Posted on 06/22/2002 12:48:03 PM PDT by LadyDoc
What should I know about Smallpox?
Vaccination is not recommended, and the vaccine is not available to health providers or the public. In the absence of a confirmed case of smallpox anywhere in the world, there is no need to be vaccinated against smallpox. There also can be severe side effects to the smallpox vaccine, which is another reason we do not recommend vaccination. In the event of an outbreak, the CDC has clear guidelines to swiftly provide vaccine to people exposed to this disease. The vaccine is securely stored for use in the case of an outbreak. In addition, Secretary of Health and Human Services Tommy Thompson recently announced plans to accelerate production of a new smallpox vaccine.
Are we expecting a smallpox attack?
We are not expecting a smallpox attack, but the recent events that include the use of biological agents as weapons have heightened our awareness of the possibility of such an attack.
Is there an immediate smallpox threat?
At this time we have no information that suggests an imminent smallpox threat.
If I am concerned about a smallpox attack, can I go to my doctor and request the smallpox vaccine?
The last naturally acquired case of smallpox occurred in 1977. The last cases of smallpox, from laboratory exposure, occurred in 1978. In the United States, routine vaccination against smallpox ended in 1972. Since the vaccine is no longer recommended, the vaccine is not available. The CDC maintains an emergency supply of vaccine that can be released if necessary, since post-exposure vaccination is effective.
Are there plans to manufacture more vaccine in case of a bioterrorism attack using smallpox?
Yes. In 2000, CDC awarded a contract to a vaccine manufacturer to produce additional doses of smallpox vaccine.
If someone comes in contact with smallpox, how long does it take to show symptoms?
The incubation period is about 12 days (range: 7 to 17 days) following exposure. Initial symptoms include high fever, fatigue, and head and back aches. A characteristic rash, most prominent on the face, arms, and legs, follows in 2-3 days. The rash starts with flat red lesions that evolve at the same rate. Lesions become pus-filled after a few days and then begin to crust early in the second week. Scabs develop and then separate and fall off after about 3-4 weeks.
Is smallpox fatal?
The majority of patients with smallpox recover, but death may occur in up to 30% of cases.
How is smallpox spread?
In the majority of cases, smallpox is spread from one person to another by infected saliva droplets that expose a susceptible person having face-to-face contact with the ill person. People with smallpox are most infectious during the first week of illness, because that is when the largest amount of virus is present in saliva. However, some risk of transmission lasts until all scabs have fallen off.
Contaminated clothing or bed linen could also spread the virus. Special precautions need to be taken to ensure that all bedding and clothing of patients are cleaned appropriately with bleach and hot water. Disinfectants such as bleach and quaternary ammonia can be used for cleaning contaminated surfaces.
If someone is exposed to smallpox, is it too late to get a vaccination?
If the vaccine is given within 4 days after exposure to smallpox, it can lessen the severity of illness or even prevent it.
If people got the vaccination in the past when it was used routinely, will they be immune?
Not necessarily. Routine vaccination against smallpox ended in 1972. The level of immunity, if any, among persons who were vaccinated before 1972 is uncertain; therefore, these persons are assumed to be susceptible. For those who were vaccinated, it is not known how long immunity lasts. Most estimates suggest immunity from the vaccination lasts 3 to 5 years. This means that nearly the entire U.S. population has partial immunity at best. Immunity can be boosted effectively with a single revaccination. Prior infection with the disease grants lifelong immunity.
I'm a physician and I spend more on vaccines in our town than any other physician. I find it preposterous and hypocritical to have the CDC's own staff recommending to immunize THEMSELVES first and the rest of the country only after the initial cases are ill.
This is NOT reasonable policy. Please see the other thread we've been posting in.
I'll take the vaccine. Regards.
I doubt it.
The fact is that the existing Varivax campaign relies on a live virus vaccine. Varivax creates skin lesions in a small but sizable number of children. These skin lesions are known to contain the vaccine virus and can be spread to immunocompromised hosts.
Prior to offering the vaccine, I ALWAYS ask the parents about immunocompromised people in the family (either HIV or cancer patients) and counsel regarding the possibility that a skin lesion has live virus. If there are immunocompromised people in or around the household, the parents can be trusted to do the right thing (separate the child receiving the vaccine from the rest of the family).
I'm sure you would agree that the possibility of transmitting vaccinia is NOT a contraindication to public immunization.
