CDC: Smallpox Vaccine Contraindicated With Steroid Inhalers
Question:
>Ok, I changed my mind as I got to thinking about this and the reply I >sent. Back then, steroid inhalers were non existent and that was the >way it was given. >However, the military gives a combination of shots all at one time. >Don’t know what the soilder does now who is in military and has asthma >and he/she takes a steroid inhaler when they have to have the shots to >go to their foreign assignment.
We roll up our sleeves just like everybody else. If your asthma prevents you from getting the shots necessary for overseas deployment and combat – you will be medically seperated/retired. >OT: earlier yesterday on C-Span2 there was a wonderful program about >the effect of a combination of shots given to children now and their >mother all at one time and what they have observed that wasn’t given >to us older now people in their 50-60 ages and it was scary. This was >a private group of doctors and others. I usually don’t listen or watch >this but this was an eye opener. Only time I was given a combination >all at one time was going overseas with parents. Otherwise back then, >stationed stateside we were given the combination separately at >different times. Measles, smallpox,chickenpox,etc. Had parents ask >question to the doctors,etc. and the stories they told of what had >happened to their children having the combination all at one time.
Don’t allow the media to make medical decisions for you. This sort of thing will focus on what will get your attention instead of what is accurate. If they cannot produce actual statistics – then they are probably giving you hype. — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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> Known asthmatics are not accepted for military service. In the UK they > are also not accepted for the Fire Service, but mild ones may be > accepted into the Police.
Funny, my father managed to get in and work his way through the ranks from Private Soldier to Major in 28 years service. Despite taking Sodium Cromoglycate all his working life. — Dr. Paul Cummins (ULC) – Always a NetHead Wasting bandwidth since 1981
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>Ok, I changed my mind as I got to thinking about this and the reply I >sent. Back then, steroid inhalers were non existent and that was the >way it was given. >However, the military gives a combination of shots all at one time. >Don’t know what the soilder does now who is in military and has asthma >and he/she takes a steroid inhaler when they have to have the shots to >go to their foreign assignment.
Known asthmatics are not accepted for military service. In the UK they are also not accepted for the Fire Service, but mild ones may be accepted into the Police. <snip> — Five Cats
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Ok, I changed my mind as I got to thinking about this and the reply I sent. Back then, steroid inhalers were non existent and that was the way it was given. However, the military gives a combination of shots all at one time. Don’t know what the soilder does now who is in military and has asthma and he/she takes a steroid inhaler when they have to have the shots to go to their foreign assignment. OT: earlier yesterday on C-Span2 there was a wonderful program about the effect of a combination of shots given to children now and their mother all at one time and what they have observed that wasn’t given to us older now people in their 50-60 ages and it was scary. This was a private group of doctors and others. I usually don’t listen or watch this but this was an eye opener. Only time I was given a combination all at one time was going overseas with parents. Otherwise back then, stationed stateside we were given the combination separately at different times. Measles, smallpox,chickenpox,etc. Had parents ask question to the doctors,etc. and the stories they told of what had happened to their children having the combination all at one time. Michelle – Hide quoted text — Show quoted text –
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(The Advisory Committee on Immunization Practices [ACIP] advises against non-emergency use of smallpox vaccine in anyone under 18 years of age.) These people should not receive the vaccine unless they have been exposed to smallpox. OK, I disagree– Being an Army Brat during Occupied Japan and into the 1960’s, My late Mom had asthma and was given the Smallpox shot then for Japan, and going to France in the 1950’s. Then I was 5-7 yrs old then I had to have the Smallpox Vaccine to go to Occupied Japan and then To France in the above time. Had the Smallpox vaccine the last time in early 1960’s when going into Mexico for vacation. Then I had no asthma, I am still here. I have the scar on my arm . Michelle
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A rare occurance with inhaled steroids seen more with oral and IV setroids Bruce
– Hide quoted text — Show quoted text – >http://www.bt.cdc.gov/training/smallpoxvaccine/reactions/contraindica…. h >tml >> This may be a real problem, since it’s possible to get systemic >> absorption from an inhaled steroid and not yet know it–until you’re >> administered the smallpox vaccine. > Or if you have bipolar disorder go manic.. > Cortisone causes mania in persons with bipolar disorder. > =- "REMEMBER THE OAK"-= > *=-And keep an eye on yer truk-=* > This post wasn’t anonymized at http://www.xganon.com
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– Hide quoted text — Show quoted text ->What still bothers me with the steroid portion of the above >statement is that it is way to broad. Do they include inhaled >steroids, someone on a prednisone burst, just people on a long term >steroid treatment. > Here are some more precise guidelines: > "Replication of vaccinia virus can be enhanced among persons with > immunodeficiency diseases and among those with immunosuppression > (e.g., as occurs with leukemia, lymphoma, generalized malignancy, > solid organ transplantation, cellular or humoral immunity disorders, > or therapy with alkylating agents, antimetabolites, radiation, or > high-dose corticosteroid therapy [i.e., >2 mg/kg body weight or 20 > mg/day of prednisone for >2 weeks] [66])." > http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm > "What Sept. 11 did was remind us that there are > times when we must fight for our country, that, > indeed, there are things – our liberty, our > democracy, our belief in human rights and human > dignity – worth fighting for." > Newsday.com editorial – 27 May 2002
Thanks Colin! That was exactly what I was looking for. The prednisone burst and taper I’m on now leaves me over or at 20mg per day for 15 days (and under for 6 days). Sounds like a good idea to stay away from this vaccine while on or recently on a taper of this type. Spent the day bouncing from office to office working on the groundwork to get my asthma back under control. It’s amazing the trouble a sinus infection can cause (among other issues). Hope you had a nice Holiday and best wishes for a Happy New Year (hopefully they let you have some fun on base or on leave). Dan Rhea "Loyalty is for family, friends and country, not operating systems, compilers and computers" – Dan Rhea, 1986
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>Actually the best value of a mass vaccination campaign is that it >deters an attack in the first place. (What good does loosing smallpox >on people who are immune do?)
