Posted on 10/19/2001 8:30:24 AM PDT by jimkress
(CNSNews.com) - The nation faces a possible threat from a disease that was declared eradicated by the World Health Organization (WHO) in 1980. Bioterrorism experts at the Heritage Foundation fear that smallpox presents a greater threat to the general population than anthrax.
Heritage Foundation Foreign and Defense Policy Analyst Michael Scardaville said smallpox presents a dilemma for the government planners because of its highly contagious nature along with the delay between initial infection and the appearance of the first symptoms of the disease.
According to Scardaville, smallpox symptoms take 5-7 days to develop, consequently "people could [spread] it before anyone knows that there has been an attack."
According to the Virginia Department of Health's "Smallpox Fact Sheet," smallpox is spread by close contact with the mucus or saliva of an infected individual or contact with objects contaminated by an ill individual.
The fact sheet states that the initial symptoms of the disease are chills, a high fever around 106 degrees, joint and muscle aches (especially backaches), nausea and vomiting.
A rash will appear on the skin several days after the first symptoms of the disease appear. It is soon followed by the appearance of ulcerating lesions covering all parts of the body, which contaminate bodily fluids with the virus.
Eventually the lesions will scab, and then the contaminated scabs will fall off leaving scars behind. The virus can lead to death if it attacks the eyes, lungs, heart, throat, or liver, according to the fact sheet.
"At this time, no medications have proven effective for treating smallpox. Patients with this disease would be given supportive therapy, including treatment to keep the patient as comfortable as possible by keeping the skin clean, trying to control the itching, relieving the pain and other symptoms as much as possible," the fact sheet said.
The Virginia Department of Health also reports that the only known samples of the smallpox virus are at the Centers for Disease Control facility in Atlanta, Ga. and at the Institute for Viral Preparations in Koltsovo, Russia. The health department said the existence of other smallpox stockpiles could not be confirmed.
Smallpox Virus Falling in the Wrong Hands
The Heritage Foundation report also reaffirms the difficulty of obtaining the smallpox virus.
"It is more difficult to obtain smallpox than anthrax," Scardaville said. "The only legal stockpiles are at the CDC and a laboratory in Russia, but Russia had an extensive biological weapons program during the Cold War."
"They were supposed to have developed a weaponized version of smallpox," he said.
Scardaville speculates that some Russian scientists who worked on the Soviet bio-weapons may have sold their services to the highest bidder, and that the security of the Russian smallpox samples may have been compromised.
"The security at the Russian plants is far from excellent, and it is not inconceivable that some scientists or [Russian] mafia member ... could have put a small amount of the culture into their pocket and walked out, [then] sold it to someone," Scardaville said.
"I am not going to make it sound like [smallpox] is easy to get, but I am not going to make it inconceivable."
Smallpox Vaccine
Smallpox remains a bioterror threat; despite the fact that a vaccine has existed for the disease since Englishman Edward Jenner's discovery in 1796.
The vaccine has been unavailable to health providers and the general public, however, since 1983 according the Virginia Department of Health website, which also states that smallpox vaccinations have not been routine since 1972.
"At the present time, smallpox vaccine is supplied only to certain laboratory workers who are at risk of infection with smallpox-like viruses because of their occupation. The U.S. Food and Drug Administration does not allow the release of smallpox vaccine to any other person for any reason," the Virginia Department of Health report stated.
The CDC maintains a small stockpile (14 million doses of smallpox vaccine) for emergency use according to the Heritage Foundation.
"Anyone in this country under 30 years hasn't been immunized," Scardaville said. "A government official recently said that they could water it down and still retain the effectiveness, however, we don't have enough for the entire country."
"It's [an] old stockpile, it's not stuff that was made recently," he said. "This was made back in the '70s, so it's probably effective, but who knows."
Scardaville estimates that it would take up to a year to resume production and amass enough vaccine for the entire population.
According to Scardaville, The Center for Strategic and International Studies (CSIS) last summer brought together different government officials, including Gov. Frank Keating (R-Okla.) to simulate a smallpox attack in Oklahoma City. The simulation revealed a total inability of government officials to effectively manage a smallpox epidemic, Scardaville said.
"They brought together senior people to play the president, the national security advisor, and such people that could conceivably have those jobs," he said. "Even these senior people with experience in government ... weren't able to prevent one million people from dying all over the country, [and] three million people from becoming infected, and a virtual collapse of the civil society in Oklahoma and the surrounding area."Would Vaccine Cause More Harm?
Some experts also believe the smallpox vaccine has severe health risks.
"The smallpox vaccine is the most reactive (disease causing) vaccine that we have ever used," said Barbara Loe Fisher, spokeswoman for the National Vaccine Information Center. "I do know that brain complications occurred within one to six weeks of the original smallpox vaccination, most frequently after the first dose, and that the reaction rate was between 1 in 159 and 1 in every 6,500 vaccinated persons."
According to Fisher, vaccination related brain complications were most common in children under 2 years of age, and 50 percent of those children who developed the complications died from them. She also said 35 percent of adults who developed brain complications from the smallpox vaccine also died.
Fisher asserted that, "those in fragile health, immune compromised, are at a higher risk," of complications from the vaccine, but individuals who are genetically predisposed against experiencing complications are at a lesser risk for developing disease.
"What we have to do in this crisis situation ... is to keep a perspective and a balance," Fisher said. "In any mass vaccination campaign, you are going to have casualties, and the number of casualties are going to determine if you are screening out" people likely to develop adverse reactions to the vaccine.
