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http://www.naplesnews.com/02/11/florida/d823280a.htm

State officials working on plan for smallpox vaccinations

Monday, November 25, 2002

Associated Press

ST. PETERSBURG — Vaccinating most of Florida's 16.4 million residents against smallpox in 10 days would require 320 sites operating 16 hours a day, each staffed by more than 200 people, state health officials said.

That's the size of the challenge facing public health officials, who have until next Sunday to submit a smallpox vaccination plan to the federal government.

But Dr. John Agwunobi, secretary of the state Department of Health, said the challenge can be met. A spokesman for the U.S. Department of Health and Human Services said the plans are just a first step.

"We will be working with states to refine these," said spokesman Bill Pierce.

Counties will soon begin recruiting volunteers to help, the St. Petersburg Times reported in a story for Sunday's editions.

The mass vaccination plans are designed for the worst-case scenario, likely to be employed only if a bioterrorism attack occurred.

As in most states, Florida's counties have based their plans on a model provided by the U.S. Centers for Disease Control and Prevention. Under that model, a locality would need 20 clinics operating at least 16 hours a day to vaccinate 1 million people within 10 days. Each clinic would need 117 staff for each eight-hour shift.

A smallpox shot isn't as simple as a flu shot. Rather than a single stick, a drop of the vaccine is placed on the arm, then the area is punctured several times with a special two-pronged needle.

The smallpox vaccine was required for kindergarten-age children until 1972 when the federal government determined the virus no longer posed a threat.

Mass vaccination would be the surest way to slow an outbreak, according to some experts. But others would prefer to try to contain the disease first, identifying victims and vaccinating anyone who could have come in contact with them.

But containing the disease in a mobile society would be difficult, according to Dr. Jeffrey Nadler, an infectious disease expert at the University of South Florida School of Medicine.

"You may have to vaccinate half a million people in our community within days," Nadler said. "Do you shut the airports? Do you close the port?"

One problem with mass vaccination is that up to 30 percent of the U.S. population may be ineligible for the vaccine, except in dire circumstances, because of a wide range of medical conditions.

Conditions include: eczema, pregnancy and diseases and treatments that compromise the immune system, including AIDS, chemotherapy for cancer, steroids for Crohn's disease and rheumatoid arthritis.

But because the vaccine is made from live virus, people with these conditions could be infected by co-workers and relatives who are vaccinated, at least until the vaccination spot heals.

Even when given to healthy people, the smallpox vaccine is not benign. There could be thousands of complications per 1 million vaccinations, according to Dr. David A. Neumann, director of the National Partnership for Immunization. And roughly five in a million could die, he said.

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.