Skip to comments.Info on Smallpox vaccine for freepers
Posted on 10/21/2001 10:33:10 PM PDT by bonesmccoy
Just wanted to leave you all some info on Vaccinia vaccination. Basically, last I heard the small pox immunization was not being produced in the USA. There was a report today that DOD has ordered supplies from UK. Frankly, I don't know how the UK could be producing the vaccine. The only known stockpiles of the virus (after World Health Organization/UN announced eradication of the virus from Earth) were in the US and USSR. If a UK company is making vaccine, what is in the vaccine?
The old vaccine was produced using techniques that would not be licensed or approved today. So, the stockpile doesn't meet current specs. Also, my info was that the stockpile is about 20 years old.
I don't know about you guys, but I'm not about to use 20-year-old vaccine in my practice without knowing that the vaccine was needed. I certainly would not use it in our children, unless I was convinced that a threat exists.
I do have the scar from the smallpox vaccine on my arm. My doctor gave it to me in the late 1970's. So, I feel a certain measure of comfort from that knowledge. However, it is important to note that the immunologic effect of the vaccine wanes (decreases) over the years.
Talking-heads on CNN et al have been stating that those who received the vaccine may not be immune. Well, I would like to point out to those @%^*!s that the original small pox vaccine was a LIVE VIRUS. That's why your skin ended up with welts, sores, and then scarred for life. The Japanese used the Oka Chicken Pox Vaccine for 20 years before the US gov't finally got it released to our nation. Have the Japanese seen any waning immunity from Oka Varicella Zoster Vaccine (the chickenpox vaccine)? NO! Yet, there are still idiot talking-heads who are PAID to show up on some news program and to spout incorrect info that the OkaVZV vaccine has concerns about waning immunity. ACCORDING TO WHOM?
The FDA can find an answer to the question of waning smallpox immunity real fast. THOMPSON NEEDS TO TELL CDC TO COMMISSION A FOLLOW-UP STUDY ON THE OLD SMALLPOX IMMUNIZATION. Have CDC draw serum samples on our generation of kids (who got the vaccine when we were young and are now consenting adults). Confirm when the patient received the vaccine and check the sample for any antibodies to smallpox. If you find IgG antibodies (assuming we know how to locate such antibodies, which I can not vouch for), then you will know if boosters are needed in previously immunized individuals.
Vaccinia (smallpox) vaccine, a licensed product, is a preparation of infectious vaccinia virus whose origin and manipulation is FDA approved. The vaccinia is grown in the skin of a vaccinated bovine calf (2). In 1982, the only active licensed producer of vaccinia vaccine in the United States, Wyeth Laboratories, discontinued production for general use, and, in 1983, distribution to the civilian population was discontinued. Smallpox vaccination has not been required for international travelers since January 1982, and International Certificates of Vaccination no longer include smallpox vaccination.
CDC provides vaccinia vaccine for laboratory workers directly involved with smallpox or closely related orthopox viruses (e.g., monkeypox and vaccinia). Due to clinical trials involving recombinant vaccinia virus vaccines, health-care workers (e.g., physicians and nurses) may now be exposed to vaccinia and recombinant vaccinia viruses and should be considered for vaccinia vaccination (6).
There is no evidence that smallpox vaccination has any therapeutic value in the treatment or prevention of recurrent herpes simplex infection, warts, oral thrush, or any other diseases (6). Requests for smallpox vaccine for these unapproved uses cannot be granted.
Back to questions: So, how much immunity would someone 10 years older have? Does this get back to perported "strength" of live virus in early vaccines?
Good thought..save a generation from smallpox with a 30% death rate so their brains can become swiss cheese at middle age.
Are you concerned (or anyone at the CDC) about the possibility that British smallpox vaccines involving bovine cultures could be tainted with CJD? Sounds almost scarier than smallpox.
