More on smallpox inoculation that spread to wife and son

See: [March 2007] Smallpox shot infects soldier's toddler son

Note: the smallpox vaccine that was unanimously approved by an FDA
advisory committee this week (ACAM2000) was developed from the
vaccine this child received and is expected to have a very similar
side effect profile. This means that subclinical myocarditis may be
seen as frequently as one in 30 (according to a 1970s Scandinavian
trial) to one in 145 persons (according to Acambis' own recent
clinical trial) vaccinated. Bad as the following story is, many more
lives are likely to be lost from cardiac complications of the
smallpox vaccine than from eczema vaccinatum and other skin-related
complications.--Nass, MD

The New York Times

May 18, 2007
Soldier’s Smallpox Inoculation Sickens Son

A 2-year-old boy spent seven weeks in the hospital and nearly died
from a viral infection he got from the smallpox vaccination his
father received before shipping out to Iraq, according to a
government report and the doctors who treated him.

The boy, who lives in Indiana and has recovered, became ill in early
March, two weeks after his father’s deployment was delayed and he was
allowed to make a trip home. Over the next few weeks, the boy
suffered kidney failure and lost most of his skin to the disease,
eczema vaccinatum.

Experts said the father, who had eczema in childhood, should never
have been given the vaccine because that fact made him more
susceptible to side effects like vaccinia infection. And they said
military doctors should have been doubly cautious because the son,
too, suffered from eczema and would have been highly susceptible to
infection. Military procedures call for asking about such conditions
in soldiers and their families.

Vaccinia is the live virus used in smallpox vaccine. After
vaccination, the body develops a resistance to vaccinia, a disease
that is generally milder than smallpox, and the resistance also works
against smallpox. The injection site can spread the vaccinia virus,
however, and people without strong immune systems are particularly

Smallpox was officially declared eradicated by the World Health
Organization in 1979, and inoculation of military personnel was
suspended in 1990. But after the terrorist attacks of Sept. 11, 2001,
and the subsequent cases of anthrax sent through the mail, the
government began vaccinating military personnel and many health care
workers, with 1.2 million vaccinated as of March of this year.

Since then, a handful of vaccinia cases have been reported to the
Centers for Disease Control and Prevention, including one, described
in the May 4 Morbidity and Mortality Weekly Report, of vulvar
infection in an Alaskan woman whose sex partner was a serviceman.

Dr. Inger Damon, the acting head of the disease center branch
concerned with pox viruses, said, “I think this number of cases
certainly raised our awareness and led to discussions between
ourselves and the D.O.D.”

An account of the case was published this week in the morbidity
report. According to the report, which did not give the family’s
name, the boy was taken to the University of Chicago Comer Children’s
Hospital on March 3.

Dr. Madelyn Kahana, the chief of pediatric intensive care medicine at
the hospital, said in an interview that the child had been covered
with “mounds of pox” that reminded her of photos of bees swarming
over beekeepers. “I’m a veteran of 25 years of practice in the
I.C.U.’s, and I thought I’d seen it all,” Dr. Kahana said. “But this
was stunning to the eye.”

Dr. John F. Marcinak, an associate professor of pediatrics who worked
16 hours a day with the boy, said that in the first weeks of the
case, “it was really touch and go.”

The doctors gave the boy narcotics to render him unconscious and free
of pain. They also inserted a breathing tube and put him on
mechanical ventilation to counter the breathing problems that can
come with heavy doses of narcotics.

Doctors worked with the disease control centers to get shipments of
Vaccinia Immune Globulin Intravenous. They also used an antiviral
drug, Cidofovir. That drug, which has been associated with kidney
problems in some cases, may have caused another crisis in which the
boy’s kidneys began failing and his abdomen filled with fluid.

“He looked like he was going to die,” Dr. Kahana recalled.

The doctors worked with the Food and Drug Administration to allow the
use of an experimental drug for smallpox, ST-246, from Siga
Technologies, which appeared to begin turning the case around.

Meanwhile, doctors drained the boy’s distended abdomen and cut away
the dead skin, a process called debridement that is commonly used in
burn victims. They put skin from cadavers over his exposed flesh to
promote healing underneath and dressed the wounds.

The child’s mother also developed lesions on her face and index
finger. She has recovered, but because of her infection, she had to
be confined to his room and witnessed every procedure performed on
her child. The military brought the father back from Iraq after the
boy became ill.

The procedures for smallpox vaccination were hammered out through
long discussion to prevent those who were particularly susceptible to
the side effects from receiving it, said Dr. William Schaffner, who
served on the C.D.C. Advisory Committee on Immunization Practices.

The case, Dr. Schaffner said, raises the question of “whether the
stringent procedures that were initially put in place have eroded

In an editorial accompanying the report, the authors said that the
military was studying the incident, “which will determine whether
screening and education practices need to be modified.”

The boy’s skin grew back at a phenomenal rate and shows remarkably
few signs of the ravages of the disease, Dr. Kahana said. She
attributed the recovery to “a lot of good, diligent care and a lot of
luck — and maybe divine intervention.”

As for his emotional recovery from the ordeal, she said, “He doesn’t
remember a thing.” She added, however, “His mom remembers all of it.”

Meryl Nass, MD
Mount Desert Island Hospital
Bar Harbor, Maine 04609
207 288-5081 ext. 220

Meryl Nass <>

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