Posted on 11/03/2001 2:49:26 PM PST by samtheman
ATLANTA, Nov. 3 — The government has begun taking steps to cope with the possibility of a terrorist attack involving smallpox by training doctors to recognize the disease and by vaccinating small teams of experts who would rush to any part of the country to contain and treat a suspected outbreak.
Officials at the Centers for Disease Control and Prevention, which is taking the steps, say they have no evidence that anyone is readying a terrorist attack using smallpox, a disease that was eradicated worldwide 21 years ago. But they say smallpox is so deadly that it is important to prepare for any attack.
The smallpox virus is known to exist only in laboratories in the United States and Russia. But germ warfare experts suspect that other countries, including North Korea and Iraq, may have secretly obtained stocks. It is greatly feared as a weapon because it is contagious and has a high death rate. And much of the world's population is susceptible.
Last week, the disease centers vaccinated about 140 members of epidemiologic teams that can be summoned at a moment's notice to examine a suspected case anywhere in the country.
This week, the centers will begin a series of training courses in smallpox for certain of its own employees and state and local health workers. Additional courses will be held over the next several weeks at the federal agency's headquarters here.
The vaccinations and course are part of a broader effort by health officials to respond quickly to any new bioterrorism threats that might follow the recent deliberate spread of anthrax through the mail.
"Our concerns are not limited to anthrax," said Dr. James M. Hughes, who directs the federal agency's center for infectious diseases. Those concerns include diseases like botulism, plague, tularemia and smallpox.
Smallpox is of particular concern because of its potential to spread quickly. In a military exercise this past summer called Dark Winter, researchers conducted a simulated smallpox attack on Oklahoma City. The epidemic quickly soared out of control, spreading to 25 states and millions of people.
Tens of millions of Americans under the age of 30 are susceptible to smallpox because they were never vaccinated; the United States stopped smallpox immunizations in 1972. Tens of millions of older people who were vaccinated decades ago are thought to have decreased protection because the vaccine may have worn off.
Another major concern is that generations of American doctors have never seen a case of smallpox. The only ones who have are a few hundred doctors who participated in the World Health Organization's smallpox eradication program decades ago.
Smallpox patients are usually quite sick. The infection is characterized by a rash and a fever of at least 102 degrees. The rash and symptoms begin to develop 11 or 12 days after a person is exposed to the virus. The characteristic lesions can occur anywhere on the body, but they usually appear on the face first, and they tend to appear more on the arms and legs and less on the chest, abdomen and back. Palms and soles are favorite areas. The earliest lesions tend to appear as raised bumps that often contain fluid. Over a period that can last as long as 19 days, the lesions become firm, filled with pus, and then form scabs. The illness can leave its victims blind and scarred.
Smallpox can be confused with chickenpox. In making the diagnosis, a doctor touches the skin. Smallpox lesions tend to feel as if they are deep in the skin, in contrast to the lesions of chickenpox, which feel superficial. Chickenpox itches; smallpox lesions can be very painful.
But because the earliest stage of smallpox can resemble rashes caused by many other diseases besides chickenpox, identification can be difficult without laboratory tests.
Since smallpox was eradicated, the centers have sent epidemiologists to investigate suspect illnesses a few times a year. Dr. Hughes said that the centers had already dispatched smallpox experts on short notice three times in the last month to evaluate specific cases.
None of the patients had smallpox. Instead, they had problems like allergic rashes or shingles, an illness in adults that is caused by the same virus that caused chickenpox early in life.
Dr. Jeffrey P. Koplan, the director of the disease centers, said that his agency expected false alarms as a necessary part of the efforts to encourage doctors to heighten their suspicion of anthrax, smallpox and other so-called exotic diseases.
Dr. Koplan likened the extra caution to programs that encourage patients with chest pain to seek medical attention to determine if they are having heart attacks. Many patients who are admitted to coronary care units turn out not to have had heart attacks.
Even doctors who have seen smallpox cases have been wrong. Doctors at the disease centers misdiagnosed a case of chickenpox as smallpox in Washington in the mid-1960's. And earlier this year, epidemiologists at the centers responded to a call from health officials in a Central American country where a missionary doctor who had seen smallpox became suspicious about several cases of rash and fever in a remote village. But the rash turned out to be from something else.
Dr. Stanley O. Foster and Dr. J. Michael Lane, two former disease centers employees who are smallpox experts, are helping with the centers's course on the disease. They said in interviews that they would show course participants pictures of smallpox lesions at various stages of development.
