A Marine's hard fight: leukemia and a smallpox vaccine infection

Belken was one of the estimated 12,800 Americans a year who develop acute myelogenous leukemia. He just didn't know it when he was vaccinated.

Things started to go awry about a week later.

He had a headache that didn't go away, and he slept straight through a day and a half. A friend took him to an on-base Navy emergency room.

"They drew blood, and they told me that I had half the blood that I should've had," Belken recalled. On Jan. 28, he was admitted to Naval Medical Center San Diego.

Cmdr. Amy Reese, a staff oncologist, thought it best to start chemotherapy immediately, despite the blistering and slightly enlarged size of his vaccination site.

"We know untreated leukemia is 100% fatal," she said.

Doctors weren't sure what the treatments, which wipe out both good and bad cells, would do to the vaccination site. "It's a strange situation to come across," she said.

Doctors said they don't believe his vaccination triggered the leukemia. But his depleted immune system, crippled by the leukemia and chemotherapy, did appear to leave enough of an opening for the vaccinia to take hold.

A colleague asked Lederman to take a look at Belken's lesion because he knew she worked on pox viruses during a fellowship at the federal Centers for Disease Control and Prevention.

When she lifted up the gauze March 2, seven weeks after the shot, she was shocked to see the lesion had grown to nearly 2 inches in diameter.

A rim of blistering tissue surrounded a tan-colored crust. Vaccinia appeared to be actively eating up tissue.

Lederman told Belken and family members who had flown in from Missouri that she was very concerned. She suspected a spreading infection known as progressive vaccinia. She was sending samples to the CDC.

Lederman told the family that it was a rare condition and potentially fatal. In the past, when Americans routinely received smallpox jabs, 15% of patients who developed progressive vaccinia died, despite massive amounts of vaccinia immune globulin, the standard treatment.

In his laid-back, Southern-inflected drawl, Belken asked evenly, "Can it be cured?"

Yes, Lederman told him, but it would probably require some experimental treatments in addition to the standard ones. Because she had worked on the case of the child from Indiana, she knew about a drug called ST-246. The toddler was the first vaccinia patient who had received the drug, and it had worked.