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Vaccines Shield People from Germs, Keep Them Healthy, Help Military Mission

By Rudi Williams
American Forces Press Service

WASHINGTON, Feb. 11, 2003 – Noting that DoD's anthrax and smallpox vaccination plans are part of the global war on terrorism, Army Col. John D. Grabenstein said vaccines shield people from dangerous germs, keep them healthy so they can live better lives, and help them do their military missions and return home healthy.

Vaccines prevent infections such as tetanus, typhoid fever, measles, yellow fever, smallpox, anthrax and a host of other diseases, according to Grabenstein, 20-year expert in vaccines. He is deputy director for military vaccines, Office of the Army Surgeon General. He spoke recently at the 2003 TRICARE Conference here.

"Anthrax and smallpox vaccines are very much alike and, at the same time, very much different," Grabenstein said during a conference session on DoD vaccination programs against the two diseases.

The World Health Organization declared smallpox eradicated in 1980. DoD stopped routine smallpox immunizations in 1990.

Grabenstein said President Bush announced the resumption of smallpox vaccinations on Dec. 13, 2002, and about 2,000 people on epidemic response teams received them shortly after. The total will climb to about one-half million as hospital and clinic medical teams and mission-critical military forces are immunized.

The number of combat troops vaccinated will be reported to civilian public health authorities, but will not be released to the public, the colonel emphasized.

Controversy abounds about the pros and cons of inoculations against anthrax and smallpox, but Grabenstein assured conferees that whatever DoD medical professionals say or do is rooted in science.

"We're evidence-based and have a firm foundation for what we do. We acknowledge what we don't know and try to get that data and proceed accordingly," he said. "The other key piece is that we're in the care-giving business and operate a no-fault health care system.

"Is that absolute, definitive proof that the vaccine never causes any harm to anybody? No. All medications have their side effects," Grabenstein remarked. "We operate a no- fault system, so if somebody is sick, get them care. It doesn't matter whether the vaccine did it, get them care and then we'll sort it all out."

He recalled a conversation on a bus en route to the Pentagon when one of the folks in his office said, "I thought you stopped the program with anthrax vaccinations because of all the controversy."

"No," he responded, "we almost ran out of vaccine. That's why we slowed down." DoD began anthrax vaccinations in March 1998, but manufacturer's delays resulted in a slowdown in 2000 and 2001, the colonel noted. DoD reacted in July 2000 by limiting inoculations to troops in or bound for Korea and Southwest Asia. "That wasn't enough, so we slowed down twice again," Grabenstein said.

He said Congress directed the National Academy of Sciences Institute of Medicine to start a thorough study in fall 2000 on "everything known about anthrax vaccine. The academy concluded in March 2002 that anthrax vaccine effectively protects humans against anthrax, including inhalation anthrax, "caused by all known or plausible engineered strains of B. anthracis."

Grabenstein said the Centers for Disease Control and Prevention is coordinating a study to see if the long-recommended six-shot series is really necessary or whether fewer doses would protect as well. He said he hopes the CDC data support fewer shots, say, four. The Food and Drug Administration has the final word, he noted.

As to vaccine safety, Grabenstein said, the National Academy of Sciences investigative committee listened carefully to naysayers' concerns and allegations but in the end found that anthrax vaccine has side effects "comparable to those observed with other vaccines regularly administered to adults. There's no evidence people face increased risks of life-threatening or permanently disabling adverse events immediately after vaccination nor any elevated risk of developing adverse health effects over the longer term."

In the lessons-learned category, Grabenstein said DoD has "all sorts of customers, and we need to work with them. We need to educate them and listen to their concerns and find the answers that they personally want, not just what we think most people want."

Grabenstein said there's a new resource in the vaccine area. "We started with the vaccine health care center at Walter Reed Army Medical Center in Washington a year and a half ago," he noted. "The delightful news is that the Navy is standing up the second vaccine health care center at Portsmouth, Va. And there's an additional series of sites coming along in the pipeline."

The Army, DoD's lead agent for vaccines, is using Food and Drug Administration-licensed doses of the smallpox vaccine, also known as vaccinia vaccine or Dryvax, manufactured by Wyeth Laboratories. Grabenstein said vaccinia is a weaker virus that has a lower rate of adverse reactions than the potentially lethal smallpox virus, more properly called variola virus.

He noted that the smallpox vaccination program is about preparedness. "Contagious, we know. Deadly, we know. And the effect on a military mission would be enormous," he said. "With anthrax, we talk about higher threat areas, but it's really a different construct with smallpox."

Many of the people receiving smallpox vaccinations now are those furthest from medical reinforcement, he said. "We have great resources in the states. Conditions in Afghanistan are not like that," he added.

Grabenstein estimated about 65 percent of active duty personnel and 43 percent of reservists have never been vaccinated against smallpox. Even among those who have been immunized, he said, their last dose was a long time ago.

Up to 40 percent of any group of people might be exempted from smallpox vaccination to avoid adverse events. Automatically exempted, for instance, are pregnant women, breast- feeding mothers, and persons with immune deficiencies, such as HIV infection, or with certain skin conditions and allergies.

Of the patch of skin that usually serves as a smallpox immunization site, Grabenstein gave clear warning: "Don't touch it. If you touch it by accident, wash your hands. Don't let others touch it." He also said to avoid close contact with medically exempt people. In field situations, don't share mattresses, clothes or towels with them.

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