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Smallpox: The Risk: Medical Complications
Aired December 13, 2002 - 11:15 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LEON HARRIS, CNN ANCHOR: In a few hours, the president is expected to announce his new plan for smallpox vaccination of all Americans on a voluntary basis, but thousands could get sick from the shot itself, and that is creating a controversy, as we learn from CNN's Dr. Sanjay Gupta, who joins us now on the set.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: I mean this is the announcement that we've been waiting for quite some time, no question. It is a controversial vaccine; 500,000 military personnel will probably be directed to this; 500,000 or so first responders, or health care workers, people who actually go to the site of a possible attack if that ever occurs, Leon, but it's so controversial because the fact this is a dangerous vaccine, one to two out of a million people will likely die from that.
Leon, if you vaccinate the entire country, that's about 250 to 500 people would actually die from this. So not surprising it's been so debated, so controversial.
HARRIS: Also joining us we should mention is Dr. Paul Offit, an infectious disease expert, and he's with us from Philadelphia this morning.
Good morning. how are you?
DR. PAUL OFFIT, INFECTIOUS DISEASE EXPERT: Good morning.
HARRIS: I want to give the doctor a chance to weigh in on this as well.
GUPTA: Yes, one other thing, Dr. Offit is actually the chairman of infectious diseases at Children's Hospital in Pennsylvania. One thing that comes up over and over again is kids. Should these kids be getting vaccinated? And Dr. Offit, I'm kind of curious what some of your thoughts are, especially in your position?
OFFIT: Well, I think that the recommendation by the Advisory Committee of Immunization Practices, which is the committee that recommends vaccine usage to the Centers for Disease Control has said both in June of this year as well as October of this year, is that we do not recommend it be distributed to the general public, and the reason for that is remember, there is right now no disease that has occurred on the face of this Earth in 25 years, and as you said in your intro, it is a vaccine which has severe and occasionally fatal side effects.
So I think right now, certainly for the general public, the feeling is that the risks of the vaccine outweigh its benefits.
HARRIS: Let's get right to the e-mails. We've got quite a field to get through this morning. The first one comes to us from Romeo, Michigan. Gerard writes, "I have read that smallpox is not very communicable at all, and that conditions in which it's spread are usually classified as prolonged, intense contact with an infected individual. Is that true?
GUPTA: Well, I'll tell you, this is actually a very contagious disease, which is precisely the reason that people are so scared of it. This is a disease that can be spread by people actually coughing on one another in the late stages of the disease. This is not something that you could have be actually spreading without knowing that you're spreading.
You're going to be pretty sick if you're going to be contagious. But once you are sick, you can be very contagious, Leon. There's stories about people being able to spread this to 17 people just with a cough. But again, I want to reinforce again, by the point you get contagious, you're very sick, you're not out flying at airplanes, you're not at the shopping malls; you're home in bed.
HARRIS: Let's get to the next e-mail we have here, I believe this one is from Rob in Richmond, Virginia: "I had a smallpox vaccination as a child some 35 years ago. I've heard that I may have some protection now, but probably not complete protection. If I want to be revaccinated, does that mean I won't have an adverse reaction since I didn't have an adverse reaction as a child? How about that one, Dr. Offit?
OFFIT: Well, there's two parts to that question. I think that it's very clear that if you've already received a vaccine, your chance of having a serious, adverse or fatal reaction from the vaccine is at least tenfold lower. So that's true, and that should be reassuring.
The first part of that question is one of duration of immunity, and it's hard to know the answer. There was one study done in the early 1900s in Liverpool, England, and they looked at an outbreak of smallpox and tried to answer the question, if you were vaccinated, were you protected, and if so, how long before you had been vaccinated did that protection last? What they found was 50 years after vaccination, the protection was at least tenfold as compared to a non- vaccinated group. That's reassuring.
But remember, those were back in the days when people often received, you know, one or two or three doses of the vaccine in childhood, not just the one we typically received when we were younger. So I think the answer is, there probably is some protection, but it's likely that for people that got a single dose, the protection wanes.
GUPTA: So we've got phone calls coming in as well, Chris from Scarborough Maine is on the phone.
