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http://www.cnn.com/2002/HEALTH/conditions/10/16/smallpox.cdc/

Larger smallpox vaccination plan proposed

Wednesday, October 16, 2002 Posted: 5:20 PM EDT (2120 GMT)

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ATLANTA, Georgia (CNN) -- A federal advisory committee voted Wednesday to recommend vaccinating about 510,000 hospital workers against smallpox after the Bush administration suggested that its initial proposal fell short.

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices voted 8-1 for the plan, which calls for hospital personnel who would deal with a biological attack -- such as emergency room doctors and nurses -- to be inoculated first.

That amounts to about 100 workers per hospital in each of 5,000 hospitals in the country.

The vaccine would then be offered to other health care and emergency workers -- paramedics, firefighters, police officers -- requiring between 6 million and 10 million doses. Finally it would be offered to the public.

The World Health Organization declared smallpox eradicated worldwide in 1980, and the immunization programs that had led to the virus' disappearance were discontinued. Routine smallpox inoculations in the United States ended in 1972.

But many officials fear terrorists might have obtained samples of the virus for use as a biological weapon. One administration worry is that the Iraqi regime of Saddam Hussein might have smallpox samples.

In June, the committee recommended immunizing regional or state-based teams who would be dispatched to the location of an outbreak of smallpox. That would have involved only about 10,000 to 20,000 people.

The committee changed its recommendation to include more workers after hearing from federal health officials who wanted still more people vaccinated.

The recommendation is not binding, and the ultimate decision rests with President Bush.

Committee members denied there was political pressure to make the change.

"Many hospitals, particularly those with negative pressure rooms need to be prepared, because you can't say where smallpox patients will arrive," Dr. Guthrie Birkhead told The Associated Press.

Birkhead said the earlier plan was flawed for several reasons, among them the fact some hospitals did not want the notoriety of being the "regional smallpox hospital."

Dr. Paul Offit of the Children's Hospital of Philadelphia cast the only dissenting vote on the committee.

"We're thinking about immunizing 500,000 people in a country for a disease that is still theoretical. We haven't seen a case of smallpox on this planet for 25 years," Offit told the AP. "If there's not a case of smallpox, we will be doing more harm than good."

One of the most compelling arguments against a more widespread vaccination program is that the vaccine itself could have severe and potentially fatal side effects in a fraction of patients.

Offit proposed vaccinating no one until a case of smallpox is found.

On the other hand, the virus can kill about 30 percent of non-vaccinated, infected people.

When the World Health Organization launched its immunization program in 1967, 2 million to 3 million people worldwide died each year from smallpox. The last naturally occurring case of smallpox was reported in Somalia in 1977.

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