U.S. Sets Up Plan to Fight Smallpox in Case of Attack

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.

"Don't you find it intriguing that these smallpox and anthrax scares are coming at a time when the Bush Administration is trying to mollify opposition to this Patriot Act, which is actually an UNpatriotic attack on our constitution?"

Yes, I do find it intriguing especially at this time. That is why I believe such things of this sort were planned to keep Americans "on edge". We simply cannot just relax and enjoy life anymore knowing full well that we are truly at war and we have enemies abroad from every direction we are not aware of. And I do agree that this Patriot Act is an attack on our constitution plain and simple.

"Who did this 'translation'? It is positively Clintonian and Orwellian."

I suppose the whole thing comes down to motive-motive-motive; again.

What was actually said, as opposed to what has been changed; that'd be the key pointing to who did it.
The *why* part's supposedly self evident by whatever the *message* is we're supposed to come away with after consumming the messaged version's digested.

"Reporters are not endowed with mind-reading abilities that make it acceptable to assume what the interviewee 'intends' as opposed to what he actually says."

...ahhhh, there's a HUGE difference between what I take away from a message, "if," & "has" are interchanged.

It wouldn't be the first time this new ilk of, "reporter" LIED in order to cause more panick, suspicion, or any other kind of trouble.
~Sells their rag.
Especially if the lie would be difficult to pin on said, "reporter."

IMO; Binny-Lad hasn't got a pot to pee in or a window to throw it out of.
The *source* of this "report" isn't to be trusted by this reader, in any event.

"It's almost like a fad."

Hope that that is what is turns out to be, just a fad - but then again, I never look ahead or ever worry/wonder about the future...(say Howlin, have you seen the new Rapid Response Team Coats ??????? I have - and let's just say, when they made them up - they weren't worried about the future - (very much scarcasm here!!!) Anyway...

And of course those nuclear weapons, in the hands of Bin Laden, came from the Chinese who bought out U.S. nuclear trade secrets from communist Bill Clinton. I always suspected that Bill Clinton was a mole in the U.S. working for the KGB and the Chinese PRC.

"Clinton had no direct contacts with PRC intelligence operatives. Clinton's PRC connections were through the Riadys and Charlie Trie, in other words through the triads. Since Deng Xiaoping started his "to be rich is glorious" campaign, the wealthy triad leaders, such as Charlie Trie acted as a go-between for PRC operatives and Taiwan and US links, such as Clinton. Clinton knew Trie from Little Rock and he knew the Riadys through Jackson Stephens."

Clinton may have not had direct contact with the PRC, but that is a moot point. The fact that he was having any dealings with these communists is treason. Clinton is and always has been a traitor to this country. He deserves to be in prison. Back in the 1800's, people were hung for activites like his. As this may sound barbaric so is the idea of the Chinese shooting their "prisoners" and selling their organs to the top bidder. Clinton's dealing go further back to the days when he was a scholar in England studying law. He hates this country with a passion! That is a fact.

Well, for one thing, I bet more than just the "experts" are going to get vaccinated I'll 2nd that bet. I'll bet our "esteemed" leaders in Congress and the Senate and possibily their families will have it - many RICH liberals AND conservatives will get the vaccines and if something happens to the rest of us "unwashed masses" - we're on our own and too bad. Yep you can call me a cynic because I'll bet the vaccines have already started en mass like this too.

You can be vaccinated AFTER symptoms develop and, still, receive it's benefits. Anyone exposed to that person, can be vaccinated and never suffer one symptom

I'd like to see more on this because it is my layman's understanding from what I have read that there is only a small window of opportunity for the vaccine to work AFTER exposure - about 4 days and you won't show symptoms during this time so may very well NOT know you have it.

"...discussing a test that doctors could use on those old enough to have HAD the shot to determine what if any protection we still had"

Bad news. I've talked with my cousin who is a pulmonary specialist. He stated that any previous smallpox vacs...last only seven (7) years.

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