The REAL contraindication to public immunization is that the CDC and ACIP are only thinking of themselves and not this nation!
Great point. It CAN'T be a good feeling knowing that every patient you see with acute onset of fatigue, headache, backache and high fever could potentially be carrying smallpox. And I'm not sure how much faith I have in the speed of those 12 pre-packaged push packs reaching a hot zone.
Frankly, the "push packs" will arrive too late to help the initial victims of a bioterrorist attack. Unfortunately, all physicians and medical offices are the likely victims in the first set of secondary infections following the attack. The current strategy appears to be to write off the initial victims in any terrorist hit. Frankly, this sucks! If you want me to be a physician defending our community's health, the Federal gov't needs to start to ante up!
This is totally unacceptable public health policy and it does not properly defend our citizenry. While I am a strong supporter for the GOP, I am growing dissatisfied with the lackluster performance of the response to bioterrorist threats. These threats are real and the foreign policy implications can be effectively neutralized through better preparation!
Knowing our government, the trucks carrying them will have a big "CDC Emergency Supplies" written on the side of the truck. Written in the middle of a big bullseye.
Since we're working publicly to evaluate the system, let us evaluate WHERE the push packs are located. Exactly where is the stockpile of vaccine located?
Are Feinstein and Boxer too busy to locate the vaccine stockpiles in California? Or are they more interested in discussing Chinese foreign investment and Oracle IT deals in Sacramento?
Since government hasn't been able to fully clarify how the response to smallpox will work, let me project a scenario. If a terrorist hits a local arena with a fly-by mist of viral particles, the city won't know that the flying advertisement was a bioweapon deployment. For the first two weeks everything will be fine, until the first cases avalanche into a local ER. Upon entering the ER, the entire facility will become contaminated with the viral particles and it will still take an additional 36-48 hours prior to full identification.
Since labs are not routinely running smallpox diagnostics on nasal swabs, you can bet that the first victims will get full-blown disease and a sizable percentage will perish.
Since initial waves of emergency response include paramedics, fire, police, hospital staff, physicians, nurses, and even candy-strippers; all will need to be quarantined and isolated for weeks. Since most of these people have families, their families will also be quarantined and their children are susceptible to disease in the second wave of contagion following the initial attack. Since most kids go to daycare or school, the schools will be contaminated within a few weeks of the initial hit. Mandatory immunization of the nation would likely be reinstituted at this juncture anyway.
Instead of permitting this type of disruption and civil unrest (with mammoth economic consequences that threaten US security), the ACIP should be permitting physicians to purchase the vaccines for Smallpox and Anthrax. The American citizenry deserves protection.
Just because a bunch of lunk-headed, CYA attorneys are unwilling to permit their company to be sued for product liability, 290 million Americans are at risk of bioweapons.
I suggest that freepers continue this discussion and begin to carefully evaluate their congressional delegation's logic. If your congress-critter doesn't stand up for "FREE MARKET" economics in healthcare, let's force them OUT!
In this case, the free market should permit us to purchase the vaccines. It is ONLY CLINTON ERA LIES that are preventing our own families from gaining the protection we deserve!
127 posted on 6/22/02 12:02 PM Pacific by bonesmccoy
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STATEMENT ON CDC WEBSITE http://www.cdc.gov/nip/smallpox/supp_recs.htm
In June 2001, the Advisory Committee on Immunization Practices (ACIP) made recommendations for use of smallpox (vaccinia) vaccine to protect persons working with Orthopoxviruses, to prepare for a possible bioterrorism attack and respond to an attack involving smallpox. Because of the terrorist attacks in the fall of 2001, the Centers for Disease Control and Prevention (CDC) asked the ACIP to review their previous recommendations for smallpox (vaccinia) vaccination. As a result of this review, these supplemental recommendations update those for vaccination of 1) the general population and 2) persons designated to respond or care for a suspected or confirmed case of smallpox. In addition, they clarify and expand the primary strategy for control and containment of smallpox in the event of an outbreak.
Recommendations for vaccination of laboratory workers who directly handle recombinant vaccinia viruses derived from non-highly attenuated vaccinia strains, or other orthopoxviruses that infect humans (e.g., Monkeypox, cowpox, vaccinia, and variola) remain unchanged. Other aspects of the previous recommendations (e.g., screening for contraindications, care of the vaccination site) are being reviewed, and until new recommendations are published, the June 2001 recommendations should be consulted.
