CDC tells heart patients to avoid smallpox shot for now

Mar 26, 2003 (CIDRAP News) – Because of heart problems that occurred in seven healthcare workers after they received smallpox shots, federal health officials say people who have heart disease should postpone the shot while investigators look for a possible link between the vaccine and heart disorders.

Three healthcare workers suffered heart attacks after getting the shot, and one died, the Centers for Disease Control and Prevention (CDC) announced yesterday evening. In addition, two people experienced angina and two had myopericarditis. Smallpox shots have never been linked with heart problems before.

The seven were among 25,645 people who have received shots in the civilian smallpox vaccination program, which began in late January, the CDC said. The agency said it is not clear whether the seven cases are more than would be expected normally in the population getting the shots.

"We promised to closely monitor this program and to put safety first, so we are exercising exceptional caution," CDC Director Julie Gerberding, MD, said in a news release. "If our investigation shows this precautionary measure should become permanent or the need for other changes or enhancements in the civilian smallpox vaccination program, we will take immediate action."

CDC recommended that people with known heart disease, such as cardiomyopathy, previous heart attack, or a history of angina, avoid the vaccine for now. "CDC will provide states with simple questions about heart problems to use in screening people volunteering for smallpox vaccination," the release stated.

At a news briefing yesterday evening, Gerberding said the three people who suffered myocardial infarctions after the shots were all female healthcare or public health workers in their 50s. One of them is now on life support, and another was hospitalized and later released, she said.

The Associated Press reported that the fatal case involved a hospital worker in Salisbury, Md., who died Mar 24, five days after her vaccination.

At the briefing, Gerberding said the three women who had heart attacks had clear risk factors for coronary artery disease (CAD), including diabetes, obesity, hypertension, smoking, or a history of angina. "And that's why we cannot necessarily ascribe any relationship of vaccination to these events. It could be entirely coincidental," she said. She also said the patients who had myocarditis did not have preexisting CAD risk factors.

CDC officials said they asked the Advisory Committee on Immunization Practices last week to examine reports of heart-related adverse events in the smallpox vaccination program. In addition, CDC is starting research to identify and understand any association between the vaccine and heart problems.

Cases of heart inflammation after smallpox vaccination were reported in the 1960s and 1970s, but those reports did not shed any light on who may run a higher risk of heart problems after getting the shot, the CDC statement said.

Gerberding said CDC expects that the vaccination deferral will affect fewer than 10% of prospective vaccine recipients.

The vaccination deferral for people with heart disease is in addition to several other contraindications for the shot. The CDC recommends against vaccination for healthcare workers who have, or live with people who have, a history of eczema or atopic dermatitis; those who have HIV or immunosuppressive conditions; and those who are pregnant or are trying to become pregnant.

See also:

CDC news release

Transcript of CDC news briefing

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