Friday, October 19, 2001

Smallpox a valid bioterrorism threat
By Lauran Neergaard
Associated Press

WASHINGTON — Even a single case of smallpox would be an international emergency triggering vaccinations initially for dozens of people close to the patient while detectives traced every step the victim had taken for weeks, says a federal plan obtained by The Associated Press.

Although many experts consider a bioterror attack with smallpox unlikely, they have long called for better preparedness. Thus the new plan provides step-by-step instructions for state health workers who would have to battle a contagious disease not seen for decades.

The Centers for Disease Control and Prevention is putting final touches on the plan, work that was accelerated after the Sept. 11 terrorist attacks in New York and Washington. But officials say they consider the plan operational, and have begun sending it to state health departments so they can designate a person in charge of following the rules to make preparations.

The news comes even as some government officials raise the possibility of one day resuming routine vaccinations of Americans against smallpox, inoculations that ended in this country in 1972.

The government has 15.4 million doses of smallpox vaccine and hopes to buy an additional 300 million. “It is the intention to determine, after we have sufficient supplies available to commence inoculation, to make the decision at that time,” Homeland Security Director Tom Ridge said Thursday.

Yet CDC photographs show children with sometimes fatal vaccine side effects — illustrating why routine inoculations would be tough to renew unless smallpox ever reappears.

“You’re always hesitant to immunize people against the disease unless you’re fairly certain that there is going to be a risk,” said Surgeon General David Satcher.

In fact, the plan makes clear that entire cities or states won’t get vaccinated unless CDC has evidence of more than a few cases. Instead, the CDC will carefully apportion vaccine to family, friends, co-workers and other close contacts of a smallpox patient, as well as health workers and others who come in contact with a patient in a hospital.

It takes fairly close proximity to catch smallpox — about six feet — and quickly vaccinating those who live with or work around a patient is protective.

Smallpox hasn’t occurred in the United States since 1949; the world’s last naturally occurring case was in Africa in 1977. When smallpox was declared eradicated in 1980, all research stocks of the virus were supposed to be contained at the CDC’s Atlanta laboratory and a similar lab in Russia. But the Soviets instead produced smallpox for their bioweapons program in the 1980s, and bioterrorism experts fear some may have spread to terrorist-sponsoring countries.

Smallpox symptoms include fever and a pock-like rash all over the body, appearing between seven and 17 days after exposure to the virus. People are contagious from the time the rash appears — particularly in that first week of illness — until the scabs fall off.

The CDC’s emergency plan would kick in when a doctor alerts state or federal health officials that a patient should be tested for smallpox, a test that can be confirmed only at CDC or Fort Detrick, Md.

If someone has smallpox, he or she would immediately be quarantined and anyone whom the infected person may have had close contact with would be vaccinated.