On Thursday, May 16, 2002, NBC’s “E.R.” TV show aired a 2-part season finale with a storyline that focused on a suspected case of smallpox at the fictional Chicago hospital. Briefly, a U.S. family living abroad returned to the United States, and the children were brought to the emergency room with symptoms that included a rash that was initially suspected to be smallpox. 

As in real life, the ER physicians first notified local public health officials about the suspicious rash illness, and, in turn, the public health officials determined it was appropriate to notify the CDC. A CDC team was called and sent to the hospital with smallpox vaccine. While health officials waited for the CDC to determine if the children’s illness was smallpox, the hospital’s emergency room was closed and quarantine procedures were activated.  

“E.R.” is a fictional television show that dramatizes medical and health emergencies. Storylines like the one in the “E.R.” episode can serve to heighten public awareness about smallpox disease (e.g., symptoms, vaccine, etc.) and the need for public health systems that can effectively address a smallpox emergency, if the need should ever arise.

Smallpox

Smallpox is no longer naturally occurring anywhere in the world. The last natural case of smallpox occurred in 1977, and in 1980, the World Health Organization (WHO) declared the global eradication of smallpox and recommended that all countries cease vaccination. The U.S. government currently provides the smallpox vaccine only to a few hundred scientists and medical professionals who work with viruses related to smallpox.

 Bioterrorism preparations

There are concerns that the smallpox virus could be used for bioterrorism. The risk for smallpox occurring as a result of a deliberate release by terrorists is not known, but is considered very low. On May 8-9, 2002, a joint working group consisting of members of the Advisory Committee on Immunization Practices (ACIP) and the National Vaccine Advisory Committee (NVAC), two groups that provide recommendations to the CDC and Department of Health and Human Services (DHHS) on vaccine use and policies, met in Atlanta as part of their review of the current smallpox vaccine recommendations. This working group was convened to review the June 2001 ACIP recommendations on smallpox vaccination in light of recent events, including the expected availability of about 286 million doses of smallpox vaccine by the end of the year. This stockpile would be enough to protect every United States citizen, if needed.

The ACIP-NVAC review will also involve four public forums that will be held in June to solicit feedback and information on the use of smallpox vaccine from healthcare providers, public health departments, and emergency responders, policymakers, community-based organizations, other non-governmental organizations, and the general public. The forums will be held
       June 6, 2002, in San Francisco and New York
       June 8, 2002, in St. Louis
       June 11, 2002, in San Antonio.
Any interested individual can attend these meetings to provide their comments and suggestions regarding the use of smallpox vaccine.

Following these forums, the ACIP will convene in Atlanta on June 19-20, 2002, to discuss and review information provided from the working group and the public forums. Then, if needed, the ACIP will make modifications to the 2001 recommendations on smallpox vaccination.