If they are really immune, agreed, little. >Besides, I am of the firm belief that it is better to take >preventative measures before an event than to react to the event.
You’re betting on everyone getting an effective vaccine, made years ago, watered down, and one which may not work, as you assume it will. >You always have to take ‘Murphy’s Law’ into account.
Another good reason to wait and see what bug or toxin becomes the actual enemy. >Besides, the more people vaccinated before an attack mean that > fewer people will have to be vaccinated after an attack.
There will likely be a redundancy of the pre-attack vaccination population getting the post-attack vaccine.
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>>There is also the possibility of being infected by coming in contact >with infected clothing and bedding, or a terrorist who is wearing an >infected person’s clothing. Droplet saliva and the pustules/scabs >contain virus. >But there is a very limited number of people he can get in this >manner. Without enough susceptible hosts the disease will not be able >to spread.
It doesn’t need to spread to be an effective terrorist weapon. Look what a few letters containing Anthrax did.
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>>Actually the best value of a mass vaccination campaign is that it >deters an attack in the first place. (What good does loosing smallpox >on people who are immune do?) >If they are really immune, agreed, little.
Now given that the official US response to an attack using weapons of mass destruction is to respond with our own weapons of mass destruction. Any doubt in an attackers mind concerning the effectiveness of his agent works to our advantage. >Besides, I am of the firm belief that it is better to take >preventative measures before an event than to react to the event. >You’re betting on everyone getting an effective vaccine, made years >ago, watered down, and one which may not work, as you assume it will.
It is better than nothing – and if it is too old to be effective, better to find out before an attract than after. >Besides, the more people vaccinated before an attack mean that > fewer people will have to be vaccinated after an attack. >There will likely be a redundancy of the pre-attack vaccination >population getting the post-attack vaccine.
There will be people asking to be re-vaccinated. However, they can wait. — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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>>But there is a very limited number of people he can get in this >manner. Without enough susceptible hosts the disease will not be able >to spread. >It doesn’t need to spread to be an effective terrorist weapon. >Look what a few letters containing Anthrax did.
The anthrax letter were nothing more than a large scale harassment attack. In the military there is a clear distinction between a harassment attack and a destruction attack. I am more concerned about destruction attacks than harassment attacks. — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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> I emailed the cdc and this is the response I got. UM MOM Susan <snip> > Who should NOT get the vaccine? … > HIV positive, are receiving treatment for cancer, or are taking medications > (like steroids) that suppress the immune system. (The Advisory Committee on > Immunization Practices [ACIP] advises against non-emergency use of smallpox > vaccine in anyone under 18 years of age.) These people should not receive > the vaccine unless they have been exposed to smallpox.
What still bothers me with the steroid portion of the above statement is that it is way to broad. Do they include inhaled steroids, someone on a prednisone burst, just people on a long term steroid treatment. Also, skin conditions aside, what exactly is the risk here? The vaccine doesn’t work or the person contracts the illness? Hopefully the FDA or CDC will come up with some more specific guidelines. My personal concern is the fact that I’ve been on three prednisone bursts in the last four months… What group of "steroid" category does this put me into? Anyway, I’m not flaming or complaining to anyone here, I’m just grumbling about the inadequate information we have been given so far from the CDC and/or the FDA. Unless they want the hospitals flooded by however many millions of asthmatics there are at present with Smallpox (in the event of an attack), they (the powers that be), need to get a lot more specific with these warnings. Dan Rhea "Loyalty is for family, friends and country, not operating systems, compilers and computers" – Dan Rhea, 1986
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>What still bothers me with the steroid portion of the above >statement is that it is way to broad. Do they include inhaled >steroids, someone on a prednisone burst, just people on a long term >steroid treatment.
