By Sanjay Bhatt, Palm Beach Post Staff Writer
Friday, May 17, 2002
 

Thursday night's TV drama ER showed the paranoia and chaos that a smallpox scare could wreak in Chicago, but Gainesville went through a real scare last September -- and it was far more hush-hush.

And the next time it happens in Florida, a bill now before the governor would allow health officials to quarantine, vaccinate and treat people against their will.

Coming on the heels of Sept. 11, Florida's experience with a suspected smallpox report and then the nation's first inhalational anthrax case in Palm Beach County rattled the highest levels of state government.

A flurry of efforts to beef up the state's ability to cope with a bioterrorism attack followed, with legislation presented to Gov. Jeb Bush on Tuesday giving the state health secretary specific powers in a public health emergency such as smallpox.

A week before Florida's chief epidemiologist received a call from Palm Beach County about a possible anthrax case there, he was scrambling on a report that a Gainesville graduate student might have smallpox, a contagious viral infection that kills one out of three victims.

"At the time we were worried it was smallpox," Dr. Steven Wiersma said last fall. "It was something we were very concerned about alarming the public about before we knew what we were dealing with."

A poll of 1,000 registered voters nationwide in early March found that 80 percent believe a biological or chemical attack in the United States is likely in the next five years. The randomly selected voters were evenly divided about whether their local public health system is prepared to respond to an attack. The poll, released Thursday, was conducted by The Mellman Group and Public Opinion Strategies on behalf of The Trust for America's Health, a nonprofit group that advocates strengthening the public health system.

Upon hearing about the Gainesville case, investigators from the U.S. Centers for Disease Control and Prevention in Atlanta quickly met with state officials on Sept. 26.

The 29-year-old researcher had been working with viruses in a laboratory. She had arrived at North Florida Regional Medical Center's emergency room with several lesions. She tested negative for chickenpox.

Infectious disease specialists couldn't rule out smallpox under the circumstances.

If true, the case would have been a global emergency as well as an act of terrorism. The World Health Assembly declared smallpox eradicated in 1980. Officially, only the United States and Russia still have supplies of the virus, but for years experts have feared that terrorists obtained clandestine stocks.

The woman was isolated in a negative-pressure room, and hospital staff donned masks and other protective clothing while treating her, said Tom Belcuore, director of the Alachua County Health Department.

County health staff discovered that none of the patient's co-workers had symptoms. No lockdown or quarantine of the hospital was necessary, Belcuore said.

By 8 p.m. on Sept. 27, CDC scientists identified the virus as vaccinia, a strain so similar to smallpox that it is used in the smallpox vaccine. Vaccinia virus, used in genetic research, causes mild symptoms in humans and is less contagious than smallpox.

The CDC receives about 10 requests a year for assistance with diagnosing suspicious rashes, said Glen Nowak, spokesman for the CDC's National Immunization Program.

"Many of them never become public," he said. Usually the rashes turn out to be varicella, commonly known as chickenpox.

Chickenpox vaccine runs low

The vaccine designed to prevent children from contracting chickenpox has been in short supply nationwide since last winter. Doctors are having to delay giving children the second of two vaccine doses, raising the risk of more chickenpox cases -- and more confusion about smallpox.

On Thursday, Florida's secretary of health issued a statement encouraging physicians to become familiar with how to distinguish smallpox from chickenpox, allergic drug reactions and other common illnesses. The department is distributing the information to doctors and hospitals.

"This awareness campaign is a vital component of our preparedness efforts," Dr. John Agwunobi said in a statement. "It is imperative that physicians are aware of uncommon diseases that may be due to bioterrorism as well as how and to whom they need to report them."

Many physicians have limited knowledge of smallpox and the vaccine because the last case in the United States was in 1949. The last known case worldwide was in 1977. Few if any doctors have seen an actual case of the disease and thus may not recognize it.

An emergency rule enacted by the Florida Board of Medicine in October allows doctors to apply a continuing education course on bioterrorism toward their license renewal requirements. In addition, the department has established an Office of Public Health Preparedness, whose Web site (www.doh. state.fl.us/terrorism/index.htm) offers information on smallpox.

The new legislation presented this week to Bush delineates specific powers that the health secretary can exercise during a public health emergency. The secretary now has broad, undefined powers in a state of emergency, but the bill defines a "public health emergency" for the first time.

Enforced treatment

A public health emergency is defined as any natural or man-made event that could substantially harm the public's health "from infectious diseases, chemical agents, nuclear agents, biological toxins, or situations involving mass casualties or natural disasters." The emergency would be limited to 60 days unless the governor agrees to extend it.

Bush has until May 29 to sign or veto the bill (S1262). A Health Department spokesman said the bill was developed with Bush's office and is expected to survive any potential legal challenge.

A provision of the bill allows the secretary to order an individual "to be examined, tested, vaccinated, treated or quarantined for communicable diseases that... present a severe danger to public health." If an individual refuses to be tested, vaccinated or treated because of his health, religion or conscience, the person could be quarantined.

And if the person doesn't comply with quarantine or if there's no practical way to quarantine the person, the health secretary "may use any means necessary to vaccinate or treat the individual," including immediate enforcement by police, according to the bill.

Because of its live nature, the smallpox vaccine could be deadly to give to certain people, such as those age 65 and older, children or others with weak immune systems.

The legislation also allows the secretary to direct drugmakers to ship products first to hospitals and pharmacies in affected areas.

The Health Department plans to begin creating rules based on the legislation in the fall, a spokesman said. Public hearings won't be scheduled unless requested.

Meanwhile, the CDC is seeking public comment before the June 19-20 meeting of the federal Advisory Committee on Immunization Practices, which shapes national vaccine policy. The committee will debate whether the government should offer the smallpox vaccine to emergency room doctors and paramedics, or even the general public.

Now, only a few hundred scientists who work with viruses related to smallpox, such as the vaccinia virus in the Gainesville laboratory, are allowed to be vaccinated. About 150 CDC employees who make up a rapid-response team are vaccinated as well, the CDC's Nowak said.

Even if the federal panel recommends that more people should have access to the vaccine, Nowak said the public shouldn't interpret that to mean the threat of an attack is more likely. The probability of a smallpox attack is considered "very low," he said.