http://www.washingtonpost.com/wp-dyn/articles/A19297-2001Nov26.html?referer=email
U.S.
Details Response to Smallpox
Cities Could Be Quarantined and Public Events
Banned
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By Justin Gillis and
Ceci Connolly
Washington Post Staff Writers
Tuesday, November 27, 2001; Page A01
The plan, by the Centers for Disease Control and Prevention, calls for
stepped-up awareness by doctors, health officials and the public to be able to
detect any outbreak of smallpox, a disease officially eradicated from the
planet 21 years ago -- and to be able to respond quickly enough to stop it
before a pandemic can sweep the nation.
Prompted by the terrorist attacks of Sept. 11 and the anthrax scare that
followed, the plan is the federal government's most detailed description since
1972 of how authorities might respond to an outbreak of smallpox. Overall, the
plan drew praise from several experts yesterday.
However, one aspect of the plan drew immediate criticism from some state
health officers. The CDC has vaccinated 80 to 100 of its employees against
smallpox so they can respond to an attack, but the draft plan rules out any
broader campaign to vaccinate state workers, who might be the first to respond
to an outbreak.
In making that judgment, the CDC noted that vaccine supplies are limited. It
said the federal government could rush vaccines to a state and inoculate state
employees as soon as an outbreak is confirmed. Vaccination is effective even
after exposure to the smallpox virus, if given within a few days.
"The point is that this vaccine works once exposed, so those people who
would go out and respond to a confirmed case would in fact be vaccinated
essentially as they're going out the door," said Harold Margolis, senior
adviser for smallpox preparedness at the CDC. "At that point, they are
protected."
But several state health commissioners said yesterday the plan does not take
into account the worst-case scenario: simultaneous smallpox attacks in multiple
cities, overwhelming the CDC. In such an event, they said, unvaccinated state
nurses and state police would be on the front lines trying to contain the
epidemic.
"You need to go in and talk to the person who has smallpox" to
identify contacts, said Georges C. Benjamin, Maryland's health secretary, who
is president of the Association of State and Territorial Health Officials.
"That process starts at 3 o'clock in the morning. That process doesn't
start 24 to 48 hours later, when the team gets there from Atlanta [where the
CDC is located]."
In an attack on multiple cities, "CDC in their role as the cavalry will
simply not be able to go to all those places," said Leslie M. Beitsch,
Oklahoma's health commissioner and chairman of a state health officers'
association task force on bioterrorism. "If we can't have our first
responders protected, then we risk chaos and panic."
The state health officers are expected to press the CDC to reconsider its
decision, if not now then in the next few months, as more smallpox vaccine
becomes available. At the moment, supplies are limited to an aging national
stockpile of about 15 million doses in Pennsylvania. The government has asked
companies to re-launch production of the smallpox vaccine, aiming to build a stockpile
of 300 million doses in a year.
Although the CDC plan would permit large-scale quarantine, that would be a
last resort, employed only if other control measures were failing. The heart of
the plan is the classic "ring vaccination" strategy used to eradicate
smallpox a generation ago.
That strategy depends on quickly spotting a case of smallpox, isolating the
initial patients, and identifying and vaccinating others who might have caught
the virus from them. Public health workers would continue to identify possibly
infected people by considering ever-larger rings of people centered around the
earliest cases.
"The main thing you want to do is try to get as much vaccine used in
the place where it's going to do the most good -- that is, around the contact
of a case and around the families of those contacts, so if they do come down
with a disease, there's a barrier around them," said Donald A. Henderson,
who led the global campaign that eradicated smallpox and who is now director of
health preparedness at the federal Department of Health and Human Services.
Local officials would try to locate people thought to have been exposed on a
train or at a sports stadium, Henderson said. Should locating them prove
impossible, he said, health officials would be forced to consider a broader
vaccination program, such as inoculating a large group -- even a whole city.
If early control efforts fail or an initial outbreak is sufficiently large,
still more aggressive measures might be necessary, the plan says. In the most
extreme case, federal and state authority would be used to erect a "cordon
sanitaire" -- a sanitary ring -- around a city or other large area.
Control of a big outbreak "may require suspension of large public
gatherings, closing of public places, restriction of travel" and other
measures, according to the plan.
The last smallpox case in the United States occurred in 1949, and the last
naturally occurring case in the world occurred in Somalia in 1977. The
eradication of the disease, which the World Health Organization declared in
1980, is considered to be one of medicine's greatest achievements.
But as a result of the disease's eradication, vaccination has stopped. No
one under 30 is immune to the disease, and older people who were vaccinated as
children are believed to have only limited immunity.
Although a CDC lab in Atlanta and a Russian lab in Siberia are the only
official repositories of the virus, many experts fear a handful of countries,
such as Iraq and North Korea, may have secret stashes that could wind up in
terrorists' hands.
A single case of smallpox would be an international health emergency of the
highest order. The CDC plan makes clear that if an attack occurred in the
United States, avoiding mass panic would be a challenge.
"In the event of a bioterrorism event involving smallpox, the level of
threat perceived by the public -- whether real or imagined -- may be
extreme," the guidelines warn. "In these circumstances, state and
local health officials should be prepared for a high level of demand for
vaccine by the public."
© 2001
The Washington Post Company
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