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Ramirez requested a transfer to Davis-Monthan Air Force Base in Tucson, where he has lived with his wife and three children since March. He has been given a medical waiver, postponing the resumption of the shot series. And he has been sent to a variety of specialists, both on and off base, to determine what is wrong with him. Valley fever, arthritis and other ailments have been ruled out, he says. But a rheumatologist has determined that he has some sort of degenerative disease and that it is now in his spine.
In another letter mailed recently to more members of Congress, he asked for their advice on whether he should resume the shots once his medical waiver ends:
"Should I risk more medical problems and stay in until I retire or do I speak up and risk all the years of dedicated service and say no? Please help me with this."
Dr. Meryl Nass, the internist and anthrax expert from Maine, says that in 1998, when the vaccination program began, she wasn't sure whether people should submit to the series of vaccinations.
"But now I tell them you are really playing Russian roulette with your health," she says. "You have to be aware of it because there is a very good chance you're going to develop things like sleep disturbances, neurological problems, muscle joint aches and headaches, significant memory loss, seizures or spacing out where you wake up 50 miles away from where you're supposed to be."
Nass, who has testified twice before Congress on anthrax, says when she first heard the Department of Defense was considering ordering mandatory vaccinations, she thought it was a bad idea. Her chief argument then was simply that the plan wouldn't work. Vaccinating everyone against one particular strain of anthrax, or one particular biological weapon, for that matter, would only protect them against that one thing. The enemy forces could then merely develop a new strain of the disease or another type of biological weapon, she reasoned, making the whole effort moot.
Her opinions, which were published in a U.S. infectious-disease publication and later cited in a British medical journal, apparently didn't have much influence. She continued to oppose the idea, but "I did not anticipate that it would make people sick," she says.
But within months after the first shots were given in early 1998, Nass started getting calls. People reported a host of problems that began after they took the vaccine. Nass says she talked to more than 1,000 people and now believes that the vaccine is indeed making people sick. She has set up a Web site (www.anthraxvaccine.org) with her conclusions.
Her research has shown that the vaccine can cause chronic symptoms that often worsen after the fourth shot is administered. Initially, she says, many experience abdominal cramping, diarrhea, fever, chills and a headache. Later symptoms can include chronic fatigue, dizziness, joint and muscle pain, headaches, memory loss, sleep disorders, chest pains and recurring rashes.
According to a list of actual cases presented during a congressional hearing, some of these symptoms can be disabling. One specialist reported vertigo so severe she couldn't walk, a major suffered crippling joint pain, a flight engineer had numerous seizures.
Many of these symptoms could have other causes, so the government and many doctors are reluctant to link them directly to the vaccine, Nass and others say. Also, congressional testimony shows, many troops are afraid to report their symptoms, fearing they will lose job opportunities or be forced to take a medical retirement with a fraction of their pay and benefits.
And according to Nass and others, the Vaccine Adverse Event Reporting System, used by the Defense Department to monitor bad reactions, doesn't accurately reflect the numbers of problems caused by the vaccines. Reporting is voluntary, so not all adverse reactions are reported. Many doctors or medical workers are unwilling to say a symptom has been caused by a shot.
And many of the chronic reactions that are being reported fail to meet the criteria for serious reactions -- more than 24 hours off work or hospitalization. (Even Robert Ramirez, the suffering Tucson airman who did file a report, says his case won't show up in those serious categories. "I come to work every day. When my [medical] appointments come up, I go to them. And what would they hospitalize me for?")
The federal numbers that are being reported are posted on the Internet and updated regularly. The most recent chart showed that of 620 reports filed, there were 70 cases in which the shot "certainly or probably" caused a recipient to stay off work for more than 24 hours and only six cases in which the vaccine resulted in hospitalization. And all of those six cases, according to the report, involved allergic, inflammation reactions at the injection site.
Defense officials say these are not alarming results. They say all vaccines can have side effects. But they say the anthrax serum only rarely causes serious problems.
Mild local reactions, which include redness and warmth at the shot site, affect about 30 percent of those vaccinated, the government says. Moderate local reactions, more serious redness and itching, can affect 1 percent to 5 percent of people getting the shots. And larger local reactions, like a swollen arm, occur in about 1 percent of the cases.