Vaccination News Home Page

http://www.startribune.com/stories/1556/3482410.html

If smallpox broke out anywhere in the world, public health officials in Minnesota would launch an immediate response that could mean mass vaccination of the state's 4.9 million people in less than a week.

In preparation, state health officials also plan to offer the smallpox shot over the next few months to about 10,000 Minnesota health care and law enforcement workers who would be part of the mobilization.

State officials are awaiting President Bush's decision to authorize this step.

These plans are described in a 175-page report on the public health response to a smallpox biological attack. The Star Tribune obtained a copy of the plan, which the state Health Department submitted Monday to the U.S. Centers for Disease Control and Prevention (CDC).

The decision to offer mass vaccinations is largely up to federal officials, who control the vaccine stocks. The federal government is preparing to deliver vaccine supplies to states within 12 hours if needed. All vaccinations would be voluntary, state officials said.

States were required to submit smallpox response plans last week as part of federal bioterrorism defense efforts that have evolved since the Sept. 11 terrorist attacks and subsequent anthrax attacks.

Smallpox has high priority in bioterrorism planning because the disease kills about 30 percent of its victims and routine vaccination against it ended in the United States in 1971. The last confirmed case was in 1977 in Africa.

Extraordinary steps

The Minnesota plan outlines extraordinary public health measures, including some last used in the era when polio and other vaccine-vanquished diseases ran rampant.

Shopping centers, county fairground buildings or even large arenas such as the Metrodome could be turned into mass-vaccination clinics for the public. The National Guard would protect vaccine supplies and manage crowds at clinics. Health officials also could quarantine smallpox patients, as well as suspected victims or people who came in contact with them.

Quarantine holding areas could include hospitals designated as smallpox care centers or hotels or other buildings commandeered by health officials. People suspected of having the disease also could be confined to their homes or placed under travel restrictions.

"This is designed as far as it can be to cover every worst-case scenario. It's going to be a little scary," said state epidemiologist Dr. Harry Hull. "You can never be prepared for everything, but on the other hand, with good preparation you can do a lot."

The Health Department would play a pivotal role in the state's smallpox response, according to the plan. Disease detectives would be on alert for any sign of smallpox in the state. If it appeared, its spread would be tracked closely. The department would coordinate communication and other efforts with political leaders and officials from public safety, emergency management and local public health agencies.

The response would start the moment smallpox is confirmed anywhere because "this will be a true public health emergency," Hull said.

The decision to start mass vaccination would depend on the extent of the outbreak and the public reaction to it, he said. The details of what would trigger such a step are not spelled out in the plan.

Risk of side effects

The smallpox vaccine has serious potential side effects and is thought to cause death in one of every million people who get it. Mass vaccinations in Minnesota could result in four or five deaths.

Some experts have called for "ring" or "containment" vaccination strategies to give shots only to those most likely to have been exposed. Another option is to mass-vaccinate people in the area where a smallpox victim lives or is believed to have contracted the disease. Getting the vaccine within a week of smallpox exposure can prevent the disease or minimize its severity even in someone who is infected.

This focused mass-vaccination approach is the main strategy underlying the Minnesota and federal plans.

"Containment vaccination is more in the mode of putting your resources where they're needed most. If there is a case in Duluth, and you have 500,000 [doses] of vaccine, it makes sense to put it in St. Louis County rather than Mankato," Hull said. "Unless we have airplanes spraying smallpox all over the state, I'm confident we can control smallpox pretty quickly this way."

However, he said, a statewide mass-vaccination effort may be needed if an outbreak here or elsewhere spreads rapidly. In addition, he said, public fears over an outbreak -- no matter how small or far away -- may cause officials to begin mass vaccinations.

"There's going to be a great deal of public anxiety over this. People are going to be scared," Hull said.

Local health agencies are being asked to prepare for mass clinics that would vaccinate nearly every Minnesotan in less than a week, Hull said. Detailed local plans still are in the works.

"We are prepared to do this," Hull said. "One of the biggest challenges I see is parking and traffic jams from people abandoning their cars and running to clinics."

People who got the voluntary shot also would get a card saying they are protected.

Health workers would screen people to avoid vaccinating those at highest risk of side effects. These include people with weakened immune systems, pregnant women, infants, people with allergies to certain antibiotics and those with eczema or other skin conditions.

While quarantine measures may sound Draconian, "we have to balance the rights of individuals with the rights of the public to be protected against disease," Hull said.

The first limited supply of the smallpox vaccine will arrive in the state soon after President Bush gives the go-ahead to vaccinate health workers and first responders, Hull said. Minnesota officials will submit more details to the CDC on Tuesday about the first round of vaccinations, he added.

Bioterrorism experts Michael Osterholm and Ed Lord, both based in Minneapolis, said they hadn't seen the Minnesota plan. But they said it sounds thorough and appropriate.

"Mr. and Mrs. Minnesotan should feel safe because we have people in charge of the operation who know what we're facing and how we're going to respond to it," said Lord, a consultant and former emergency planning official with the Veterans Administration. "All of us buy car insurance hoping we'll never have to use it. This is insurance at the maximum level."

-- Jill Burcum is at jburcum@startribune.com.

Vaccination News Home Page

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.