title: Ischemic cardiac events during the Department of Health and Human Services Smallpox Vaccination Program, 2003.
abstract: Ten ischemic cardiac events (ICEs) were reported among 37,901 initial US Department of Health and Human Services (DHHS) smallpox vaccinees. Symptoms developed a median of 10 days after vaccination (range, 0-28 days). The median age of case patients was 56 years (range, 42-65 years), and 60% were male. Seven (70%) of the case patients had >/=3 cardiac risk factors or probable coronary artery disease before vaccination. Two women, 55 and 57 years of age, experienced acute myocardial infarction and fatal cardiac arrests. Background rates of ICEs during a 3-week period for civilian populations that were age and sex matched to DHHS vaccinees were estimated. The observed number of myocardial infarctions exceeded estimated expectations (5 vs. 2) but remained within the 95% predictive interval (PI) (0.6-5.4). New onset angina was observed significantly less frequently than estimated expectations (1 vs. 10; 95% PI, 3.5-15.7). After persons with >/=3 cardiac risk factors or known heart disease were deferred from vaccination, no ICEs were reported among an additional 6638 vaccinees.
authors.affiliation: Smallpox Vaccine Adverse Events Monitoring and Response Activity, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. DLS3@cdc.gov
authors.forename: David L
authors.initials: DL
authors.lastname: Swerdlow
authors.forename: Martha H
authors.initials: MH
authors.lastname: Roper
authors.forename: Juliette
authors.initials: J
authors.lastname: Morgan
authors.forename: Richard A
authors.initials: RA
authors.lastname: Schieber
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Sperling
authors.forename: Mercedes M
authors.initials: MM
authors.lastname: Sniadack
authors.forename: Linda
authors.initials: L
authors.lastname: Neff
authors.forename: Jacqueline W
authors.initials: JW
authors.lastname: Miller
authors.forename: Christine R
authors.initials: CR
authors.lastname: Curtis
authors.forename: Mona E
authors.initials: ME
authors.lastname: Marin
authors.forename: John
authors.initials: J
authors.lastname: Iskander
authors.forename: Pedro
authors.initials: P
authors.lastname: Moro
authors.forename: Paige
authors.initials: P
authors.lastname: Hightower
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Levine
authors.forename: Mary
authors.initials: M
authors.lastname: McCauley
authors.forename: James
authors.initials: J
authors.lastname: Heffelfinger
authors.forename: Inger
authors.initials: I
authors.lastname: Damon
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Török
authors.forename: Melinda
authors.initials: M
authors.lastname: Wharton
authors.forename: Eric E
authors.initials: EE
authors.lastname: Mast
authors.forename: Gina T
authors.initials: GT
authors.lastname: Mootrey
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D005260:Female; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D008297:Male; D032541:Mass Vaccination / Q000009:adverse effects*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology; D018571:Sentinel Surveillance; D012900:Smallpox Vaccine / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: C078786:DryVax vaccine; D012900:Smallpox Vaccine