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Greetings: Welcome to this Friday Letter Special Edition. With all of the talk about anthrax and other bio-terrorist weapons, Gilder Biotech Report editor Scott Gottlieb filed the following comments we thought you'd find of interest.
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Dear Friday Letter Reader:
Over the last week I've been asked a lot of questions about how to protect against smallpox -- a threat which seems to have a growing number of people concerned. A friend who works with the CDC says some there believe it may the bioterrorists' weapon du jour.
Given the lack of technical sophistication of this crowd, any smallpox attack would likely consist of a dozen bioterrorists self-infecting and then walking around the New York City subways. The simplicity of such an action provides some opportunities to protect ourselves, including making available some powerful antivirals, many of which came about during the AIDS crisis.
First a little background on smallpox. The virus spreads from person to person, primarily by tiny droplets expelled from the throats of infected persons and by direct contact. Contaminated clothing or bed linens can also spread the virus.
Patients spread smallpox primarily to household members and friends; large outbreaks in schools, for example, were uncommon. This finding was accounted for in part by the fact that transmission of smallpox virus did not occur until onset of a rash. By then, many patients had been confined to bed because of the high fever and lethargy caused by the early stages of the illness. Secondary cases were usually restricted to those who came into contact with patients, usually in the household or in the hospital.
The patient was most infectious from onset of rash through the first 7 to 10 days of rash. As scabs formed, infectivity waned rapidly. Although the scabs contained large amounts of viable virus, laboratory studies showed that they were not especially infectious, presumably because the virus particles were bound tightly in the rash.
Infection starts after virus particles are implanted in the throat, nose, or lungs. The infectious dose is unknown but is believed to be only a few virus particles. After about two weeks, patients experience high fever, malaise, headaches and backaches. Severe abdominal pain and delirium are sometimes present. A rash that resembles chicken pox then appears in the mouth and throat, face, and forearms, and spreads to the trunk and legs As patients recover, the scabs break and turn into pitted scars.
Back as late as the 1970s, when the last cases of smallpox were reported in the Western world, there were few treatments -- other than vaccination. That has changed. There are at least half-dozen antivirals that are believed to have efficacy against smallpox. Many of these can probably be used as post-exposure prophylaxis.
Most of the studies with these drugs have been conducted in animals and test tubes. There are a few human trials to draw on. I will focus on two drugs: one because it's believed to be excellent, and could be available in the time of a crisis. The second, while not as effective, is widely available today.
The first is Cidofovir, an antiviral agent aimed at DNA viruses, developed by Gilead Sciences (GILD). Cidofovir was tried against HIV, but didn't work that well. First of all, it had to be delivered intravenously to be effective. Also, it was toxic to the kidneys. So it was largely abandoned. The drug, however, is still on the market for limited use in some complications of AIDS, and there is laboratory and clinical data that it would be very effective against smallpox.
The other drug is Rifampin, a mainstay in the treatment of tuberculosis. While Rifampin lacks the potency of Cidofovir, it's widely available and could provide some measure of post-exposure prophylaxis. It works by blocking assembly of the smallpox virus. It's easy to get, and certainly better than nothing.
All this is not to say anyone expects an imminent attack. But even a few cases of smallpox would be catastrophic. For all the fear over anthrax, it's still a one-time agent. It doesn't spread from person to person. To catch it you need to come directly in contact with the spores. And the first thing we do in the hospital is wash down the suspected victims.
The real test for our nation will come when a communicable disease like smallpox crops up. Even doctors are petrified of the possibility. There have been a lot of stories about the risk of a looming attack. Let's hope it's just media hype.
--Scott Gottlieb, M.D.
Click here, https://www.gilder.com/biotech/biotechnewsSub.asp, if you'd like to subscribe to the Gilder Biotech Report by Scott Gottlieb, MD
Also, what kind of "brain complications" are they talking about?
The smallpox vaccination, from my understanding, can be given AFTER infection and still be effective, which is a good thing to know.
Apparently the vaccine is good for up to 10 years. I had mine in the late '60s. Another Freeper recently tried to get the vaccine for his two young daughters...pediatrician said something to the tune of, "We don't have that vaccination any more."
My former mother-in-law had smallpox as a child in Afghanistan. Killed her entire family, almost killed her and she still has the pock-marks on her face. Horrible disease. Horrible.
None of these have been "proven effective" specifically against smallpox, only because there hasn't been any smallpox to treat since development of these drugs.
Even the lesser of the anti-virals (drugs like acyclovir) dramatically reduce symptoms of herpetic lesions (like chicken pox and cold sores.) And that doesn't include any of the most potent anti-crials that have hit the market since AIDS became a household word.
After all, the reason the Soviets never nuked is because they knew they would get nuked back, and everyone would lose. The terrorists presumably wouldn't want smallpox to cause the same destruction to Islam that it would to the West.
The tricky part is whether they are sophisticated enough to know that. They might think that it would be contained to the West and never think of the larger consequences.
I suspect Iraq is sophisticated enough to realize it. However, Saddam is no Islamic Fundamentalist, either. If he ever comes to the conclusion that his days are numbered no matter what, then he has nothing to lose by giving the virus to the terrorists to spread or doing so himself.
That's a significant reason why any attack on Saddam by us ought to be unexpected and brutally quick.
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