Here are some more precise guidelines: "Replication of vaccinia virus can be enhanced among persons with immunodeficiency diseases and among those with immunosuppression (e.g., as occurs with leukemia, lymphoma, generalized malignancy, solid organ transplantation, cellular or humoral immunity disorders, or therapy with alkylating agents, antimetabolites, radiation, or high-dose corticosteroid therapy [i.e., >2 mg/kg body weight or 20 mg/day of prednisone for >2 weeks] [66])." http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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> Basically, there is a chance that people on inhaled steroids may not > develop an immunity to smallpox on the first vaccination. This is > real easy to spot as if you do not develop the characteristic pustule > and subsequent scar – you are likely to need another shot. > A nuisance perhaps – but not a danger.
Colin, I’m a bit confused here. I cannot get (and never have had) a smallpox vaccination because I have eczema. There is a nasty condition called eczema vaccinatum that I’m vulnerable to because of that. It’s my impression that the article was saying that smallpox vaccination could be contraindicated for those using steroids. That is, steroids lower the immunity enough that anyone getting a smallpox vaccination while using steroids could also be vulnerable to eczema vaccinatum, not because the vaccine might not be effective against preventing smallpox. (In the same way, those with compromised immune systems are advised against getting smallpox vaccinations.) Joan
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I emailed the cdc and this is the response I got. UM MOM Susan Thank your for your inquiry. This is in response to your email to the Center for Biologics Evaluation and Research (CBER) regarding the smallpox vaccine. CBER, one of six centers within FDA, is responsible for the regulation of biologically-derived products, including blood intended for transfusion, blood components and derivatives, vaccines and allergenic extracts. These links will provide additional information to answer any additional questions you may have: http://www.bt.cdc.gov/agent/smallpox/index.asp http://www.bt.cdc.gov/agent/smallpox/overview/faq.asp Having said that, Crohn’s disease should not specifically preclude you from being immunized. Who should NOT get the vaccine? People who should not get the vaccine include anyone who is allergic to the vaccine or any of its components; pregnant women; women who are breastfeeding; anyone under 12 months of age; people who have, or have had, skin conditions (especially eczema and atopic dermatitis); and people with weakened immune systems, such as those who have received a transplant, are HIV positive, are receiving treatment for cancer, or are taking medications (like steroids) that suppress the immune system. (The Advisory Committee on Immunization Practices [ACIP] advises against non-emergency use of smallpox vaccine in anyone under 18 years of age.) These people should not receive the vaccine unless they have been exposed to smallpox. Adrienne Hornatko-Munoz Consumer Safety Officer FDA/CBER Office of Communication, Training & Manufacturers Assistance phone 301-827-2000 fax 301-827-3843
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>Colin, I’m a bit confused here. I cannot get (and never have had) a >smallpox vaccination because I have eczema. There is a nasty condition >called eczema vaccinatum that I’m vulnerable to because of that.
Then you are one of the people who should not get the shot – and must depend on the rest of us getting ours. >It’s my impression that the article was saying that smallpox vaccination >could be contraindicated for those using steroids. That is, steroids >lower the immunity enough that anyone getting a smallpox vaccination >while using steroids could also be vulnerable to eczema vaccinatum, not >because the vaccine might not be effective against preventing smallpox. >(In the same way, those with compromised immune systems are advised >against getting smallpox vaccinations.)
Inhaled steroids are not the issue here. Long term oral steroids are. There are several groups of people who will not be able to get the shot. The only way to protect them is through ‘herd immunity’ (having enough people get the shot that every unimmunized person is surrounded by immunized people). — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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> The only way to protect them is through ‘herd immunity’ (having >enough people get the shot that every unimmunized person is surrounded >by immunized people).
This mass immunization philosophy will probably not help much in the current situation, as exposure will come from "unnatural means", weaponized airborne delivery or less likely, through human vector. By the time a terrorist vector becomes infectious, they are in bed, too sick to walk around airports, malls, etc., with obvious and hideous lesions about their mouth and face. The way to best protect us in this situation will be through quarantine of those who are found to be infected. Those people will be vaccinated at that time, along with those with whom they have come in contact. We don’t even know yet if the available vaccine is protein-specific for a possibly genetically altered virus. Beefing up one’s immune system is a prudent preventive approach for everyone, including those who cannot have the vaccine. Eat clean, wholesome foods, load up on anti-oxidants if you are so inclined, exercise, drink clean water and get lots of rest. And pray that our armed services continue to interdict the terrorists, as they have been doing, splendedly and thankfully.
