AMA Weighs In On Smallpox ("..300 Americans Who Would Die..[from] Mass Vaccination Itself")

(CBS) The American Medical Association said on Tuesday it was not in favor of an immediate mass U.S. smallpox vaccination program, saying the potential threat of bioterror attack did not warrant inoculating every American against the disease.

The AMA's governing House of Delegates, meeting in San Francisco, instead asked the U.S. government to evaluate the risks and benefits of mass vaccination while continuing to plan for a program should the need arise.

"The science would not indicate that mass vaccination is the appropriate thing to do," Dr. John Nelson, a member of the AMA's board of trustees, told a news conference.

The U.S. government last month ordered additional smallpox vaccine doses to build a stockpile large enough to vaccinate every American against the disease, but officials said they were not planning to launch a mass immunization program.

Acambis Plc and Baxter International Inc. jointly will produce the new shots for $428 million, with delivery expected by next fall.

U.S. health officials accelerated efforts to prepare for a smallpox attack after the Sept. 11 attacks that killed about 3,900 people and as five people died in a mysterious rash of anthrax attacks starting in early October.

Smallpox was eradicated more than two decades ago, but experts fear it could resurface if there were a biological attack. Easily spread from person to person, it kills about 30 percent of its victims and leaves others disfigured. There is no effective treatment once someone falls ill, but giving a vaccine in the days immediately following exposure can prevent illness.

The AMA, the nation's largest and most influential doctors' group, noted that the Centers for Disease Control and Prevention was against a mass inoculation program in part out of fears that some people - roughly one in every million - could die from adverse reaction to the smallpox vaccine.

"If you vaccinate the whole country, you could have as many as 300 Americans who would die as a result of that mass vaccination itself," said Dr. Ron Davis, a public health expert and AMA board member.

Davis said the AMA instead supports the study of alternative vaccination strategies, such as immunizing "rings" of people around smallpox cases once any have been detected.

"This is the strategy that worked in eradicating smallpox from the world back in the 1960's and 1970's," he said.

The AMA's action Tuesday was in response to a proposal by Florida doctors that the AMA back nationwide vaccines despite those risks.

"We are at threat," Dr. Bernd Wollschlaeger of North Miami Beach, Fla., said during debate of the issue on Sunday.

Others urged the AMA to endorse voluntary vaccinations that would be left to the discretion of prescribing doctors.

But Davis pointed out Tuesday that the United States has only 15.4 million doses of vaccine currently available. The federal government did recently agree to pay a total of $428 million to Baxter International Inc. and Acambis Plc. for 155 million doses of smallpox vaccine. But those new doses won't be available for at least a year.

Until then, Dr. Joy Maxey of Atlanta advocated inoculating doctors such as herself to protect against contracting the disease from patients.

"We should at least be offered that opportunity," Maxey said Tuesday. The AMA sent Maxey's proposal to vaccine so-called "front-line defenders" such as doctors and paramedics to a committee for study.

AMA officials said the nation's medical community was still carefully evaluating the potential risk posed by smallpox and other bioterror agents, and was working hard to educate doctors about diseases that many have never seen in their professional careers.

But they stressed that the current information did not warrant a crash smallpox vaccination program.

"Let's make sure that science rules the day," Nelson said. "We need to make sure that we maintain as much calm as possible."

Tainted letter can't be tracked
Task impossible,' threat has lapsed

Connecticut Post

By BILL MCALLISTER and PETER URBAN

MediaNews Washington Bureau

Postal officials said Tuesday it's impossible to identify all of the 241 Connecticut-bound letters that passed through a U.S. Postal Service center in New Jersey on the same day that letters to two senators carrying deadly anthrax spores went through the facility. And officials don't plan to try to track them down.

Officials said they can obtain only a list of destination ZIP codes after a sorting machine completes a run of letters. That makes it impossible to say exactly where in Connecticut the letters were heading, they said.

However, investigators do know the Connecticut letters all begin with a 064 prefix, according to Paula McCarren, a spokesman for the Postal Inspection Service.

While postal inspectors were able to determine the number of letters sent to Connecticut, there is no effort to track them down.

"It's been almost 60 days [the longest incubation period for anthrax infection], and we have no reports of anyone else becoming ill [since Ottilie Lundgren of Oxford died Nov. 21]," McCarren said. "If anybody contracted anthrax, we would have known by now."

