Between January 24 and March 21, 2003 the smallpox vaccine was administered to 25,645 civilian health care and public health workers in 53 jurisdictions as part of an effort to prepare the United States in the event of a terrorist attack using smallpox.

Seven cases of cardiac adverse events have been reported among civilian vaccinees since the beginning of the smallpox vaccination program. In addition, 10 cases of myopericarditis have been reported among military vaccinees. This report summarizes data on the seven cases reported among civilians and provides background information on recent military vaccinees. Although a causal association between vaccination and adverse cardiac events in the civilian population is unproven, as a precautionary measure, CDC recommends that persons with physician-diagnosed cardiac disease with or without symptoms (e.g., previous myocardial infarction, angina, congestive heart failure, or cardiomyopathy) be excluded from vaccination during this smallpox preparedness program.

The seven adverse events of cardiac origin among civilian vaccinees include three myocardial infarctions, two cases of angina, and two cases of myopericarditis. The median age of patients was 50 years (range: 43 to 60 years), and five were women. Two of the three patients who had a myocardial infarction died.

As of March 23, a total of 10 cases of myocarditis and/or pericarditis have been identified among approximately 225,000 primary military vaccinees in the smallpox vaccination program. All had onset of chest pain six to 12 days following vaccination and all had clinical, laboratory, electrocardiographic, and/or echocardiographic evidence of myocardial and/or pericardial inflammation. None of the cases were clinically severe, and all patients recovered fully and returned to active duty. No cases of myocarditis or pericarditis were detected among approximately 100,000 persons in the military program who were revaccinated.

MMWR March 28, 2003/52(12);248-250

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References:

[1] Whiteman, T. Hypercoagulable States. Hematol. Oncol. Clin. North Am. - 01-Apr-2000; 14(2): 355-77

[2] Marshall, John C. MD, FRCSC. Inflammation, coagulopathy and the pathogenesis of multiple organ dysfunction syndrome. Crit Care Med. Vol. 29; No. 7. July, 2001

[3] Berg, David. Berg D, Berg LH, Couvaras J, Harrison H. Chronic fatigue syndrome &/or fibromyalgia as a variation of antiphospholipid antibody syndrome (APS): An explanatory model and approach to laboratory diagnosis. Blood Coagulation and Fibrinolysis 1999: 10 435-438.

[4]Arid, William C., MD Endothelial cell dynamics and complexity theory. Crit Care Med
Vol. 30; No.5; May, 2002

[5] Friedman, H.M. Virus infection of endothelial cells. J Infect Dis. February 1, 1981; 143(2): 266-73

Marcel Levi, MD. Endothelium: Interface between coagulation and inflammation. Crit Care Med. Vol. 30, No. 5. May, 2002.

[7] http:// query.nytimes.com/ search/ restricted/ article? res= F30B17FE3D5 D0C7B8EDDAA0 894DB404482

Hannan KL. et al. Activation of the coagulation system in Gulf War Illness: a potential pathophysiologic link with chronic fatigue syndrome. Blood Coagulation and Fibrinolysis, 11(7);2000:673-678.

[9] Jeffrey T. Kuvin, MD et al. Effect of short-term antibiotic treatment on chlamydia pneumoniae and peripheral endothelial function. The American Journal of Cardiology. Vol. 91; No. 6 • March 15, 2003

[10] Diepgen TL. Is the prevalence of atopic dermatitis increasing? In: Williams HC, ed. Atopic Dermatitis: The Epidemiology, Causes and Prevention of Atopic Eczema. New York: Cambridge Univ Pr; 2000:96-112.

[11] United Network for Organ Sharing (UNOS). All Recipients: Age at Time of Transplant. www.unos.org

[12] Joint United Nations Programme on HIV/AIDS. Epidemiological Fact Sheets on HIV and Sexually Transmitted Infections: United States. http:// www.unaids.org/ fact_sheets/ index.html

[13] National Cancer Institute. CanQues. http:// srab.cancer.gov/ Prevalence/ canques.html

[14] CDC. Preventing Heart Disease and Stroke: Addressing the Nation’s Leading Killers http:// www.cdc.gov/ nccdphp/ aag/ aag_cvd.htm