Second Vaccinated Health Worker Dies of Heart Attack

By Ceci Connolly

Washington Post Staff Writer

Friday, March 28, 2003; Page A09

A second health care worker recently immunized against smallpox has died of a heart attack, federal officials confirmed yesterday, although they do not know whether the deaths were related to the vaccine. The Centers for Disease Control and Prevention in Atlanta has called an emergency meeting today of its vaccine advisory committee, cardiac specialists and military epidemiologists to discuss possible changes in the vaccination program in light of new concerns about heart risks. A total of seven health care workers and 10 military personnel have reported heart trouble since being immunized, prompting CDC to recommend against vaccinating anyone with known heart disease. But some inside the agency, as well as experts outside, have argued it might be necessary to take a more cautious approach. "This is a vaccine that carries substantial risks with as-yet-unknown negative health consequences," said Brian Strom, chairman of the Institute of Medicine's committee on smallpox vaccination program implementation. The institute, a branch of the National Academy of Sciences, advises the government on medical issues. Strom said it might be time for the Bush administration to reassess whether it is necessary and safe to continue with its aggressive plan to inoculate millions of health care workers and emergency responders. "Let's go back to the purpose of the campaign, which is preparedness," he said in a press briefing. The committee also urged Congress to enact a compensation program for people who are harmed or die from the vaccine. CDC dispatched specialists to Maryland's eastern shore and St. Petersburg, Fla., to help investigate the two fatal heart attacks. Authorities identified the second woman as Virginia Jorgensen, a 57-year-old nurse assistant with a history of smoking and hypertension. The government called initially for vaccinating 450,000 hospital and public health workers who would treat early cases and set up mass vaccination clinics during any outbreak. Because only 25,000 people have volunteered, the CDC has quietly opened the program to other emergency responders. "This is part of our effort to prepare the United States for a smallpox attack should that ever occur," said Walter Orenstein, director of CDC's National Immunization Program. Yet J. Michael Lane, the former chief of the CDC's smallpox eradication program, said absent a smallpox attack or evidence an enemy possesses the deadly virus, 25,000 vaccinated medical workers may be sufficient. "Is it really important for us to vaccinate five or 10 times that many?" he asked. At a minimum, he suggested CDC and state health departments be more selective in recruiting volunteers for vaccination. "It's kind of silly to vaccinate people with established, serious chronic illness, because they might not be the right people to put on a high-stress team," Lane said. With respect to the more serious episodes -- three heart attacks and two cases of angina -- Orenstein said early analysis suggests those figures may be typical in a group of 25,000 middle-aged civilians, many with risk factors such as obesity, hypertension and diabetes. 2003 The Washington Post Company

House defeats smallpox compensation created: March 31, 2003 - 10:19 PM
updated:
April 01, 2003 - 11:23 PM
posted by Web Producer Jeannie Piper

WASHINGTON (AP) - A Republican-crafted bill compensating people injured by the smallpox vaccine was defeated in the House Monday amid complaints that the payments were too stingy, and the troubled vaccination program was temporarily suspended in at least ten states.

State officials said they were suspending their programs to give federal officials time to investigate whether the vaccine played any role in three heart attack deaths. The vaccine carries well-documented, serious risks, though heart disease had never been considered one of them.

Despite widespread agreement that compensation is needed for people injured or killed by the vaccine, Congress has been unable to agree on a package of benefits.

On Monday, the House defeated, 206-184, a GOP-backed bill establishing a set of payments. Republicans were invoking rules needing a two-thirds majority, usually used for noncontroversial matters, but they failed to get even a simple majority.

It was a rare defeat for House Republicans, who were not sure what to do next. They were considering attaching it to a spending bill moving through Congress now.

Democrats complained that the Republican bill was not generous enough to persuade health care workers and others to sign up for the vaccine.

All involved with the government's smallpox program believe it's imperative that Congress establish payments for those injured or killed by the vaccine. Congress has already barred most lawsuits that might stem from the vaccine, and state workers' compensation programs offer only spotty coverage.

The number of people volunteering for the shot is well below what was expected, partly because of concerns that injured people won't be compensated for medical expenses, lost work time and other expenses.

The national vaccination program also has suffered from questions about the relationship between the vaccine and heart problems after three people died of heart attacks after being inoculated.

While experts suspect the vaccine is probably not to blame, nine states -- Arizona, California, Illinois, Maine, Michigan, Nevada, New York, Vermont and Washington state -- have suspended their programs during an investigation.

A tenth state, Connecticut, ordered a two-day suspension. And in Idaho, state officials recommended that that local health districts temporarily suspend vaccinations.

The Centers for Disease Control and Prevention told states Monday that it is now recommending that people with heart disease -- or at risk of heart disease -- refrain from vaccination. The CDC was sending out new forms to help states screen people for the vaccine.

Still, some predicted the heart problems would continue to hold the program back.

"Even if this is not related to the vaccine at all ... a lot of people have been spooked to begin with," said Dr. Elizabeth MacNeill, chief medical officer for the Pima County Health Department in Arizona. "I think this will make it even harder to get people to volunteer."

The heart attacks have also sharpened demands that Congress act on compensation. While heart attack has never been associated with the smallpox vaccine, known risks include terrible rashes, blindness and life-threatening infections.

The Republican bill, based on a proposal from President Bush, would provide $262,100 if a person should die or be permanently and totally disabled by the vaccine. The amount is based on an existing program to compensate injured police and firefighters.

Those less severely injured by the vaccine could receive up to $50,000 per year in lost wages, up to a maximum of $262,100, if they are out of work for at least five days. They could also get unpaid medical expenses.

The Democrats' version would provide the same $262,100 for those who die or are permanently disabled but would pay $75,000 per year in lost wages, with no lifetime cap.

Additionally, the Democrats would guarantee the money, while the Republican bill would force this program to compete for funding each year.

There is similar disagreement in the Senate, where a committee was considering the matter later this week.

House Republicans, fearing the Democratic plan might pass, were trying to arrange things so they would not have to vote on it. They argued their version was generous enough.

"If these caps are good enough for our public police officers and our firefighters who die in the line of duty, then I submit that indeed they are good enough for this program as well," said Rep. Billy Tauzin, R-La.

Democrats said the GOP compensation package would persuade too few workers to be vaccinated, given the known risks.

"The bill that is on the floor today will not give nurses, firefighters, other first responders the assurances that they need to be vaccinated," said Rep. Lois Capps, D-Calif. "It will not work."

(Copyright 2003 by the Associated Press. All Rights Reserved)