I have a small scar on my wrist,I suspect was a "share a blister"when one of my kids were done..but I dont know how effective that would be as a mode of immunity
"Approximately half of the US population has never been vaccinated For those who were vaccinated, it is not known how long immunity lasts (most estimates suggest 3-5 years); meaning that nearly the entire US population has partial immunity at best Immunity can be boosted effectively with a single revaccination Prior infection grants lifelong immunity"
Wyeth has a patent on a vaccine called Prevnar. In other words, they have a complete monopoly on this vaccine. After they got the patent, the CDC suggested (and the ACIP agreed) to putting Prevnar on the national required vaccine list in 2001. The vaccine is $70.00 per dose and is the single most expensive vaccine on the market. The Wyeth people refuse to permit the doctors a 90 day payment plan (it takes 45-90 days for most insurance companies to reimburse the cost of the vaccine). This means that the medical group/physician has to subsidize the vaccines for the kids in their practice. No other company has such pricing or rules.
Ironically, the company has been in hot water over their inability to properly produce the vaccine in sufficient quantity. So, for the past six months there have been periodic shortages of the vaccine.
Now, class, think about this one... if the company can not produce enough vaccine (and THEY spent two years lobbying the national committees to add the vaccine to the national protocol), does anyone in the class think the company can suddenly produce 10 million doses of smallpox vaccine?
All together class! "NOT"
I'm hoping that I still have some immunity too. I was born in '66 so I must have been part of the last group of people to get the smallpox vaccine. My husband was born the same year but he never got the vaccination.
I'd like to know if I have immunity because if there is an outbreak I could be the person who gets supplies while the rest of the family stays home to wait for vaccinations.....but, otoh, I wouldn't want to venture out and get the pox and give it to the rest of the family. Basically, I agree that there needs to be some more studies or reports released about this so I'll know the best way to handle the situation if an outbreak occurs.
If so, I stand corrected. Where did you get that info? It's helpful to me if I could get that reference.
Dryvax,® the vaccinia (smallpox) vaccine currently licensed in the United States, is a lyophilized, live-virus preparation of infectious vaccinia virus (Wyeth Laboratories, Inc., Marietta, Pennsylvania). Vaccinia vaccine does not contain smallpox (variola) virus. Previously, the vaccine had been prepared from calf lymph with a seed virus derived from the New York City Board of Health (NYCBOH) strain of vaccinia virus and has a minimum concentration of 108 pock-forming units (PFU)/ml. Vaccine was administered by using the multiple-puncture technique with a bifurcated needle. A reformulated vaccine, produced by using cell-culture techniques, is now being developed.
Neutralizing antibodies induced by vaccinia vaccine are genus-specific and cross-protective for other Orthopoxviruses (e.g., monkeypox, cowpox, and variola viruses) (16--18). Although the efficacy of vaccinia vaccine has never been measured precisely during controlled trials, epidemiologic studies demonstrate that an increased level of protection against smallpox persists for <5 years after primary vaccination and substantial but waning immunity can persist for >10 years (19,20). Antibody levels after revaccination can remain high longer, conferring a greater period of immunity than occurs after primary vaccination alone (3,19). Administration of vaccinia vaccine within the first days after initial exposure to smallpox virus can reduce symptoms or prevent smallpox disease (2--4).
Although the level of antibody that protects against smallpox infection is unknown, after percutaneous administration of a standard dose of vaccinia vaccine, >95% of primary vaccinees (i.e., persons receiving their first dose of vaccine) will experience neutralizing or hemagglutination inhibition antibody at a titer of >1:10 (21). Neutralizing antibody titers of >1:10 persist among 75% of persons for 10 years after receiving second doses and <30 years after receiving three doses of vaccine (22,23). The level of antibody required for protection against vaccinia virus infection is unknown also. However, when lack of local skin response to revaccination with an appropriately administered and potent vaccine dose is used as an indication of immunity, <10% of persons with neutralizing titers of >1:10 exhibit a primary-type response at revaccination, compared with >30% of persons with titers <1:10 (24). Lack of major or primary-type reaction can indicate the presence of neutralizing antibody levels sufficient to prevent viral replication, although it can also indicate unsuccessful vaccination because of improper administration or less potent vaccine.
