CDC reports four more cardiac episodes in smallpox vaccinees

Apr 10, 2003 (CIDRAP News) – The Centers for Disease Control and Prevention (CDC) has reported three more possible cases of heart inflammation and another heart attack in recent civilian smallpox shot recipients.

With 31,297 civilians vaccinated so far, the new report brings the number of suspected or probable myocarditis and/or pericarditis cases to seven. In addition, a total of seven civilians have had a myocardial infarction (MI), in two cases fatal, or angina within days or weeks after getting the shot. CDC reports the new cases in the Apr 11 issue of Morbidity and Mortality Weekly Report.

The initial reports of heart difficulties in vaccinees prompted the CDC on Mar 25 to warn against smallpox vaccination for people with known heart disease. Later the warning was broadened to include people with three or more major cardiac risk factors, such as diabetes, hypertension, and current smoking.

Of the three new heart inflammation cases, two are listed as suspected and one as probable. In one case, a previously vaccinated 52-year-old man experienced chest pain 8 days after his revaccination. A second case involved a previously vaccinated 49-year-old woman who had sharp chest pain 2 days after she was revaccinated. Tests indicated possible pericarditis in both patients, and investigation was continuing. The third cardiac inflammation case was not described.

The heart attack was in a 46-year-old man who had had a previous MI and had been having chest pain for 3 days before his smallpox revaccination. His pain worsened the evening after he was vaccinated, and an MI was diagnosed after he reported to a hospital. He underwent angioplasty and received three stents and is now discharged and well, according to the report.

Given the man's previous chest pain and the fact that viral replication is not likely to occur the same day as vaccination, the MI probably was not a direct result of the shot, the report states. But it says investigation is continuing.

Other "serious" adverse events reported between Mar 31 and Apr 4 in connection with the civilian vaccination program included one case of acute appendicitis, one case of pneumonia, five cases of atypical chest pain, one case of atypical chest pain with asthma, and one case of new-onset atrial fibrillation. No cases of vaccinia virus transmission from vaccinees, including 19,508 healthcare workers, to others have been seen in the vaccination program so far, the report says.

See also:

April 11 MMWR report:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5214a5.htm

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