BOSTON Dec. 20 —
Americans are deeply confused over just about every aspect of
smallpox, including the risks of vaccination, whether it can be treated
and even whether people still catch it.
A newly released survey found that a majority actually believes
smallpox cases still occur in some parts of the world, even though the
disease was eradicated 25 years ago in one of the greatest public health
victories in history.
"It's staggering," said Robert J. Blendon, who directed the survey at
the Harvard School of Public Health.
Like several other recent surveys, this one found that about
two-thirds of Americans say they would like to be vaccinated, though
that willingness would plummet if people found their own doctors avoided
the vaccine.
The survey will be published in the Jan. 30 issue of the New England
Journal of Medicine, along with several other reports on smallpox. The
journal posted all of the smallpox papers on its Web site Thursday.
Three decades after the U.S. smallpox vaccination program was
retired, it is to resume in January because of the risk that terrorists
could introduce the disease, using virus stockpiled after
person-to-person spread was eliminated.
The vaccine will be mandatory for about 500,000 military personnel
and recommended for another half-million who work in emergency rooms and
on special smallpox response teams. The government will make the vaccine
available to anyone else who wants it beginning late next spring or
early summer, though it will not encourage ordinary people to get the
shots.
The government's policy of targeting doctors and nurses is supported
by a detailed analysis in the journal, sponsored by the RAND Center for
Domestic and International Health Security, that examines various
scenarios of smallpox release.
"We show there would be a net benefit to vaccinating health workers,
even if there is a low probability of an attack, because health workers
are at greatly increased risk," said the study's director, Dr. Samuel
Bozzette of the Veterans Affairs San Diego Healthcare System.
Blendon's survey was based on calls to 1,006 randomly selected adults
over the past two months. It carried a sampling error of plus or minus 3
percentage points.
Among the findings:
30 percent believe there has been a smallpox case in the United
States in the past five years, and 63 percent think there has been one
somewhere in the world. Actually the last U.S. case was in 1949 and the
last in the world was in 1977.
25 percent said it was likely they would die from the vaccine. The
actual death rate from the shots is estimated to be less than three per
million.
78 percent said they thought medical treatment for smallpox would
prevent death or serious illness. Actually, there is no proven treatment
after symptoms start.
16 percent think the country has enough vaccine to give everyone in
case of a smallpox attack. The government says it has enough for all.
58 percent do not believe that vaccination within a few days of
exposure will prevent people from contracting smallpox. Actually, it
will.
The Centers for Disease Control and Prevention has largely focused on
educating doctors about smallpox, assuming they will then communicate
with patients. "If and when a licensed vaccine is made available to the
general public, the plan here is to embark on a mass-media education
campaign that could include posters, advertisements and public service
announcements," said CDC spokesman Tom Skinner.
The possibility of rare but potentially serious side effects is the
main drawback of widespread smallpox vaccination. The Bush
administration estimates that one to two people per million would die
from the shots. After reviewing about 14,000 medical articles going back
100 years, Buzzette's team chose a somewhat higher estimate of about 2.7
deaths per million.
If 60 percent of the 290 million Americans were vaccinated, that
would mean nearly 500 deaths, even if smallpox never reappears. However,
in any outbreak, health care workers are the ones most likely to catch
the virus. They make up 3 percent of the population but would account
for 20 percent to 60 percent of all smallpox cases, depending on which
scenario of disease spread is used.
Smallpox could be spread by terrorists in various ways. One scenario
would be to let three smallpox-infected terrorists ride mass transit in
a large city. The researchers estimated that fewer than 20 people would
die before the disease was contained through a vaccination campaign.
The worst scenario imagined was turning 40 terrorists loose on a busy
day in 10 large airports with portable nebulizers spraying smallpox into
the air. Unless most of the population had already been vaccinated,
between about 40,000 and 55,000 people would die.
EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special
correspondent for The Associated Press.
On the Net:
Journal:
CDC:
photo credit and caption:
Milly Noonan, with the Kentucky
Department of Public Health, left, practices the technique for
administering a smallpox vaccination on co-worker Peggy Ware, also
with the Kentucky Department of Public Health during a Centers for
Disease Control and Prevention-sponsored smallpox vaccination
training session in Atlanta, Wednesday, Dec. 18, 2002. Saline was
used in place of actual smallpox vaccine in the training session for
state health service workers. The workers will return to their
respective statesto train other workers. (AP Photo/Ric Feld)
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