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Create Vaccine Buffer Around Smallpox - US Doctors

Oct. 07, 2002 00:04 EDT

CHICAGO - If the United States comes under bioterror attack with smallpox, authorities ought to create a vaccinated buffer zone around infected individuals rather than immunize the entire populace, a doctors' group said on Sunday.

In a policy statement, the American Academy of Pediatrics supported the ``ring vaccination'' approach rather than universal inoculation in part because of the vaccine's potentially dangerous side effects -- which could kill as many as 40 out of every 1 million people.

The idea would be to form a buffer zone of immunized people who came in contact with an infected individual to prevent the highly contagious disease's from spreading, the group said. Such a strategy was used successfully in the 1960s and 1970s to eradicate smallpox globally, a feat attained in 1980.

Mass vaccinations against smallpox were halted in the United States in 1972, raising fears it could be used as a biological weapon on a susceptible populace and prompting a stockpiling of vaccine doses.

Small stocks of the virus were kept in U.S. and Russian laboratories and there have been fears that other countries may have developed smallpox as a weapon. The issue took on urgency following last year's Sept. 11 attacks and subsequent letter-borne anthrax attacks that killed five people.

Last month, the U.S. Centers for Disease Control and Prevention said the country had 155 million doses of smallpox vaccine on hand and will have 280 million doses -- enough for everyone in the country -- by the end of the year.

It said clinics would have to remain open around the clock to accomplish the enormous task of vaccinating everyone in case of a biological attack. But the pediatricians group said exhausting the supply of the vaccine would leave none left if additional smallpox cases occurred.

``The policy is flexible and could change if there is an actual outbreak of smallpox or if a safer vaccine becomes available,'' lead author Dr. Robert Baltimore, a member of the academy's Committee on Infectious Diseases, wrote in the group's journal, Pediatrics.

The CDC, which has said immunizations could kill one or two people directly and cause life-threatening complications in as many as 15 in a million people -- not counting those sickened through contact with them -- has not recommended immunizing the entire population.

CDC officials have raised the possibility that health care and emergency workers might be inoculated ahead of an attack and that the decision to seek preventive inoculations might be left open to the rest of the population.

Past campaigns to immunize against smallpox focused on children, the statement said, and the reaction of older people with diminished immune systems was not well known.

Common side effects from the vaccine include fever, weakness and lymph gland swelling or tenderness a week after immunization, the statement said. Studies from the 1960s show approximately 1,200 people per 1 million immunized will suffer serious complications and at least 40 people per million developed potentially life-threatening complications.

Multiply that by 280 million Americans and ``those reactions would end up being very high numbers,'' Baltimore said.

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