Meanwhile, the officials, who briefed reporters on the agency's operations and finances Tuesday in Washington, disputed a claim by a senior national health official that "tens of thousands" of letters had been exposed to anthrax.

Dr. Jeffrey Koplan, director of the Centers for Disease Control and Prevention, said that "tens of thousands" of letters could have been exposed to the risk of cross-contamination from the two anthrax-laden letters sent to Sens. Tom Daschle, D-S.D., and Patrick Leahy, D-Vt.

Deputy Postmaster General John Dolan called Koplan's statement "sheer speculation."

"If there were any real danger, it would have shown up by now," Nolan said.

The anthrax-tainted letters passed through postal facilities in New Jersey and Washington in early October, and any other letters that were contaminated by them should have been long delivered, postal officials said.

Pat Donahoe, the agency's chief operating officer, said not only was "the real risk [from the mail] absolutely minimum," but that the agency was now delivering the mail "smoothly" across the nation.

As postal officials spoke in Washington, investigators in Oxford ran up against another stone wall in their search for how 94-year-old Lundgren contracted a fatal case of anthrax.

While authorities believe the Oxford woman got the disease from a letter cross-contaminated as it traveled through the postal system, as of Tuesday, 232 samples taken from Lundgren's home since Nov. 20 have all tested negative for the bacteria.

Investigators have been trying to link Lundgren's death with cross-contamination of mail. They checked ZIP codes of mail that passed through the Hamilton, N.J., machine and were able to discover one letter, which tested positive for one spore of anthrax, sent to the home of John Farkas on Great Hill Road in Seymour.

Since then, authorities found trace amounts of anthrax on three machines at the Southern Connecticut postal facility in Wallingford, which is now being decontaminated.

Sixty-three samples taken from the Seymour Post Office and four from the postal truck that served Lundgren's and Farkas' route all tested negative for anthrax.

Back in Washington, members of Connecticut's congressional delegation left a meeting with Connecticut's top public health official Tuesday confident that no new cases of anthrax are likely to emerge from letters that arrived in Connecticut after passing through the tainted New Jersey processing center Oct. 9.

Connecticut Public Health Commissioner Joxel Garcia said that investigators have not found a letter to Lundgren among them. "Because we have not found a letter or piece of mail addressed to Mrs. Lundgren we cannot say with 100 percent certainty that she contracted anthrax from cross-contamination," Garcia said.

Garcia said that people who are concerned they may have received a tainted letter should contact health officials.

Of particular concern, he said, would be any letter that has a postmark from New Jersey on Oct. 9. If a person finds such a letter that is unopened, they should bring it to the attention of a local health director, Garcia said.

Rep. Rosa DeLauro, D-3, said that she feels comfortable Connecticut is doing all it can to allay fears and resolve the anthrax issues.

"This is all new, but people are on top of it," DeLauro said. <> Rep. Christopher Shays, R-4, said he hopes investigators will be able to discover exactly how Lundgren came into contact with anthrax.

Back in Connecticut, Dr. Matthew Cartter, the state Department of Public Health epidemiology program coordinator, advised people to use common sense in dealing with old mail.

"No one should keep any unnecessary mail around," he said. "Perhaps it's a good time to do some housecleaning."

But he pointed out that with the billions of pieces of mail crisscrossing the country, only a few people have been infected by cross-contamination.

Some people have questioned whether microwaving the mail might be a way to decontaminate it. But Cartter pointed to comments made by Philip C. Hanna, a University of Michigan professor of microbiology, who said that microwaving works on liquids, and spores have no water in them.

Staff writer Michael P. Mayko contributed to this report. Bill McAllister is chief of the MediaNews Washington Bureau.

Anthrax Pervades Florida Site, and Experts See Likeness to That Sent to Senators

By ANDREW C. REVKIN and DANA CANEDY

New York Times

Dec. 5, 2001

Thomas Friedman on Terrorism presents six of Mr. Friedman's Op-Ed columns on the threat of terrorism facing the U.S. prior to the attacks of Sept. 11. Read now for just $4.95.

wo months after the death of Robert Stevens, the first of the nation's anthrax victims, new tests at his Florida workplace reveal a pattern of pervasive contamination that mystifies investigators.

