09/25/02

JONATHAN BRINCKMAN

Oregon public health officials said Tuesday the federal government's new guidelines for administering mass smallpox vaccinations won't change the state's strategy for combating an outbreak of the illness:

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Contain it quickly.

On Monday, federal health officials told each state to make preparations to vaccinate as many as 1 million people in 10 days in the event of a biological attack with the smallpox virus. The guidelines are voluntary but make specific recommendations about setting up vaccination clinics.

Oregon will stick to its double ring plan, said Dr. Paul Cieslak, head of the state's communicable disease program. Public health workers would first vaccinate close friends and household members of anyone infected with smallpox -- creating ring one -- then would vaccinate close friends and household members of those people, creating a second ring.

"We still don't plan to use mass vaccinations," Cieslak said. "That won't be our first strategy."

The ring plan makes the most sense, he said, because the smallpox vaccine itself is dangerous. The vaccine, composed of a live virus called vaccinia, is not recommended for people with skin diseases or immune system deficiencies. In rare instances, it can cause the disease.

"It's a vaccine with nasty side effects," Cieslak said. "The ring strategy gives maximum disease control for minimum people exposed to the vaccine."

Oregon also is unlikely to use quarantines to control smallpox because they are rarely effective, he said. "No matter how draconian measures are, people are ingenious. When they want to get out of a quarantined area, they will find a way to get out."

Quarantines also can lead to the infection of healthy people who are in the quarantine zone, he said.

But the federal guidelines on a potential smallpox outbreak are useful, he said, because they show how difficult it will be to set up a system for mass vaccinations.

Oregon will first develop more general plans for dealing with potential mass outbreaks of infectious diseases, whether caused by bioterrorism or by influenza or other viruses. Only after general plans have been developed will the state establish a mass vaccination plan for smallpox. Cieslak said he doesn't know when such a plan will be developed.

The 48-page federal plan, produced by the national Centers for Disease Control and Prevention in Atlanta, calls for each state to gear up to run 20 clinics that could vaccinate 5,000 people a day for 10 days.

Each clinic, operated for 16 hours a day, would require a staff of 234 people, the CDC calculates. Only 16 people would give the vaccines, eight for each eight-hour shift. The rest would be support personnel, including triage nurses, information distributors, recordkeepers and others. The state's 20 clinics would need a total of 4,680 workers.

"This outline shows us what it would take if we had to go to mass vaccinations." Cieslak said. "It would take a lot."

Mass vaccinations probably would be needed if 1,000 people or more were infected with smallpox at one time, he said.

Oregon will use federal grant money to develop its mass-vaccination plan for smallpox. The federal government announced in July that Oregon and 23 other states would share $1.1 billion to prepare public health agencies for bioterrorism.

Oregon's share of the total, $14.2 million, represents the state's largest one-time investment in public health. Half the money will go to the state and half directly to the state's 34 local health departments.

Meanwhile, Oregon is preparing for its first shipments of the smallpox vaccine. The disease was eradicated worldwide two decades ago, and the virus now exists in only two known locations: a laboratory in Moscow and at the CDC in Atlanta.

Federal officials have not said when they will ship vaccines to the states, but Cieslak expects Oregon's initial supply to arrive within two months. Jonathan Brinckman: 503-221-8190; jbrinckman@news.oregonian.com