Chris, go ahead with your question please. CALLER: Yes, what is the difference between the side effects from a smallpox vaccine and side effects from regular childhood vaccines?
GUPTA: Dr. Offit, do you want to go ahead? Did you hear that question?
OFFIT: Yes, I did, and I think that's a really important question. We're so used to modern vaccines, which were developed all, for the most part, within the last 60 years, which have excellent safety profiles. The fact of the matter is, 3 1/2 million to 4 million children every year get vaccines, and they don't cause permanent harm, and they certainly don't cause death. I mean, we're really fortunate to have modern vaccines. It's really wiped out much of the scourges of childhood. But that's not this vaccine. The smallpox vaccine is not a modern vaccine. It was developed by Edward Jenner (ph) in the late 1700s, and the vaccine that we have today is essentially the same vaccine.
Now you could ask, wouldn't it be possible to use modern technology and make a better vaccine, and I think the answer to that question is yes, but it's going to take several years for that to happen, and then the question becomes, can we wait that long?
HARRIS: Let's get to the next e-mail. See if we can squeeze as many as we can in this morning. Next one is from Emilio in Caguas, Puerto Rico. "Can you tell me which is the most effective treatment for smallpox?"
GUPTA: This is a fascinating question, because there really isn't good treatments for smallpox, and one of the things we've talked about a lot is in order to develop a good treatment for smallpox, Leon, you'd have to knowingly actually infect human beings to be able to test whether or not that treatment was actually a good treatment. No one's going to knowingly infect themselves with smallpox to be able to test that.
There are some good what are called antiviral medications. One of them, I won't bother you with the name of. There is one antiviral medication that seemed to have some promise, at least in laboratories, specially in monkeys in laboratories, but it's really hard to know in human beings, and as Dr. Offet pointed out, we haven't seen this in almost 25 years.
HARRIS:: You can't test on an animal to find out about humans. That's a tough one.
Next e-mail is from A.M. in Branson, Missouri, who writes, "Why is smallpox vaccination considered so dangerous due to possible side effects when as children we were all forced to be inculcated in order to be allowed to enter school? Are the dangerous greater in this new vaccine."
Good question.
GUPTA: Maybe we both can take a stab, because this is an important point and worth reinforcing. It's the same vaccine as the doctor just pointed out, Jenner (ph) in 1796 developed this vaccine, 200 years later, we have the same vaccine. It was just as dangerous as it is today. A couple things have changed. One thing is there's more cases of HIV and chemotherapy than there was before, so more people are at risk, and also the virus doesn't exist like it did before, wouldn't you agree, Dr. Offit?
OFFIT: I think that's exactly right. When you assess the safety of a vaccine, you obviously compare the risks of the vaccine with the risk of the disease, well, the fact is, is that 50, 60 years ago, the disease still did exist, I mean, to a lesser extent in this country, but certainly in the world, now the disease is gone. So therefore, one focus largely just on the risks of the vaccine, and we've made the decision for the last 25 years or so that the risks of the vaccine outweigh its benefits. That's why we haven't been giving it.
HARRIS: I got a phone call the last time you were on to talk about this, a man who has eczema, who was wondering about the particular risks for those with eczema and this vaccine.
GUPTA: Huge topic, eczema affects about 10 percent of the population, 28 to 30 million people. Basically, eczema is a condition of the skin. If you get this vaccine, you have a higher likelihood of spreading the vaccine, this little scar blister thing, all over your entire body, a condition know as eczema vaccinatum (ph). This is a condition that if you see the pictures, Leon, you've probably seen some of them, just terrible pictures, rashes all over the body, and it can potentially be deadly as well. That's why people are very concerned, if you've eczema ever, if you have it now, or if you live with someone with eczema this vaccine is probably not a good idea for you.
HARRIS: Do not get the shot, there you go. If the caller is watching this morning, I can't remember his name, but I hope you heard the answer there.
Dr. Sanjay Gupta, Dr Paul Offit, thank you very much, appreciate the insight and the expertise this morning.
