report.