The course leaders are also trying to find ways to put photographs of smallpox lesions on the Internet so that doctors anywhere will recognize it if they see a real or suspected case.
Participants will also learn how to use the two-pronged needle required to administer smallpox vaccine.
But disease centers officials are not planning mass smallpox vaccinations at this time. One reason is that not enough vaccine exists. Another is that the risks of mass vaccination could outweigh any benefits, particularly if no smallpox case appears.
Smallpox vaccine, made from a different virus, has risks that are difficult to quantify for today's population.
Among the 5.5 million Americans who received their first smallpox vaccination in 1968, Dr. Lane said, eight died as a result. About two people per million who were vaccinated had an often fatal reaction known as vaccinia necrosum, which destroyed flesh and muscle. About four per million developed encephalitis, or inflammation of the brain.
Today, a particular concern is the hundreds of thousands of Americans with weakened immune systems from H.I.V. and other viruses, as well as drugs used to treat cancer and prevent rejection of organ transplants. The danger is that such people can become ill from the vaccine itself, and transmit the vaccine virus to other people, including those with impaired immune systems.
The standard epidemiologic response to smallpox is to identify the disease, isolate cases, vaccinate everyone known to have had direct contact with infected people since the first week of symptoms and then monitor their state of health.
Mass vaccination is not considered the appropriate medical response to an outbreak of smallpox. But if epidemiologic information determines that the virus was introduced widely through the air — at a public gathering, for instance — then mass vaccination might be required.
The government has ordered millions of doses from a British company. There presently is no capability in this country to manufacture smallpox vaccine.
If the terrorists blow up the British firm that is making vaccine, be very worried.
The glee of "eradicating" smallpox caused an all-too-typical case of hubris. If we have eradicated it, we don't need to make or use any vaccine anymore, right?...with the result that most of the world's population is now "innocent" of smallpox, meaning that their immune systems have never been exposed in any way. If the virus is released it would cut through the human population like a wildfire. Maybe 1, 2 billion dead.
--Boris
This is absurd.
The benefit of mass vaccination is that it takes smallpox off the table for the terrorists.
Americans are going to die in this war-6000+ are dead already.
The notion that any military intervention, like commando raids on the Taliban, or smallpox immunizations of 280 million people, can have a zero risk or zero casualty rate is absurd.
I strongly favor universal smallpox immunization ASAP.
It's like setting your sister's room on fire. Sounds good until you realize that your room burns up, too.
Sound reasoning unless the terrorists feel like their days are numbered. Then, they may just adopt the attitude, "F*** it, I'm goin' down, everyone's goin' down." Hard concept for all of us to get used to that these radical Islamists do NOT behave rationally.
Realistically, we're more likely to contain the disease than the Islamic countries which are crowded and have questionable sanitation.
On the question of supply, how hard can it be? What decade technology are we talking about here? 1940? 1910? 1890?
In 1980, as a result of Jenner's discovery, the World Health Assembly officially declared "the world and its peoples" free from endemic smallpox.
And yet all the smallpox vaccine is, is a virus which replicates very quickly. It's not like they really have to manufacturer it, it manufacturers itself.
I get very suspicious of why they are pretending it's hard to fill the supplies. It can't be incompetence because the small pox virus and vaccine aren't new issues they are really having to learn about for the first time.
They are not pretending.
One of the major problems is that vaccines are low-profit items. Hence pharmecutical makers don't want to make vaccines--especially given the legal liability issues from the few persons who have a bad reaction to a vaccine.
Since nobody wants to make them, and they are low-profit, nobody wants to invest in the plants and machinery necessary to manufacture vaccines.
This point of view held prior to the current bio-terror scare. Thus there is not now any native capacity to make new vaccines.
Another problem is absurd FDA hoops that drug manufacturers have to jump through. The sinlge U.S. source of Anthrax vaccine is Bioport, which used to be run by the State of Michigan (I think)...and which cannot manufacture any vaccine today because it cannot meet the FDA's regs.
Most of the vaccines in use in the 1950s could not be passed today under current FDA regulations.
--Boris
I get very suspicious of why they are pretending it's hard to fill the supplies. It can't be incompetence because the small pox virus and vaccine aren't new issues they are really having to learn about for the first time.
I too am suspicious. Very suspicious. What gives, oh mighty government? What coverup in yonder Capitol taketh place?
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