Always good to see you, Sanjay. Have a good weekend. Dr. Offit, take care. We'll see you soon.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired December 13, 2002 - 11:15 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LEON HARRIS, CNN ANCHOR: In a few hours, the president is expected to announce his new plan for smallpox vaccination of all Americans on a voluntary basis, but thousands could get sick from the shot itself, and that is creating a controversy, as we learn from CNN's Dr. Sanjay Gupta, who joins us now on the set.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: I mean this is the announcement that we've been waiting for quite some time, no question. It is a controversial vaccine; 500,000 military personnel will probably be directed to this; 500,000 or so first responders, or health care workers, people who actually go to the site of a possible attack if that ever occurs, Leon, but it's so controversial because the fact this is a dangerous vaccine, one to two out of a million people will likely die from that.
Leon, if you vaccinate the entire country, that's about 250 to 500 people would actually die from this. So not surprising it's been so debated, so controversial.
HARRIS: Also joining us we should mention is Dr. Paul Offit, an infectious disease expert, and he's with us from Philadelphia this morning.
Good morning. how are you?
DR. PAUL OFFIT, INFECTIOUS DISEASE EXPERT: Good morning.
HARRIS: I want to give the doctor a chance to weigh in on this as well.
GUPTA: Yes, one other thing, Dr. Offit is actually the chairman of infectious diseases at Children's Hospital in Pennsylvania. One thing that comes up over and over again is kids. Should these kids be getting vaccinated? And Dr. Offit, I'm kind of curious what some of your thoughts are, especially in your position?
OFFIT: Well, I think that the recommendation by the Advisory Committee of Immunization Practices, which is the committee that recommends vaccine usage to the Centers for Disease Control has said both in June of this year as well as October of this year, is that we do not recommend it be distributed to the general public, and the reason for that is remember, there is right now no disease that has occurred on the face of this Earth in 25 years, and as you said in your intro, it is a vaccine which has severe and occasionally fatal side effects.
So I think right now, certainly for the general public, the feeling is that the risks of the vaccine outweigh its benefits.
HARRIS: Let's get right to the e-mails. We've got quite a field to get through this morning. The first one comes to us from Romeo, Michigan. Gerard writes, "I have read that smallpox is not very communicable at all, and that conditions in which it's spread are usually classified as prolonged, intense contact with an infected individual. Is that true?
GUPTA: Well, I'll tell you, this is actually a very contagious disease, which is precisely the reason that people are so scared of it. This is a disease that can be spread by people actually coughing on one another in the late stages of the disease. This is not something that you could have be actually spreading without knowing that you're spreading.
You're going to be pretty sick if you're going to be contagious. But once you are sick, you can be very contagious, Leon. There's stories about people being able to spread this to 17 people just with a cough. But again, I want to reinforce again, by the point you get contagious, you're very sick, you're not out flying at airplanes, you're not at the shopping malls; you're home in bed.
HARRIS: Let's get to the next e-mail we have here, I believe this one is from Rob in Richmond, Virginia: "I had a smallpox vaccination as a child some 35 years ago. I've heard that I may have some protection now, but probably not complete protection. If I want to be revaccinated, does that mean I won't have an adverse reaction since I didn't have an adverse reaction as a child? How about that one, Dr. Offit?
OFFIT: Well, there's two parts to that question. I think that it's very clear that if you've already received a vaccine, your chance of having a serious, adverse or fatal reaction from the vaccine is at least tenfold lower. So that's true, and that should be reassuring.
The first part of that question is one of duration of immunity, and it's hard to know the answer. There was one study done in the early 1900s in Liverpool, England, and they looked at an outbreak of smallpox and tried to answer the question, if you were vaccinated, were you protected, and if so, how long before you had been vaccinated did that protection last? What they found was 50 years after vaccination, the protection was at least tenfold as compared to a non- vaccinated group. That's reassuring.
But remember, those were back in the days when people often received, you know, one or two or three doses of the vaccine in childhood, not just the one we typically received when we were younger. So I think the answer is, there probably is some protection, but it's likely that for people that got a single dose, the protection wanes.
GUPTA: So we've got phone calls coming in as well, Chris from Scarborough Maine is on the phone.
