As federal health officials raced to investigate a possible link between smallpox immunizations and heart problems, the federal vaccination campaign faced fresh skepticism yesterday from physicians, health care groups and Democratic lawmakers.
On Capitol Hill, House Republican leaders retreated from plans to vote on a compensation package for people harmed by the vaccine, further clouding the future of the Bush administration's efforts to inoculate millions of health care workers and emergency responders.
At least 17 people recently immunized against smallpox have experienced cardiac-related problems, including a Maryland nurse who died of a heart attack Sunday. Although heart problems have not been traced to the smallpox vaccine, the surprising number of recent incidents has raised alarm.
Yesterday, the Centers for Disease Control and Prevention issued an alert to state health commissioners recommending that people with heart disease not get the vaccine. The agency called the move temporary and precautionary, but it summoned a team of cardiologists and its vaccine advisory committee to review the developments.
"My gut feeling is they are probably coincidental," said Walter Orenstein, director of CDC's National Immunization Program. "We want to err on the side of caution and investigate further."
Ten members of the armed services -- out of 350,000 immunized -- have been treated for inflammation in and around the heart, a condition known as pericarditis or myocarditis, said Col. John Grabenstein, who runs the military vaccination program. Every case was treated with pain relievers, and long-term damage is not expected, he said.
On Sunday, Andrea Deerhart Cornitcher, 56, became the first civilian death potentially tied to the immunization program. The nurse, who lived in Princess Anne, was inoculated five days before her death.
Another woman, whose whereabouts have not been disclosed, suffered a heart attack after inoculation and is on life support; a Florida health care worker is recovering from a heart attack. Two people experienced angina, and two had myocarditis. Nearly all of them had a history of heart trouble or a risk factor such as obesity, smoking or high blood pressure, Orenstein said. It is possible, he said, that the heart problems would have occurred even without exposure to the smallpox vaccine.
CDC planned to rush new information packets and consent forms to local health officials last night describing the concerns and recommending that anyone who has suffered a heart attack or has a history of coronary artery disease not be immunized.
Other health experts said that recommendation fell short.
"That's nice if you know you have heart disease," said Richard Wenzel, chief of internal medicine at the Virginia Commonwealth University Medical Center in Richmond. "It doesn't help if you don't know."
Eric J. Topol, chairman of cardiovascular medicine at the Cleveland Clinic, said the safer course would be to halt vaccinations in anyone over 50 or do thorough medical exams first. "A simple question about prior heart disease is not going to be enough," he said.
As the vaccination program passes the two-month mark, only 24,000 health care workers have responded to the call for volunteers to be inoculated in preparedness for a possible biological attack. News of the cardiac cases -- even if they turn out to be coincidence -- was certain to add another layer of hesitation, some experts said.
"I think many doctors will be just as conservative as the CDC," said William Schaffner, chairman of preventive medicine at Vanderbilt University. "They'll say, 'Why don't you wait till this sorts itself out? There's no rush; the president said there's no immediate threat. You can be vaccinated later.' "
Schaffner, who praised the CDC for its swift response to the new information, said the recent cases highlight the challenges in administering a risky vaccine to an adult population. Between illness and risky behavior, "adults come to vaccination with many more risk factors than children," he said.
In a letter to President Bush, Andrew Stern, president of the Service Employees International Union, said, "The grave dangers associated with the smallpox vaccine may no longer be a remote possibility for seven American civilians. . . . We expect full disclosure of the conclusive evidence before another frontline worker is put at unnecessary risk, before another family faces indescribable grief."
On Capitol Hill, lawmakers squabbled over the compensation bill. Democrats have said the White House offer to pay $262,000 in death or disability benefits and up to $50,000 in lost wages is insufficient.
"I am deeply disappointed that the compensation scheme the administration has proposed is so inadequate and unfair that it may not jump-start this faltering program," Sen. Edward M. Kennedy (D-Mass.) said. Republicans, describing the benefits as "generous," said the White House is pressing for broader participation.
"We can't delay it any more because the administration clearly identifies it as a must-do emergency measure," said Energy and Commerce Committee Chairman W.J. "Billy" Tauzin (R-La.). "It's fifty-fifty right now."
Staff writers Juliet Eilperin, Anita Huslin and Michael D. Shear contributed to this report.