Side Effects and Less Severe Adverse Reactions. In a nonimmune person who is not immunosuppressed, the expected response to primary vaccination is the development of a papule at the site of vaccination 2--5 days after percutaneous administration of vaccinia vaccine. The papule becomes vesicular, then pustular, and reaches its maximum size in 8--10 days. The pustule dries and forms a scab, which separates within 14--21 days after vaccination, leaving a scar (Figure 3). Primary vaccination can produce swelling and tenderness of regional lymph nodes, beginning 3--10 days after vaccination and persisting for 2--4 weeks after the skin lesion has healed. Maximum viral shedding from the vaccination site occurs 4--14 days after vaccination, but vaccinia can be recovered from the site until the scab separates from the skin (50).
A fever is also common after the vaccine is administered. Approximately 70% of children experience >1 days of temperatures >100 F for 4--14 days after primary vaccination (21), and 15%--20% of children experience temperatures >102 F. After revaccination, 35% of children experience temperatures >100 F, and 5% experience temperatures of >102 F (24). Fever is less common among adults after vaccination or revaccination (CDC, unpublished data, undated).
Inadvertent inoculation at other sites is the most frequent complication of vaccinia vaccination and accounts for approximately half of all complications of primary vaccination and revaccination (Tables 2,3). Inadvertent inoculation usually results from autoinoculation of vaccinia virus transferred from the site of vaccination. The most common sites involved are the face, eyelid, nose, mouth, genitalia, and rectum (Figure 4). Most lesions heal without specific therapy, but vaccinia immunoglobulin (VIG) can be useful for cases of ocular implantation (see Treatment for Vaccinia Vaccine Complications). However, if vaccinial keratitis is present, VIG is contraindicated because it might increase corneal scarring (51).
Erythematous or urticarial rashes can occur approximately 10 days after primary vaccination and can be confused with generalized vaccinia. However, the vaccinee is usually afebrile with this reaction, and the rash resolves spontaneously within 2--4 days. Rarely, bullous erythema multiforme (i.e., Stevens-Johnson syndrome) occurs (52).
Moderate to Severe Adverse Reactions. Moderate and severe complications of vaccinia vaccination include eczema vaccinatum, generalized vaccinia, progressive vaccinia, and postvaccinial encephalitis (Table 2). These complications are rare but occur >10 times more often among primary vaccinees than among revaccinees and are more frequent among infants than among older children and adults (53--55) (Table 3). A study of Israeli military recruits aged >18 years, who were vaccinated during 1991--1996, reported rates of the severe complications progressive vaccinia (i.e., vaccinia necrosum rate: 0/10,000 vaccinees) and postvaccinial encephalitis (rate: 0/10,000 vaccinees) similar to those reported in previous studies (56).
Eczema vaccinatum is a localized or systemic dissemination of vaccinia virus among persons who have eczema or a history of eczema or other chronic or exfoliative skin conditions (e.g., atopic dermatitis) (Figure 5). Usually, illness is mild and self-limited but can be severe or fatal. The most serious cases among vaccine recipients occur among primary vaccinees and are independent of the activity of the underlying eczema (57). Severe cases have been observed also after contact of recently vaccinated persons with persons who have active eczema or a history of eczema (see Contacts of Vaccinees) (Figure 6).
Generalized vaccinia is characterized by a vesicular rash of varying extent that can occur among persons without underlying illnesses (Figure 7). The rash is generally self-limited and requires minor or no therapy except among patients whose conditions might be toxic or who have serious underlying immunosuppressive illnesses (e.g., acquired immunodeficiency syndrome [AIDS]) (58).