40,000 Texans could receive smallpox vaccinations

Anti-terror plan aids Texas health workers

By TODD ACKERMAN
Copyright 2002 Houston Chronicle Medical Writer

About 40,000 Texas health care workers -- 6,000 of them in Harris County -- will be vaccinated against smallpox if President Bush authorizes emergency first-round inoculations, according to a state proposal.

The plan, sent Monday to the U.S. Centers for Disease Control and Prevention, would provide voluntary vaccinations for workers at 51 hospitals in Houston and eight elsewhere in Harris County, as well as public health department officials.

"We're moving ahead with due diligence on this," said Richard Gaston, emergency response coordinator for the county health department. "I've never before seen the federal government act with this kind of urgency and thoroughness to a threat."

A presidential announcement is expected soon because of concern that hostile nations or terrorist groups have the smallpox virus and could use it in a terrorist act.

The first to be vaccinated would include those most likely to encounter highly contagious smallpox patients: workers on special response teams investigating suspicious cases and workers in hospital emergency rooms.

States, cities and territories were told in late November to submit their plans for the first round of vaccinations by Monday, and 44 of 62 met the deadline. Others are expected in coming days.

Immunizations are to begin soon after the presidential announcement. States have been told they will have 30 days to deliver the shots once an announcement has been made.

Texas and Harris County officials said that their plans are still developing because of the quick deadline federal officials gave. The state's plan calls for vaccinating 36,750 workers at 375 hospitals and 3,250 workers in 70 public health systems, but a Texas Department of Health official said he expects those numbers to grow.

"We expect more will sign up," said department spokesman Doug McBride. "There's 550 hospitals in the state and we're still waiting on word from some that said they might participate or they want to check legal issues or something."

Under guidelines set by the Centers for Disease Control and Prevention, large hospitals will receive a maximum of 100 vaccinations and small hospitals will get 45.

Smallpox, with a 30 percent death rate, tops national security experts' lists of potential biological weapons posing the greatest threat. The last human case in the world occurred in 1978 and the disease was declared eradicated in 1980.

Since then, the virus has resided officially in a few designated research freezers.

But security experts believe the pathogen also could be in the hands of terrorists. The appearance of a single human case would spawn a worldwide crisis.

But any mass inoculation would be controversial because experts estimate that the vaccine will kill one or two of every 1 million people receiving it for the first time. They also estimate that 15 out of every 1 million will suffer life-threatening side effects.

One local hospital leader active in bioterrorism preparedness, Ben Taub Hospital Chief of Staff Kenneth Mattox, said the vaccination planning also should include a comprehensive look at the issue. He said he has asked Baylor College of Medicine President Ralph Feigin, the head of a special medical team Mayor Lee Brown formed to consider bioterrorism issues, to reconvene that team to discuss smallpox.

"This matter raises broad epidemiologic, public health, governance and legal issues," Mattox said. "Instead of each hospital developing its own plan, I think it needs to be done on a communitywide basis."

He said Ben Taub could easily handle more than 100 vaccinations.

Nationwide, about a half-million people are expected to receive the first round of inoculations, but informal surveys suggest the shots aren't likely to be evenly distributed across the country.

According to plans submitted Monday, for instance, vaccinations initially would be given to 500 people in Georgia, 20,000 in Louisiana and 70,000 in California.

A second stage of inoculations, likely to cover other health care workers and emergency responders, is expected to total as many as 10 million nationally.