Practical Practitioner
By: Pamela Egan, FNP-C CDE
The pros and cons of the smallpox vaccine
Dear Pam,
Should we or should we not get vaccinated for smallpox?
This is a complicated issue that involves a careful balance between the possibility that smallpox might actually be released at some time by terrorists, and the known risks that are associated with the smallpox vaccine itself. Those who will be recommended for vaccination will want to study the issue and other Americans with questions about the disease and the vaccine will also need the best information available.
Smallpox is a serious disease caused by the variola virus. While the disease has made people sick off and on for thousands of years, the world has not seen a case of smallpox since 1978. Successful worldwide vaccination programs made it possible to eliminate the disease. With the increasing threat of terrorism, there is now concern that smallpox could make a comeback.
When a person infected with smallpox coughs, sneezes or talks, air droplets containing the virus are released. Generally, prolonged close contact is required to spread the virus from one person to another. To catch the disease it is likely you would have to spend hours with an infected person. It is easier to catch measles, chickenpox or the flu from another person than it is to become infected with smallpox. Smallpox can also be spread by touching the objects (bed linens or clothes) of a person who has the disease. You cannot get smallpox from insects or animals.
A person exposed to smallpox will usually feel fine for the first 12 to 14 days of the disease. The first symptoms of smallpox begin with a high fever, head and body aches and sometimes vomiting. A rash follows, which will turn into raised bumps that crust, scab and fall off after about three weeks, leaving a pitted scar. A person with small pox is contagious once the rash appears and until all of the scabs fall off. The smallpox vaccine contains a virus, which is related to smallpox. Some common reactions to the vaccine include flu-like symptoms such as fever, headache and muscle aches. Very bad reactions can also occur including severe skin reactions, brain inflammation (encephalitis) and infection from the virus in the vaccine. It is estimated that if 1 million people were vaccinated, about 39 would develop skin reactions, 12 would get encephalitis and one or two would die. The vaccine is predicted to provide protection three to five years.
In summary, incubation time after exposure is about two weeks. First symptoms are like a severe flu. Patients become contagious two to four days later when they get mouth sores and a rash on their face and body.
Remaining immunity from vaccinations prior to 1972 is iffy. The mark on your arm (if you’re over 30) is probably next to worthless. New vaccinations will be provided to “first responders” such as emergency crews, hospital workers and military. Fortunately, in case of attack, the vaccine is effective three days after exposure. Vaccination might be voluntary for the public starting in 2004. Side-effects will scare many off. Routine vaccinations were stopped in 1972 because of the risks. For every million vaccinated, up to 50 had a severe complication such as eczema vaccinatum or encephalitis and one died.
The antiviral cidofovir might also turn out to be useful for severe smallpox vaccine reactions, and for treating smallpox.
A new website has been launched at www.smallpox.gov.
This article was originally published December 26, 2002 in The St. Tammany News.
Related Articles:
PamelaEgan.com > Health Articles > Disease
