3rd Smallpox Vaccine Death Reported

Three people have died of heart attacks after receiving the smallpox vaccine, and expert advisers are recommending that the federal program be slowed down, throwing a struggling campaign into even deeper trouble.

Health experts are investigating a possible link between the vaccine and heart problems that have occurred in 17 people, including the three fatalities. Two of those were health care workers in private hospitals. The third, announced Friday by the Pentagon, was a 55-year-old National Guardsman, the first death in a military inoculation program that has treated 350,000 people.

The civilian program, which unlike the military's is voluntary, has moved much slower. Federal officials had aimed to offer the vaccine to at least 450,000 people in the program's first month. After two months, only about 25,000 have been vaccinated, with many hospitals opting out of the program altogether.

Despite the low numbers, the Institute of Medicine recommended this week that federal officials consider whether they have vaccinated enough people to handle a terror attack using the smallpox virus, should one occur. Many states might discontinue their programs as they reconsider their readiness, said Dr. Brian Strom, the head of the Institute of Medicine's smallpox committee, which is advising the Centers for Disease Control and Prevention on the program.

The recent deaths add weight to the recommendation, Strom said in an interview Friday.

"They're going to have more trouble now" getting volunteers, he said. "I think people are going to be afraid."

He predicted that questions about heart disease may also prompt states formally or informally to suspend their programs. Already, New York state suspended vaccinations for two weeks while questions are sorted out about the possible link between heart disease and the vaccine.

At the CDC, officials are trying to figure out what changes are needed, given the possibility of a heart disease connection.

They believe the vaccine may be to blame for a dozen cases of people who have suffered heart inflammation, a relatively mild condition. But there is no way to screen out those who are at risk for it, so there is little they can do to prevent it.

There are known risk factors for heart attacks and angina, or chest pain, but experts are not convinced that these conditions are related to the vaccine. Four people who had been vaccinated suffered heart attacks, including the three who died, and two reported angina. Many Americans suffer from heart disease, so these could be coincidental.

All three heart attack victims had risk factors for heart disease. The Guardsman, who died Wednesday after a heart attack a day earlier, smoked and had high cholesterol, and an autopsy showed that he had had coronary disease, the Pentagon said.

Still, to be safe, after learning of the first death, the CDC ordered that people with a history of heart disease not be vaccinated. The Pentagon now has adopted the same precaution.

On Friday, a panel of technical advisers to the CDC recommended that the screening be expanded to exclude anyone with at least three risk factors for heart disease, such as smoking, high blood pressure, high cholesterol and diabetes. The CDC estimated that would exclude about 6 percent of health care workers and 10 percent of the general public.

That panel, the Advisory Committee on Immunization Practices, had considered a more drastic step: Excluding anyone over the age of 50. But members worried that would essentially kill the program.

Still, at least one member of the panel want to go even further and suspend all vaccinations while the heart question is investigated.

"There still hasn't been a case of smallpox anywhere in the world," said Dr. Paul Offit of The Children's Hospital of Philadelphia.

"There are a lot of people who have heart problems and may not know it," he said, suggesting that the screening system might not find everyone at risk.

No matter what the recommendation, news of the deaths is likely to make health care workers even more wary of the vaccine, said Dr. Deborah Kamali of the University of California, San Francisco, who helped organize area doctors to write the CDC and urge that the program be stopped. They argue that known risks of the vaccine outweigh the unknown risks of an attack with smallpox, which was wiped from the Earth more than two decades ago.

"I think it will definitely make health care workers more reluctant. This is something they can relate to," she said. "As a field, we've already been reluctant."