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http://www.mailtribune.com/archive/2003/0509/local/stories/14local.htm

May 9, 2003

Smallpox vaccine preparedness starts — just in case

By BILL KETTLER

Mail Tribune

A few pinpricks in Jim Hostick’s arm mark the local start of a national campaign to protect Americans from an ancient scourge.

The Jackson County Jail nurse is the first Rogue Valley health worker to be vaccinated against smallpox as part of a national smallpox preparedness program. Hostick and a few other soon-to-be-vaccinated health workers would immunize others if the disease surfaced in or near Oregon.

Local smallpox response teams across the United States would be the first line of defense if smallpox resurfaced. Each local team would vaccinate hospital workers, ambulance crews, police, physicians and others who might encounter infected individuals, said Dr. Jim Shames, Jackson County’s health officer.

"There needs to be a core group of health care workers who can immunize without putting themselves at risk," Shames wrote in an April letter to Jackson County health care providers. "This team also would serve to immunize future vaccinators quickly in the case of an outbreak."

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Smallpox has been eradicated in the natural world, but in recent years there has been growing concern that terrorists could reintroduce it. American physicians stopped vaccinating against smallpox in the early 1970s, thinking smallpox was gone for good. Now millions of people are vulnerable to a disease that kills one-third of its victims and leaves survivors terribly scarred or blinded.

Hostick was vaccinated last week when a group of health care workers met in Bend. Others, including Shames, probably will be immunized in June.

"The vaccination itself is a real piece of cake," Hostick said. "They just dip a little short two-pronged needle into the vaccine and poke the outside of your arm a few times. It feels kind of like they took a straight pin and poked you in the arm."

Smallpox vaccine is effective if administered within three days of a person’s exposure to the virus. That 72-hour margin of safety allows health care workers to immunize others with a strategy known as "ring vaccination."

"You isolate the individual (with smallpox) and form a ring (of vaccinated people) around that person," Shames said in an interview on Wednesday.

Health officials have chosen to avoid vaccinating the general public because the vaccine poses some risks. For every 1 million vaccinations, about one person dies, and 15 to 20 people have life-threatening reactions. Fifteen to 20 percent of all those vaccinated come down with a fever and swollen lymph nodes for a day or two.

Those complication rates led local hospitals to postpone immunizing health care workers until smallpox actually reappears.

"As long as there is not one case of smallpox anywhere in the world, the risks outweigh the benefits," said Carlene Lawrence, an infection control specialist at Providence Medford Medical Center.

Providence Medford and Rogue Valley Medical Center have both screened their staffs to determine who could be immunized without undue risk.

Shames said complications from immunization have become a bigger concern because more people have compromised immune systems these days. People who are on chemotherapy, for example, or organ-transplant recipients who take strong anti- rejection drugs might be more likely to have complications.

Although a bioterror attack on Southern Oregon seems unlikely, the region lies astride the West Coast’s major north- south travel artery. People who might be infected in a larger city could expose Rogue Valley residents to the disease as they passed through.

"Even though we’re just little Medford, we’re on Interstate 5," said Susan Patronik, an infection control specialist at Rogue Valley Medical Center. "So we’ve got to have a plan."

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.