BMJ  2004;328:1220 (22 May), doi:10.1136/bmj.328.7450.1220-b

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Number reacting to smallpox vaccination is higher than expected

New York

Although few US military personnel have myopericarditis reactions to smallpox vaccinations, the number is high enough to be of concern if a larger population needs vaccination, the American Medical Association told a media briefing in New York last week.

Smallpox vaccination caused myopericarditis in 1.6 people per 10 000 who had never been vaccinated before, said Dr Dimitri Cassimatis, a cardiology fellow at Walter Reed Army Medical Center in Washington, DC. He reported results for more than 450 000 US military personnel. The rates of myopericarditis were higher than expected from reports from the 1950s to 1970s ( Journal of the American College of Cardiology 2004;43: 1503-10).

Symptoms included burning sensations or pressure in the chest, fatigue, and shortness of breath. Treatment with non-steroidal anti-inflammatory drugs for a month or six weeks was usually effective.

However, Dr Cassimatis cautioned that, in a terrorist attack, "if these results are generalisable to the public, we could see thousands of cases—1600 cases per 10 million exposed [to the vaccine]."

Surgeon General Richard H Carmona is pictured having his smallpox vaccination last year.

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