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Heart Patients Not to Receive Smallpox Vaccine for Now

Cheryl A. Thompson

Myocardial infarctions within two and a half weeks after smallpox vaccination have left one women dead and another on life support, prompting the Centers for Disease Control and Prevention (CDC) Tuesday to temporarily add cardiac disease to the list of conditions precluding administration of the vaccine.

Update, 28 March 2003—The Centers for Disease Control and Prevention revealed in today's Morbidity and Mortality Weekly Report that the woman who was on life support died Wednesday.

The move came about one month after CDC described the first incident of a vaccinee having a cardiac event. At the time, the agency did not consider the episode of angina, which occurred in a 60-year-old man with a history of chest pain on exertion, linked to smallpox vaccination. The man also had hypertension, hyperlipidemia, and a family history of coronary artery disease.

Ten military personnel have had myopericarditis, an inflammation of the muscular walls of the heart and the sac surrounding the organ, since receiving the vaccine through the Department of Defense's smallpox vaccination program, according to a health advisory from CDC. All 10 servicepersons recovered fully. Several hundred thousand military personnel have been vaccinated through the program.

Update, 28 March 2003—The Department of Defense reported today (PDF) that a National Guard soldier called to active duty died of a myocardial infarction five days after smallpox vaccination. He had a history of cardiac disease. All three vaccinees—two civilians and one military person—who have died in the weeks following smallpox vaccination were in their 50s.

A total of seven people have had cardiac events after vaccination through the program for civilian public health personnel and first responders, CDC reported. Two people have had myopericarditis, two had angina without myocardial infarction, and three had an acute myocardial infarction, one of which was fatal. The incidents of myocardial infarction and angina, CDC said, occurred in people whose medical history revealed risk factors for coronary artery disease. More than 25,000 people have been vaccinated through the civilian program.

CDC advised that persons offered smallpox vaccine should be told that myopericarditis is a potential complication. Also, all vaccinees should be instructed to seek medical attention if they have chest pain, shortness of breath, or another symptom of cardiac disease in the first two weeks after vaccination.

CDC's current list of conditions precluding a person from smallpox vaccination, unless directly exposed to the smallpox virus, is as follows:

  • Known cardiac disease, such as cardiomyopathy, congestive heart failure, previous myocardial infarction, or a history of angina,     
  • Evidence or a diagnosis of coronary artery disease,     
  • Eczema or atopic dermatitis (personal or in the same household),     
  • Burns, chickenpox, shingles, impetigo, herpes, severe acne, psoriasis, or a similar skin condition (personal or in the same household),     
  • Weakened immune system, which occurs from cancer treatment, medications taken after organ transplantation, infection with the human immunodeficiency virus, primary immune deficiency disorders, some severe automimmune disorders, medications to treat autoimmune disorders, or other illnesses known to weaken the immune system (personal or in the household),     
  • Pregnancy or intends to become pregnant within one month of vaccination,    
  • Allergy to smallpox vaccine, polymyxin B, streptomycin, chlortetracycline, or neomycin,     
  • Age less than 12  months,     
  • Moderate or severe short-term illness,     
  • Breastfeeding, or     
  • An eye condition being treated with a corticosteroid solution or suspension.