Pentagon officials announced Friday that a National Guardsman who had been vaccinated against smallpox had died and that until a possible link between the vaccine and heart attacks is ruled out, the military will not inoculate personnel with heart disease.
Four state health departments, including California's, have gone further.
California's health director, Diana M. Bonta, directed health departments throughout the state Friday to suspend all smallpox vaccinations until at least April 7. She said the suspensions will give the federal Centers for Disease Control and Prevention in Atlanta more time to update recommendations regarding health conditions that might increase the risk of adverse reactions to the vaccinations.
New York has temporarily suspended its vaccination program, and Illinois will vaccinate no one for at least a week. In Florida, frontline health-care workers who had been scheduled to receive the vaccine must go through a revised screening process designed to eliminate volunteers with heart conditions.
The Pentagon policy matches the restrictions adopted this week by the CDC. It reflects the concern of public health officials about a growing number of heart attacks and other cardiac problems among people recently vaccinated against smallpox.
The committee that advises the CDC on immunization practices also took a more conservative approach Friday. Its members, meeting by telephone, recommended additionally withholding the vaccine from people who have three known risk factors for heart disease -- such as diabetes, high blood pressure and high cholesterol.
The committee also considered, but ultimately rejected, recommending temporarily excluding everyone over 50 from the vaccination program or suspending it altogether.
A majority of committee members said overly broad exclusions or a temporary suspension would all but doom the program. In December, President Bush called for the vaccination of up to 450,000 frontline health-care workers and 10 million police, fire and emergency personnel to help the nation prepare for a possible bioterrorist attack using the smallpox virus.
The vaccine, which contains a live virus, is known to pose risks, particularly for individuals who are pregnant or have weakened immune systems or a history of eczema.
Until this week, however, there had been relatively few serious side effects -- and no deaths -- among the 25,645 civilians and more than 350,000 military personnel who have been vaccinated.
The death late Wednesday of the 55-year-old National Guardsman was the third heart attack fatality among the recently vaccinated in less than a week.
On Sunday, a 55-year-old Maryland nurse with a history of high blood pressure, high cholesterol and smoking died in Virginia. And on Wednesday, a 57-year-old nurse's aide died in Florida after suffering a heart attack 10 days earlier.
Pentagon officials said it was "unlikely" that the heart attack of the guardsman, described as a smoker with high cholesterol, was caused by the smallpox vaccine, which he received five days earlier. An autopsy indicated a narrowing of the blood vessels leading to his heart.
Although health officials say it is likely that the smallpox vaccine has caused at least 12 cases of heart inflammation, Grabenstein and civilian government health officials think the three heart attack deaths are probably "coincidental."
Paul Offit, head of the Vaccine Education Center at Children's Hospital of Philadelphia and a member of the CDC advisory committee, argued unsuccessfully for suspending the vaccination program.