July 8
— By Maggie Fox, Health and Science Correspondent
WASHINGTON (Reuters) - U.S. health officials said on Monday they are
considering the possibility of mass inoculations to combat a smallpox
attack.
Although they are still formulating the policy, a spokesman said such
a widespread effort was among the scenarios being weighed in the event
of any smallpox attack -- now considered more likely after a series of
anthrax-laced letters killed five people last fall and made 13 other
severely ill.
At issue is whether it is better to immunize a lot of people with a
vaccine that can have side-effects, or vaccinate fewer people, limiting
the risk of side-effects but leaving more people vulnerable to
infection. Health and Human Services Secretary Tommy Thompson is
supposed to announce a decision later this year.
An HHS spokesman said a report in The New York Times on Sunday that
said 500,000 health and emergency workers would be vaccinated in the
coming weeks was premature.
"There are a great many decisions that remain to be made by the
secretary, including working with states to better understand exactly
what the recommendation is," spokesman Bill Pierce said. "Therefore no
official estimate yet exists."
Even before the Sept. 11 attacks against New York and Washington, and
before the anthrax letters were sent, the government had been planning
better preparations for a possible biological attack.
Anthrax and smallpox were at the top of the list of potential agents
-- because they are easily spread, can be deadly, and because they are
hard to diagnose at first.
Smallpox, which was declared eradicated worldwide in 1980, is highly
infectious and kills about 30 percent of patients.
The United States stopped routine vaccination in 1972. Only the U.S.
and Russian governments are supposed to have any samples of the virus,
but experts say the former Soviet Union and possibly Iraq made smallpox
into weapons.
THE FIRST VACCINE
Smallpox vaccine was the first vaccine -- the word vaccine comes from
the name of the vaccinia, or cowpox, virus used to make it.
But it is based on old technology and can have severe side-effects
including, in about two in a million cases, death. Thus the dilemma on
whether to limit vaccination.
Current interim policy calls for what is known as ring vaccination --
finding the people likely to have been in contact with every infected
person, and vaccinating them. This approach wiped out smallpox at the
end of the epidemic.
The Advisory Committee on Immunization Practices, a committee of
doctors that advises the government, last month endorsed this approach
-- along with immediate vaccination of so-called first responders such
as emergency room staff so they could safely help in case of an actual
attack.
But it still is not clear who counts as a "first-responder," said Dr.
Paul Pepe, chairman of the Emergency Medicine Department at the
University of Texas Southwestern Medical center and the medical director
for the metropolitan medical response system in Dallas.
"Am I a first responder, are nurses in hospitals first responders,
are pediatricians?" he asked.
He advocated vaccinating firefighters and paramedics and training
them to administer the vaccine -- and treatments for other potential
bioterrorist agents -- so an attack could be quickly contained.
The committee also advised the government be ready to move to mass
vaccination if necessary.
Ed Kaplan, who makes mathematical models of epidemics at Yale
University, says mass vaccination would be the best approach from the
beginning.
He published a study in this week's issue of the Proceedings of the
National Academy of Sciences that shows far more people would die from
smallpox in an attack than would die from the side-effects of
vaccination.
photo credit and caption:
U.S. health officials said on July
8, 2002 they are considering the possibility of mass inoculations to
combat a smallpox attack. Although they are still formulating the
policy, a spokesman said such a widespread effort was among the
scenarios being weighed in the event of any smallpox attack -- now
considered more likely after a series of anthrax-laced letters
killed five people last fall and made 13 other severely ill.
Smallpox lesions on the skin are shown in this photograph taken in
1973 in Bangladesh. Photo by Reuters (Handout)
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