November 15, 2002
(The Atlanta Journal-Constitution) -- With the White House expected to
announce shortly how many Americans will be vaccinated against smallpox to
protect against a bioterrorist attack, research by four Atlanta professors
says that immunity already present in the population will be a key factor
in how fast the disease could spread.
In a paper published today in the journal Science, Dr. M. Elizabeth
Halloran and colleagues from Emory University's Rollins School of Public
Health say immunity could be left over from childhood vaccinations
received by those born before 1972 --- 57 percent of the U.S. population.
Or it could be newly created by giving vaccine to health care workers and
other first responders likely to come in contact with the first victims.
President Bush is reportedly close to ordering the inoculation of
hundreds of thousands of U.S. troops against smallpox but will delay
acting on vaccinating civilians due to concerns over possible side
effects, The Washington Post said today. Bush's top advisers are said to
have endorsed the plan, which was recommended by the Pentagon.
If the U.S. population has some degree of immunity, the authors say, a
strategy of "ring vaccination" will be adequate to protect the population
once an attack begins.
The Centers for Disease Control and Prevention, which will oversee
smallpox vaccinations, prefers that strategy over a mass vaccination
campaign. Ring vaccination limits protective shots to those who have been
in close contact with victims, and the contacts of those contacts,
creating a bull's-eye-shaped firebreak of immunity that the smallpox virus
cannot cross.
Ring vaccination, which the CDC and the World Health Organization used
to eradicate smallpox in the developing world in the 1970s, tends to use
fewer doses of vaccine. That would be important, the authors say, because
fewer Americans would be exposed to the risks of serious side effects ---
from skin disorders to encephalitis to death --- that come with the
smallpox vaccine.
Today's finding is the latest in a series of complex computer models
that have examined different strategies to protect against smallpox. Other
studies, by scientists at the CDC, Yale University and the Massachusetts
Institute of Technology, have supported mass vaccination, or ring
vaccination if a quarantine of infected areas is included.
The Emory study uses a model that assumes people interact with specific
groups in their daily lives --- households, neighborhoods and day care
center clients, for instance --- rather than roaming freely through the
entire population. Because smallpox usually spreads through face-to-face
contact, the authors say the risk of acquiring the disease would be
highest in the groups where victims spend the most time, and less in
places where they spend short amounts of time or do not go regularly.
"The idea is to put vaccination where transmission of a disease is
occurring," said Ira Longini Jr., a co-author.
In a key feature, the research assumes that Americans older than 30
retain some immunity to smallpox due to the vaccinations they received in
childhood. How long that immunity lasts has been hotly debated for the
past year; some scientists contend that immunity is lifelong, while others
say older Americans are as vulnerable to the disease as those who were
never vaccinated.
Copyright 2002 The Atlanta Journal-Constitution.