The following recommendations were developed after formation of a joint Working Group of the ACIP and the National Vaccine Advisory Committee (NVAC) and a series of public meetings and forums to review available data on smallpox, smallpox (vaccinia) vaccine, smallpox control strategies, and other issues related to smallpox (vaccinia) vaccination. A website was established to solicit public opinion and input on options for smallpox (vaccinia) vaccine use.
The ACIP will review these recommendations periodically, or more urgently if necessary. These reviews will include new information or developments related to smallpox disease, smallpox (vaccinia) vaccines (including vaccine licensure), risk of smallpox attack, smallpox (vaccinia) vaccine adverse events, and the experience gained in the implementation of the current recommendations. Revised recommendations will be developed as needed.
| Smallpox Transmission and Control |
Smallpox is transmitted from an infected person once a rash appears. Transmission does not occur during the prodromal period that precedes the rash. Infection is transmitted by large droplet nuclei and only rarely has airborne transmission been documented. Epidemiologic studies have shown that smallpox has a lower rate of transmission than diseases such as measles, pertussis, and influenza. The greatest risk of infection occurs among household members and close contacts of persons with smallpox, especially those with prolonged face-to-face exposure. Vaccination and isolation of contacts of cases at greatest risk of infection has been shown to interrupt transmission of smallpox. However, poor infection control practices resulted in high rates of transmission in hospitals.
The primary strategy to control an outbreak of smallpox and interrupt disease transmission is surveillance and containment, which includes ring vaccination and isolation of persons at risk of contracting smallpox. This strategy involves identification of infected persons through intensive surveillance, isolation of infected persons, vaccination of household contacts and other close contacts of infected persons (i.e., primary contacts), and vaccination of household contacts of the primary contacts (i.e. secondary contacts). This strategy was instrumental in the ultimate eradication of smallpox as a naturally occurring disease even in areas that had low vaccination coverage.
Depending upon the size of the smallpox outbreak and the resources that were available for rapid and thorough contact tracing, surveillance and containment activities in areas with identified smallpox cases was sometimes supplemented with voluntary vaccination of other individuals. This was done in order to expand the ring of immune individuals within an outbreak area and to further reduce the chance of secondary transmission from smallpox patients before they could be identified and isolated. Regardless of the geographic distribution, number of cases, or number of concurrent outbreaks, surveillance and containment activities remained the primary disease control strategy.
| Critical Considerations |
A number of factors and assumptions were used in developing these supplemental recommendations.
Level of disease risk and threat
Information provided to the ACIP indicated that the risk for smallpox occurring as a result of a deliberate release by terrorists is considered low, and the population at risk for such an exposure cannot be determined. It was further assumed that regardless of the mode of a bioterrorism release, the epidemiology of subsequent person-to-person transmission would be consistent with prior experience. These recommendations also assumed that in addition to vaccination, health care workers and others would be afforded protection from infection through appropriate infection control measures, including the use of appropriate personal protective equipment.
Expected severe adverse reactions to vaccination
These supplemental recommendations assume that appropriate screening for contraindications to vaccination would be implemented and would include both the vaccinated persons, as well as their contacts. It is further assumed that recommended precautions would be taken to minimize the risk of adverse events among vaccinees as well as their close contacts (e.g., patients, household members).
Vaccine and vaccinia immune globulin (VIG) supply
The supplemental recommendations assume that both would be available for use, in sufficient supply, and handled and administered correctly. Smallpox (vaccinia) vaccine and VIG are currently available only under Investigational New Drug (IND) protocols (i.e., protocols for products that are not yet licensed). As such, it was assumed that appropriate informed consent, patient follow-up, and administrative oversight by federal, state, and local public health officials would be required. Further, any administration of smallpox (vaccinia) vaccine would be voluntary.
State and local vaccination capacity and capability
Surveillance and containment, including ring vaccination, is the primary strategy for the control and containment of smallpox. In addition, state and local health departments would be able, if necessary, to expand immunization to additional groups, up to and including their entire population, in a timely manner.
| Smallpox Vaccines and VIG Availability |
Currently, there are no commercially available (e.g., licensed) smallpox vaccines. Smallpox vaccines previously produced by Wyeth (Dryvax) and Aventis-Pasteur are available under Investigational New Drug (IND) protocols held by CDC. Both vaccines were prepared from calf lymph with a seed virus derived from the New York City Board of Health strain of vaccinia virus. Studies conducted among young adults with no previous smallpox vaccination history showed that a 1:5 dilution of Dryvax (Wyeth Laboratories, Inc) produced take rates among vaccinees equivalent to those of the undiluted vaccine.
