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Questions Linger Over Pentagon’s Use of Multiple, Simultaneous Vaccinations

By David Ruppe
Global Security Newswire

WASHINGTON — Questions persist about possible serious health risks faced by U.S. military personnel who are required to receive multiple, simultaneous vaccinations, some national experts said this week. The Armed Forces Epidemiological Board met in Florida this week to review that question and other possible consequences of the vaccine policy, such as the risk of lesser side effects. The review could prompt the board to recommend spreading out military vaccinations over time when possible.

“There are reasons that if you have that opportunity, it probably makes sense to try to do it,” board president Stephen Ostroff, who is the associate director for epidemiologic science at the U.S. Centers for Disease Control and Prevention, said in an interview yesterday. The military is evaluating simultaneous vaccinations in response to the April 2003 death of 22-year-old Army Reservist Specialist Rachel Lacy, who was vaccinated against anthrax, hepatitis B, measles-mumps-rubella, smallpox and typhoid fever a month earlier as she was preparing for service in Afghanistan (see GSN, Jan. 9, 2004).

Low Risk of Serious Illness

Reviewing previous studies, national experts presenting to the board Tuesday reported little biological or epidemiological evidence suggesting that simultaneously administering vaccinations could pose a risk of serious illness to the average soldier.

“There are a lot of individuals who have received multiple vaccinations over long periods of time, both inside the military and outside the military … and there is relatively little data that suggests it is a particular problem,” Ostroff said.

Some presenters concluded, however, that more research is needed to examine whether simultaneous military vaccinations could prompt perfectly healthy personnel with latent immunologic diseases such as lupus and rheumatoid arthritis to contract those diseases.

A post-mortem examination of Lacy’s blood specimens showed evidence of latent antibodies suggesting a predisposition to lupus, Ostroff said.

“There is at least some scientific information that suggests that it is possible that this could stimulate some parts of the immune system that could potentially activate latent disease,” Ostroff said.

“Now that’s all based on basic research and how well that translates into clinical experience is always difficult to know,” he added.

Possible Screening?

The possibility could present difficulties for the military.

“Can you screen for [latent predisposition to such diseases] and if you do screen for that, what does that mean for their future careers? Is there something you would do differently?” Ostroff said.

“I think that is part of what will ultimately have to be deliberated in terms of what our final response will be,” he said.

For the sake of expediency, the military has for decades quickly given large numbers of service personnel simultaneous vaccinations against natural diseases and more recently against potential biological weapons agents such as anthrax and smallpox that they might encounter on a deployment.

“Simultaneous immunization bears considerable advantage in efficiency increasing the immunity of military personnel, returning them to duty with few medical visits,” according to Col. John Grabenstein of the U.S. Army Medical Command, in a slideshow delivered to the board.

Citing numerous studies, Grabenstein concluded that, “Published evidence and accumulated experience of tens of millions of simultaneous vaccinations over decades suggests that harm from simultaneous vaccinations per se (in contrast to same number of separate vaccinations) is either very rare or nonexistent.”

He wrote also though that, “Additional work is need[ed] to help identify risk factors that might predispose to rare problems.”

Spreading Out Vaccinations Seems Preferable

Lacy’s case raised another issue under consideration by the board relevant to the simultaneous vaccination issue. Two panels in November said they were unable to conclude whether her death might have been prompted by a reaction to one specific vaccine since the effects of one vaccine can be difficult to isolate when given simultaneously with others (see GSN, Nov. 19, 2003).

“If they do have problems after receiving [a] vaccine, it’s hard to know which one they are having a reaction to if you’re giving them at the same time,” Ostroff said.

Presentations to the board this week also suggested that the simultaneous vaccination practice could increase less-severe side effects, he said.

“There was a sense that at least for the overall well being of the individual that’s getting them, it is preferable to spread them out,” he said.