By ROGER CLINE Staff Writer

Smallpox -- a dead disease.

But will 2003 be the year of the second coming for the disease -- thought eradicated worldwide in 1980 -- which killed hundreds of millions in the centuries before an effective vaccine was available?

The vaccinations -- which carry a risk of dangerous side effects -- were discontinued in the United States in 1972. Faced with a possible bioterrorist threat, President George W. Bush decided in December to make the vaccinations available on a voluntary basis to all Americans. Certain high-risk groups would have first dibs on the vaccine.

"The military, certainly," said Dr. Miguel Escobedo, regional public health director with the Texas Department of Health. "The proposal that is on the table, and this is by presidential decree, is to vaccinate on a voluntary basis healthcare teams from hospitals. And also public healthcare response teams."

Afterwards, the immunizations will be opened up to the general public on a voluntary basis, Escobedo said.

Locations and dates of the first immunizations will remain secret, he added.

"The recommendation is because this does have bioterrorism implications, we would like to do that," he said. "But it's no secret that the president has made an announcement that people will be immunized. I believe the Jan. 24 is when the Homeland Security Act will come into effect. That will address some of the concerns around liability. When you immunize people, there can be side effects and it answers some of the liability issues. I think it will go into effect fairly soon. I think the goal is to be able to immunize at least the public health officials within about 30 days of the announcement."

The fear is that research strains of the smallpox disease kept in the Soviet Union may have passed into the hands of other nations after that country's collapse near the end of the 20th century.

"There were thoughts of destroying these strains, but evidently they weren't destroyed for reasons of wanting to be able to study the disease if it ever surfaced again in the world. For that reason the virus was maintained under very strict security precautions," Escobedo said. "The concern is that even though the U.S. did a very good job of securing them only for legitimate research purposes, with other countries that may not be the case. A lot of credible sources believe that other bad people from other countries may have gotten strains of smallpox which they could potentially use for criminal purposes, for bioterrorism purposes."

Iraq is one of the potential recipients of the Soviet smallpox strain.

"We're talking about not just Iraq, but other countries may have gotten strains or samples that they may have in their possession," Escobedo said. "Iraq is one, but before the Soviet Union disintegrated, they had a very active biological warfare program. Even though they fell, it's conceivable other countries may have access to samples from the old Soviet Union."

Smallpox can be spread very easily and its high mortality rate makes it an ideal secret weapon for a terrorist organization.

"The mortality may be as high as 20 to 30 percent," Escobedo said. "Most of the people survive, but in terms of mortality 20 to 30 percent is unacceptable. It's unacceptably high. If you're talking in terms of a large city, as many as a third, a fourth to a third of the population is potentially in mortal danger."

And older people who have already been vaccinated can't depend on that old immunization in case of a bioterror attack.

"The fact that you received one smallpox vaccine will not fully protect you from reinfection," Escobedo said. "It's been so long. It's usually good for the first three to five years and after that the protection diminishes tremendously. So if you were to be re-exposed, there's a very good chance you would be reinfected."

Many younger physicians, Escobedo included, have never seen an actual case of smallpox, so descriptions of symptoms have to come from old medical records and accounts.

"Just looking at the literature, smallpox is a disease that is manifested by a one- or two-week incubation period during which the person may not feel too bad," the doctor said. "But after that in the next few days they will come down with fever, malaise, weakness, flu-like symptoms. Then they will develop sores, particularly around the mouth followed very rapidly by lesions, pox-like lesions around the body starting with the face."

The lesions will be raised, with a hard kernal-like pox in the center. Eventually the lesions burst, and can cause significant scarring.

For more information about the disease, contact Big Spring's Texas Department of Health office at 263-9775.

Contact Staff Writer Roger Cline at 263-7331 ext. 232 or by e-mail at newsdesk@crcom.net