Tuesday, July 6, 2010

Side Effects of the Smallpox Vaccine

A piece in the New York Times this morning, described a risk from sexual contact with a member of the military who had been given the smallpox vaccination.  The smallpox vaccination does not use the smallpox virus--so no one has gotten smallpox.  The vaccination does use a virus called vaccinia.  The Centers for Disease Control has a website that discusses the vaccine and recommendations from 2001.  The website mentions a 1968 study suggesting that transmission to contacts results in 27 cases per million total vaccinations.  Not a major risk.  The piece in the New York Times mentioned a total of five known cases in the past twelve months from women who had sexual contact with a member of the military.  None of these cases were described (at least in the article) as passing it along to anyone else.  Vaccinia is described as not being a threat to an otherwise healthy individual but being a danger to those with a compromised immune system

How should this information affects our perception of the value of the vaccination?   This relatively small number of cases of infection (with none apparently leading to mortality) would probably not change the conclusion about the economic value of smallpox vaccination for members of the United States military.  The argument is not likely an easy economic argument in any case--the risk of smallpox as a terrorist weapon is not well defined for the general public.

Two things may be interesting to consider.  (1) Given the ongoing risk to contacts of vaccinated members of the military, would educating primary care providers about the potential for transmission be a cost-effective way of speeding up the process of diagnosis?  Possibly.  In the New York Times story mentioned at the start, the infected individual did need to see an infectious disease specialist to obtain a proper diagnosis.  (2) Whose perspective is of the most interest?  Certainly, the non-military contacts are important from society's perspective.  However, non-military contacts may not be as important from the point of view of the military.  Who makes the decisions?  Do they consider the economics?  And what perspective do they use when making these considerations?

All things to think about when there are risks to others in society from a vaccination program for the military for a threat to the military that is more than imagined but for which the general public has very limit information to assess the true level of the threat.    

4 comments:

  1. Omniyat Al HajeriJuly 9, 2010 at 2:13 PM

    very interesting topic, i think more information should be available through specific research to assess the magnitude of the risk imposed and how real is the threat to the public before any final decisions are made.

    the threat of small pox as a terrorist weapon is applicable to the public as much as it is applicable to milittary personnel,the world is just turning into a crazy place!!

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  2. I suppose in the US the thought was that the military are more at risk for small pox being used as a weapon in the field rather than as a weapon against the general public. Alternatively, someone could have done a CEA looking at vaccinating either just the military or the entire population and found that the first of those two was much more cost-effective.

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  3. Omniyat Al HajeriJuly 12, 2010 at 1:02 PM

    makes since... It is clearly going to be more cost effective in the military population in a conflict situation.... I believe thinking of it as a risk to the general population is a side effect of watching a lot of CSI TV episodes :)

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  4. Or 24 (on TV). Although it is difficult to predict how anything that initially affects a military population affects the general public.

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