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>> The only way to protect them is through ‘herd immunity’ (having >enough people get the shot that every unimmunized person is surrounded >by immunized people).
There is also the possibility of being infected by coming in contact with infected clothing and bedding, or a terrorist who is wearing an infected person’s clothing. Droplet saliva and the pustules/scabs contain virus.
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>> The only way to protect them is through ‘herd immunity’ (having >enough people get the shot that every unimmunized person is surrounded >by immunized people). >This mass immunization philosophy will probably not help much in the >current situation, as exposure will come from "unnatural means", >weaponized airborne delivery or less likely, through human vector. By >the time a terrorist vector becomes infectious, they are in bed, too >sick to walk around airports, malls, etc., with obvious and hideous >lesions about their mouth and face.
Actually the best value of a mass vaccination campaign is that it deters an attack in the first place. (What good does loosing smallpox on people who are immune do?) Besides, I am of the firm belief that it is better to take preventative measures before an event than to react to the event. You always have to take ‘Murphy’s Law’ into account. Besides, the more people vaccinated before an attack mean that fewer people will have to be vaccinated after an attack. — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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>>> The only way to protect them is through ‘herd immunity’ (having >>enough people get the shot that every unimmunized person is surrounded >>by immunized people). >There is also the possibility of being infected by coming in contact >with infected clothing and bedding, or a terrorist who is wearing an >infected person’s clothing. Droplet saliva and the pustules/scabs >contain virus.
But there is a very limited number of people he can get in this manner. Without enough susceptible hosts the disease will not be able to spread. — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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>The CDC has stated that even steroid inhalers (not just oral steroids) >may be a contraindication for the smallpox vaccine:
Meanwhile, anyone with active eczema should avoid smallpox vaccinations–period. Eczema vaccinatium (sp?) ain’t pretty. jrw
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I’m not surprised. Steroid inhalers are not without serious risks. For example, they may cause diabetes. — Marty
> The CDC has stated that even steroid inhalers (not just oral steroids) > may be a contraindication for the smallpox vaccine: > "….Consult an expert allergist/immunologist or the CDC. Requires > individualized decisions as the absorption varies both with the steroid > used and the dosage and frequency of administration."
http://www.bt.cdc.gov/training/smallpoxvaccine/reactions/contraindica… tml – Hide quoted text — Show quoted text -> This may be a real problem, since it’s possible to get systemic > absorption from an inhaled steroid and not yet know it–until you’re > administered the smallpox vaccine. > — > Steven D. Litvintchouk
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>I’m not surprised. Steroid inhalers are not without serious risks. For >example, they may cause diabetes.
Just like alternative medicine ‘may cause diabeties.’ Basically, there is a chance that people on inhaled steroids may not develop an immunity to smallpox on the first vaccination. This is real easy to spot as if you do not develop the characteristic pustule and subsequent scar – you are likely to need another shot. A nuisance perhaps – but not a danger. — "What Sept. 11 did was remind us that there are times when we must fight for our country, that, indeed, there are things – our liberty, our democracy, our belief in human rights and human dignity – worth fighting for." Newsday.com editorial – 27 May 2002
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The CDC has stated that even steroid inhalers (not just oral steroids) may be a contraindication for the smallpox vaccine: "….Consult an expert allergist/immunologist or the CDC. Requires individualized decisions as the absorption varies both with the steroid used and the dosage and frequency of administration." http://www.bt.cdc.gov/training/smallpoxvaccine/reactions/contraindica… This may be a real problem, since it’s possible to get systemic absorption from an inhaled steroid and not yet know it–until you’re administered the smallpox vaccine. — Steven D. Litvintchouk
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>The CDC has stated that even steroid inhalers (not just oral steroids) >may be a contraindication for the smallpox vaccine: >"….Consult an expert allergist/immunologist or the CDC. Requires >individualized decisions as the absorption varies both with the steroid >used and the dosage and frequency of administration." >http://www.bt.cdc.gov/training/smallpoxvaccine/reactions/contraindica… >This may be a real problem, since it’s possible to get systemic >absorption from an inhaled steroid and not yet know it–until you’re >administered the smallpox vaccine.
According to the CDC website: "Equivalent to 2 mgm/kg or greater of prednisone daily, or 20 mgm/day, particularly if given for longer than 14 days." And there is a very good way of checking to see if the vaccine ‘takes’ – if the vaccination works it will leave a small scar. (And if you are still not sure – do what the Army does and give the immunization again.) — "We are fighting today for security, for progress, and for peace, not only for ourselves but for all men, not only for one generation but for all generations. We are fighting to cleanse the world of ancient evils, ancient ills." Franklin Delano Rosevelt State of the Union Address – 1942
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