In October 2001, the federal government contracted with Acambis and Acambis-Baxter Pharmaceuticals for at least 209 million doses of smallpox vaccine produced in cell-culture. These vaccines use a clone of the same strain of vaccinia virus (New York City Board of Health), which was utilized in the smallpox vaccines produced from calf lymph. These doses are expected to be available at the end of 2002 or soon thereafter.
Smallpox vaccines are formulated and packaged for administration with a bifurcated needle, which provides a fast, easy, and effective means for administration. All vaccines are packaged in 100 dose vials, except when Dryvax is diluted 1:5 resulting in vials that contain 500 doses.
The CDC National Pharmaceutical Stockpile (NPS) has developed protocols to allow for the rapid, simultaneous delivery of smallpox vaccine to every state and US territory within 12-24 hours. State and local bioterrorism response plans should provide for the rapid distribution of vaccine within their jurisdiction.
Currently, there is enough VIG available under an IND protocol to treat about 600 serious adverse events. This is enough VIG doses to treat the adverse reactions that would be expected to result from the vaccination of 4 million to 6 million people. Contracts for additional supplies of VIG are in progress.
| Surveillance |
Currently, cases of febrile rash illnesses, for which smallpox is considered in the differential diagnosis, should be immediately reported to local and/or state health departments. Following evaluation by local/state health departments, if smallpox laboratory diagnostics are considered necessary, the CDC Rash Illness Evaluation Team should be consulted at 770-488-7100 or 404-639-2888. As smallpox was eradicated in 1980 and no longer occurs naturally, an initial case of smallpox must be laboratory confirmed. At this time, laboratory confirmation for smallpox is available only at CDC. Clinical consultation and a preliminary laboratory diagnosis can be completed within 8-24 hours.
To assist medical and public health personnel in evaluating the likelihood of smallpox in patients with febrile rash illnesses, CDC has developed a rash illness assessment algorithm. Poster copies of this algorithm are available from state health departments and on the CDC website Orders for copies of the poster can be made over the Internet at: https://www2.cdc.gov/nchstp_od/PIWeb/niporderform.asp
Surveillance activities, including notification procedures and laboratory confirmation of cases, would change if smallpox is confirmed. Additional information regarding surveillance activities following laboratory confirmation of a smallpox outbreak can be found in the CDC Interim Smallpox Response Plan and Guidelines.
| Recommendations |
|
Under current circumstances, with no confirmed smallpox, and the risk of an attack assessed as low, vaccination of the general population is not recommended, as the potential benefits of vaccination do not outweigh the risks of vaccine complications. Recommendations regarding pre-outbreak smallpox vaccination are being made on the basis of an assessment that considers the risks of disease and the benefits and risks of vaccination. The live smallpox (vaccinia) vaccine virus can be transmitted from person to person. In addition to sometimes causing adverse reactions in vaccinated persons, the vaccine virus can cause adverse reactions in the contacts of vaccinated persons. It is assumed that the risk of serious adverse events with currently available vaccines would be similar to those previously observed and could be higher today due to the increased prevalence of persons with altered immune systems. |
Pre-Release Vaccination of Selected Groups to Enhance Smallpox Response Readiness
Smallpox Response Teams
|
Smallpox vaccination is recommended for persons pre-designated by the appropriate bioterrorism and public health authorities to conduct investigation and follow-up of initial smallpox cases that would necessitate direct patient contact. To enhance public health preparedness and response for smallpox control, specific teams at the federal, state and local level should be established to investigate and facilitate the diagnostic work-up of the initial suspect case(s) of smallpox and initiate control measures. These Smallpox Response Teams might include persons designated as medical team leader, public health advisor, medical epidemiologists, disease investigators, diagnostic laboratory scientist, nurse vaccinators, and security/law enforcement personnel. Such teams may also include medical personnel who would assist in the evaluation of suspected smallpox cases. The ACIP recommends that each state and territory establish and maintain at least one Smallpox Response Team. Considerations for additional teams should take into account population and geographic considerations and should be developed in accordance with federal, state, and local bioterrorism plans. |
Designated Smallpox Healthcare Personnel at Designated Hospitals
|
Smallpox vaccination is recommended for selected personnel in facilities pre-designated to serve as referral centers to provide care for the initial cases of smallpox. These facilities would be pre-designated by the appropriate bioterrorism and public health authorities, and personnel within these facilities would be designated by the hospital. As outlined in the CDC Interim Smallpox Response Plan and Guidelines, state bioterrorism response plans should designate initial smallpox isolation and care facilities (e.g., type C facilities). In turn, these facilities should pre-designate individuals who would care for the initial smallpox cases. To staff augmented medical response capabilities, additional personnel should be identified and trained to care for smallpox patients. |
| The ACIP recognizes that the implementation of the supplemental recommendations presented in this document requires addressing a number of issues, and that this will take time. The issues include provider and public education, health care provider training, availability of vaccine and VIG, developing the appropriate investigational new drug protocols, screening, strategies to minimize vaccine wastage, vaccine adverse event surveillance, and other logistical and administrative issues. |
128 posted on 6/22/02 12:17 PM Pacific by bonesmccoy
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Those issues should not preclude citizenry, including physicians who are first-responders in this situation, from obtaining this vaccine. Waivers to disclaim liability litigation against the manufacturer and the physician are appropriate. A physician needs to administer the vaccine. It is obvious to any licensed and practicing physician who is appropriate for protection and who is not.
