New infection emerges from immunization

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By: Joel Stashenko , The Associated Press 11/16/2003

ALBANY - New York's list of communicable diseases continues to grow, as new infections find ways to thwart human immune systems and public health experts hone their methods of identifying and tracking dangerous illnesses.

The state Health Department has added yet another disease to its list: vaccinia, a virus caused by the immunizing agent in smallpox vaccines. People who get vaccinated against smallpox, which is also on the communicable disease list, can in turn become infected by the virus and pass it along to others, according to the Health Department. Starting in February, core hospital health care teams and public health response teams have been getting vaccines against smallpox amid worries that the disease can be used in a terrorist attack against the American populace.

Of more than 700 critical health care response workers immunized earlier this year, the Health Department said vaccinia was confirmed in one instance. Vaccinia immune globulin is available from the Centers for Disease Control to combat the adverse reaction to the smallpox vaccine. Health officials are considering whether to expand the smallpox immunization program to include more hospital workers, government employees and others who would respond in the case of a terrorist attack.

The state Health Department said it is crucial to track any adverse reactions to the immunizations as represented by vaccinia, especially with an expected expansion of the vaccination program.

While smallpox has been in the news because of its possible use by terrorists, New York state health officials have been tracking the disease for more than a century. The same is true of anthrax, another potentially fatal illness that homeland security officials worry can be used in weapons of mass destruction by terrorists.

As in many other states, New York began trying to systematically track instances and outbreaks of dangerous diseases in the years after the Civil War. The state Health Department had a Division of Communicable Diseases by 1909, and by 1913 a system was in place for physicians around the state to report the presence of communicable diseases to Albany. Doctors would mail special index cards to Health Department headquarters filled out with the patient's name, age, occupation, address and the confirmed or suspected disease they were suffering from.

At the time, 24 diseases were on the mandatory reporting list. They included anthrax, diphtheria, dysentery, measles, the plague, polio, smallpox, tuberculosis, typhoid fever and whooping cough. The idea behind the reporting system was to both get a better overall picture of the health of the state's residents and to identify nascent epidemics. State health officials would be dispatched from Albany to apparent epidemic areas, where they would usually order the sick quarantined and seek out the source of the problem, such as tainted wells.

Inadequate sanitation was the most frequent underlying cause of epidemics. Most of the original diseases are still on the state's list, which grew to 61 last week. More recent additions to the list have included E. coli, hepatitis, Legionnaire's Disease, Lyme disease, Rocky Mountain spotted fever and Toxic Shock Syndrome.

Before vaccinia, the state most recently added Severe Acute Respiratory Syndrome to the list. The Asian export caused alarm, especially among travelers and the elderly, when it emerged in late 2002.

"Changes are made to the list of mandatory reportable conditions to address emerging threats, such as SARS, and to respond to a reduced public health significance of other diseases," Kristine Smith, a Health Department spokeswoman, said Friday. "The changes allow us to respond quickly and effectively to communicable illnesses that pose the greatest danger to New Yorkers." While newly identified treats are added to the list, other diseases fall off. Leprosy and typhus were dropped in 1999 because no cases of the diseases originating within New York had been reported for years.

Reye's syndrome was removed the same year as the result of a better understanding of the condition, which damages the livers of youngsters. It was traced to the aspirin that some children were being given when they had the flu or chicken pox, and scientists had come to conclude that it was not communicable between people.

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