The test results, issued by the Environmental Protection Agency last week, show that anthrax spores spread throughout the three-story office building in Boca Raton that is the headquarters of American Media Inc., a tabloid publisher. Spores ended up not just in the mailroom and on Mr. Stevens's keyboard, but also in such out-of-the-way places as atop a room divider and computer monitors and in a nook between banks of shelves.

Officials involved in the effort said they were surprised by how far the material had spread. Such findings point to an extremely dangerous kind of anthrax preparation, with small particles that can easily float in the air, officials and experts said.

Because of this pervasiveness and the fact that the anthrax infected the lungs of Mr. Stevens and another worker, Ernesto Blanco, some officials and anthrax experts say it appears to have behaved very much like the anthrax shed by letters mailed later to two senators.

Investigators have repeatedly said there was something particularly deadly about the spores sent in letters to Senator Tom Daschle and Senator Patrick J. Leahy. The spores have been tied to the deaths of two postal workers in Washington, and investigators say cross-contamination from the letters may be responsible for the most recent anthrax deaths, of a woman in the Bronx and a woman in Connecticut.

The strain of anthrax in all the incidents is identical, and now, with the test results from Florida, there are at least some hints that the material sent there was equally dangerous and possibly identically prepared, investigators said.

But other contamination discovered in the American Media building conflicts with this interpretation. Investigators said that some sites found to be contaminated closely traced the routes taken by people making regular rounds from the first-floor mailroom up stairs and elevators to dozens of desks and cabinets. Spores presumably were stirred up and transported as mail was sorted and delivered. These findings point to a less-dangerous preparation with spores that do not linger in the air but fall where they are released.

These conflicting results have some investigators pondering the notion that more than one letter was sent to American Media.

But whatever ended up there, it was able to kill Mr. Stevens, 63, a photo editor, and nearly kill Mr. Blanco, 73, who worked in the mailroom. Both men developed the inhalation form of anthrax.

The new findings present a completely different picture of the contamination in the building than was developed after tests in the early stages of the investigation. Those tests, restricted to air vents on the first floor, where Mr. Blanco and Mr. Stevens worked, showed no spores, leading environmental officials to say it was unlikely that anthrax was widely dispersed.

But the full battery of tests found a much different situation. From Oct. 20 to Nov. 8, hazardous-materials teams working for the E.P.A. took 462 samples inside the quarantined building from surfaces, air filters, vacuum-cleaner bags and other spots. A total of 84 places were found to be contaminated.

In the end, two months into the oldest component of the anthrax investigation, frustrations predominate. "We still don't have a letter, we still have a death, and a lot of anthrax that was there," said a federal law enforcement official.

"Could the material have moved on its own, could it be carried on a person or float through the air?" mused the official, who spoke on condition of anonymity and said the answer could be all of the above.

American Media said, meanwhile, that it was not any closer to figuring out why it was targeted for a bioterrorism attack in the first place.

The one thing that is clear is that at least one tainted letter came to one of the company's tabloids, The National Enquirer.

This became evident after testing was done of all the post offices that served the area and spores were found leading through the post office that served Lantana, Fla., where The Enquirer had been located until about a year ago.

A clear trail of spores led through that post office to the one for Boca Raton. Spores were also found in a van that Mr. Blanco used to carry mail to the building and all around the mailroom on the first floor.

And the only other employee who was shown by testing to have been exposed to anthrax was another mailroom worker, Stephanie Daley, 36. She never became ill.

Other frustrations were simmering at American Media as well. Company representatives said they were irked by what they said was a lack of willingness on the part of state and federal officials to help with the cleanup of the building.

"I find it a little bewildering," said Michael Kahane, general counsel for the company. "You have this building that is pervasively tainted with anthrax and that the government declares a public health threat, then they close it. Then they do testing and give it back to you and say `Now you need to go out and hire a private contractor to clean it up.' "

Later this week, most of the 400 American Media employees who were put on 60-day courses of the antibiotic Cipro will come to the end of their regimen.

Many already abandoned the medication, some employees said, because of unpleasant side effects and a growing sense that the threat was behind them.

"We're all off Cipro now," said an editorial employee who spoke on condition of anonymity.

Tim O'Connor, a spokesman for the Palm Beach County Health Department, said that the mass administration of Cipro proved to be the right decision.

"Originally we were all figuring that it would be isolated to an office or a little area just in the mail room and Stevens's desk," he said. "The fact that they found it everywhere means there's a good chance that someone else would've gotten sick if we hadn't taken these steps."

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