I'm sick and tired of bumblers in Washington DC and Sacramento telling me how to practice medicine. Tell these stooges to sit down and get out of the way! We need to reinitiate vaccine distribution in a better way!
129 posted on 6/22/02 12:20 PM Pacific by bonesmccoy
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Thoughts?
That's the kind of garbage I would expect from some government beauracrat. Vacinating my 17 year old son is a higher priority than getting revacinated myself; revacinating my wife is my next concern--she has had it three times already.
Problems of individuals associating with vaccinated persons can be dealt with and resolved without denying the vaccine to the rest of us. There were people on Chemo; with skin conditions; and in other higher risk groups out there when the vaccine was available and we dealt with the issue just fine.
I am really not all that concerned that you may think you know better what is good for America at my expense. Your interference with reasonable expectations of the health care system is political--it is the same situation we would have been faced with had we elected Al Gore. Gore would not have armed pilots either.
So we can presume you're either going to vote Democratic or for a third-party candidate that will essentially give the Democrat an extra vote?
I don't know the answer to this question but at one point it was considered imperative that every American have a smallpox vaccination. I'd opt for one now if it were available.
However, unless you are willing to isolate yourself during the vaccination period, I DO have a problem with that. How many of your co workers are HIV positive, or are on chemotherapy? The sore that develops after Vaccination is infectious. We rarely ran into problems with it in past years, when most people had immunity and before the HIV epidemic. But now?
Wait till they vaccinate "primary responders", and see if we get headlines blaring about the deaths and illnesses in by standers.
Actually, I feel vaccination should be voluntary. But no one has the guts to do this. Remember Gerald Ford lost the presidency to Jimmy Carter, partly because of a couple hundred cases of Guillian Barre syndrome due to swine flu vaccine. Multiply this by a couple hundred deaths in an anti bush press, and you might see why I am so cynical about this.
Just an FYI for you, sir....
Yes- that was SO convenient- why, those 70,000,000 doses were just sitting there in a warehouse, forgotten. In an industry where EVERY unit dose i inventory is accounted for multiple times over!
Frankly, I hope that they do exist, and that the 1:10 dilution really does work- but I had some involvement in NBC (Nuclear/Biological/Chemical) weapons countermeasures in the military, and I also have seen our government lie with a perfectly straight face when it was deemed "in the public interest" to do so.
I am not some nutball Oliver Stone paranoid fantasist- my experience in this field is real, as is my familiarity with the (generally) inept U.S. intelligence services. (The British are very good at intelligence work- the only problem is that half of their top-level people turn out to be spies, working for the other side!)
One more quick point- when I was in the military, and had access and a TS security clearance, Smallpox was considered a VEREY SERIOUS threat as a bioweapon. But after it's eradication in the wild, it was "no longer a problem"- even though we KNEW from open sources that at least three stocks of the virus still existed in the world (and suspected several more...) Is that not passing strange?
Do you think that the elimination of routine vaccination of military personnel for Smallpox had anything at all to do with the appearance of AIDS in the late '70s- early 80's, and the huge outpouring of political activism that followed? See private reply.
Words can not express my anger with the Clinton team.
2. You are correct regarding lack of preparation for NBC terrorism.
3. Hooohahhh!
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