Chris, go ahead with your question please. CALLER: Yes, what is the difference between the side effects from a smallpox vaccine and side effects from regular childhood vaccines?
GUPTA: Dr. Offit, do you want to go ahead? Did you hear that question?
OFFIT: Yes, I did, and I think that's a really important question. We're so used to modern vaccines, which were developed all, for the most part, within the last 60 years, which have excellent safety profiles. The fact of the matter is, 3 1/2 million to 4 million children every year get vaccines, and they don't cause permanent harm, and they certainly don't cause death. I mean, we're really fortunate to have modern vaccines. It's really wiped out much of the scourges of childhood. But that's not this vaccine. The smallpox vaccine is not a modern vaccine. It was developed by Edward Jenner (ph) in the late 1700s, and the vaccine that we have today is essentially the same vaccine.
Now you could ask, wouldn't it be possible to use modern technology and make a better vaccine, and I think the answer to that question is yes, but it's going to take several years for that to happen, and then the question becomes, can we wait that long?
HARRIS: Let's get to the next e-mail. See if we can squeeze as many as we can in this morning. Next one is from Emilio in Caguas, Puerto Rico. "Can you tell me which is the most effective treatment for smallpox?"
GUPTA: This is a fascinating question, because there really isn't good treatments for smallpox, and one of the things we've talked about a lot is in order to develop a good treatment for smallpox, Leon, you'd have to knowingly actually infect human beings to be able to test whether or not that treatment was actually a good treatment. No one's going to knowingly infect themselves with smallpox to be able to test that.
There are some good what are called antiviral medications. One of them, I won't bother you with the name of. There is one antiviral medication that seemed to have some promise, at least in laboratories, specially in monkeys in laboratories, but it's really hard to know in human beings, and as Dr. Offet pointed out, we haven't seen this in almost 25 years.
HARRIS:: You can't test on an animal to find out about humans. That's a tough one.
Next e-mail is from A.M. in Branson, Missouri, who writes, "Why is smallpox vaccination considered so dangerous due to possible side effects when as children we were all forced to be inculcated in order to be allowed to enter school? Are the dangerous greater in this new vaccine."
Good question.
GUPTA: Maybe we both can take a stab, because this is an important point and worth reinforcing. It's the same vaccine as the doctor just pointed out, Jenner (ph) in 1796 developed this vaccine, 200 years later, we have the same vaccine. It was just as dangerous as it is today. A couple things have changed. One thing is there's more cases of HIV and chemotherapy than there was before, so more people are at risk, and also the virus doesn't exist like it did before, wouldn't you agree, Dr. Offit?
OFFIT: I think that's exactly right. When you assess the safety of a vaccine, you obviously compare the risks of the vaccine with the risk of the disease, well, the fact is, is that 50, 60 years ago, the disease still did exist, I mean, to a lesser extent in this country, but certainly in the world, now the disease is gone. So therefore, one focus largely just on the risks of the vaccine, and we've made the decision for the last 25 years or so that the risks of the vaccine outweigh its benefits. That's why we haven't been giving it.
HARRIS: I got a phone call the last time you were on to talk about this, a man who has eczema, who was wondering about the particular risks for those with eczema and this vaccine.
GUPTA: Huge topic, eczema affects about 10 percent of the population, 28 to 30 million people. Basically, eczema is a condition of the skin. If you get this vaccine, you have a higher likelihood of spreading the vaccine, this little scar blister thing, all over your entire body, a condition know as eczema vaccinatum (ph). This is a condition that if you see the pictures, Leon, you've probably seen some of them, just terrible pictures, rashes all over the body, and it can potentially be deadly as well. That's why people are very concerned, if you've eczema ever, if you have it now, or if you live with someone with eczema this vaccine is probably not a good idea for you.
HARRIS: Do not get the shot, there you go. If the caller is watching this morning, I can't remember his name, but I hope you heard the answer there.
Dr. Sanjay Gupta, Dr Paul Offit, thank you very much, appreciate the insight and the expertise this morning.
Always good to see you, Sanjay. Have a good weekend. Dr. Offit, take care. We'll see you soon.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
