Posted on 06/24/2002 5:36:24 PM PDT by bonesmccoy
I really can't think of a single American organization that really stands to gain from this policy. What does CDC really gain from leaving all of us vulnerable?
I'm glad to hear that the physician on Fox News said that. Perhaps we will go public with similar statements.
I think Henderson at Johns Hopkins has it right. He correctly predicted the entire chain of events for the anthrax attack. Liberals may attempt to paint American causes for the attack. I find none of those attempts as plausible. This anthrax was engineered and designed. I take those letters at face value. The fact that the targets were so unusual was probably meant to deceive investigators into goose chases. If the attack was launched by Saddam Hussein, he has to be laughing at our inability to track the source of the spores (which I think were Iraqi from the sources here).
Bioterrorism has occurred, is already occuring, and will occur. Leaving our children vulnerable to these diseases is awful!
In this case, CDC is really wrong. ACIP is limiting the free market and the policy needs to be reversed. If a manufacturer has a vaccine, they need to be permitted to use it.
Another example of the way vaccines are NOT being made is the Lyme Disease vaccine which was discontinued a few months ago. The media trashed the company and the vaccine (just like some misguided people are doing to the Measles-Mumps-Rubella vaccine). Regretably, there are some physicians who cave to the idolatry and attention. They claim that MMR causes autism. The reality is that we have now sent tens of millions of dollars worth of research dollars through the system to examine this possibility. The only ones profitting from these ridiculous claims are the researchers making the claims themselves.
Here's more fodder for the health care policy people in each Congressional office. I hope Freepers are reading this and sending this information to their political delegations.
ACIP has participation from AAP and AAFP. Therefore, ACIP should reflect the policies of AAP. AAP's policies are available on-line. In fact, when you peruse their policies, you find the following statement:
Government agencies should work to ensure that adequate supplies of antibiotics, antidotes, and vaccines are available to children, that they are efficacious, and that pediatric doses are established. Resource allocation plans should ensure that these agents are readily available to pediatric health care sites.
From: Chemical-Biological Terrorism and Its Impact on Children: A Subject Review (RE9959)
http://www.aap.org/policy/re9959.html
You obviously miss the whole point---YOU should make the right call, not government. If YOU don't want YOUR kids to have the vaccine, so be it, but someone else may want THEIR kids to have the vaccine, and they cannot.
I have read accounts that plenty of stockpiles of vaccine have been made, and now they're figuring out the best places for storage. Given any vaccine's problems, I don't think mass vaccination for smallpox a good idea. Anthrax is more likely than smallpox as a terrorist attack...
I am glad to read that the tetanus vaccine shortage is over.
My sister decided to stay in healthcare. She earned an RN and has been specializing in OB at Mercy Hospital in San Diego for over 20 years. The paperwork rat race is nudging her in the direction of doing something else.
The idea that epidemiologists could trace everyone who might have been infected and vaccinate their communities in time to stop a disaster is wishful thinking. The only way to prevent a successful Smallpox attack would be mass vaccination in advance. Unfortunately, if al Qaeda don't have Smallpox then we would look rather silly using mass vaccination, since we would loose about 180 people according to the accepted Smallpox vaccination risk assessments. The only problem is, are there enough doses of Smallpox vaccine to do 97% of the US population? If there aren't then it would be better to keep them for 'ring vaccination', instead of just giving them to people who want them.
Thanks for the thoughtfulness of your response. The scenario you have described is the worst case scenario. I'm sure that the intelligence authorities have to be working to identify such plans. If the terrorist organizations are willing to create a plan like 9-11, and since there are operatives still out in the field; the shipping of the weapons becomes the issue.
Currently, the anthrax attack in Sept 01 has escaped identification. It appears to me that the perp had sufficient containment to limit spread in an apartment or business. Somewhere there has to be traces of the same germ from the packaging. If the traces do not exist, then the packaging occured elsewhere and (more importantly) the manufacturing of the weapons occured outside the United States.
This poses the possibility that we have already been subjected to a biological attack by a foreign nation. I submit this is a higher possibility than domestic terrorism. The only gov't with enough to pull off the scheme is Iraq. North Korea probably doesn't have anthrax molecular biologists available. But, middle eastern college students abound in our nation. If one was bought off and entered Iraq, then they may be the perp.
Regarding ring vaccination strategies and the epidemiology of the spread of smallpox, there is one issue that you have omitted from your scenario. There is the possibility with voluntary immunization of the populace of creating "herd immunity". When a herd of cattle are susceptible to a disease, then it spreads faster if all cattle are susceptible. However, once a certain percentage of people are immune, it is possible to contain the spread of the disease more easily. Because not every individual is susceptible, some of the contagion decreases in the total population.
I submit to my colleagues on this board (who are physicians and public health officers) that herd immunity is the issue in our national defense against bioterrorism. Certainly, polio is not a likely weapon of choice. Nearly every American is immune to the virus. However, it was our own decision to stop protecting our children and it was our own lack of foresight that has created the first new generation totally susceptible to smallpox in over 100 years!
God help the politician who is silent when we request formally for the stockpiles to be released.
(Ohhh...did I say that!!! OOpsss...welll...have fun looking for scars!)
The type of vaccines needed to maintain herd immunity are likey to be different than the types used to stop an outbreak. For example the live oral polio vaccine causes a the immune system to build immunity faster than the killed version. Unfortunately the live polio vaccine sometimes mutates back to the virulent form and causes polio. While the live vaccine is no longer used in this country due to the rare but devastating side effect, it is used in countries like Afghanistan where polio is still endemic. If the US were to develop safer inactivated smallpox vaccines, the live vaccine would still be useful in case of an outbreak, because it can be given up to four days after exposure to smallpox.
We need to have bettter forethought about how diseases are exterminated in the future. If we stop vaccinating against polio after polio is erradicated, in thirty years or so we would have same kind of vulnerabilty to polio attacks as we now have to smallpox. After polio is "erradicated," WHO wants to erradicate the measles. We certainly don't want to repeat the same mistakes with the measles that have been made with smallpox. All it takes is for someone to clandestinely freeze some samples of the virus.
I have already said this to another American earlier, perhaps the vaccination method has changed since you had it. However, I doubt it, a scar from a Smallpox vaccination proves the vaccination worked. If you haven't got one there is an element of doubt as to whether or not you have any immunity.
Here's a quote regarding aftercare for successful Smallpox vaccination from one of my old textbooks: 'Jawetz, Melnick & Adelberg's Medical Microbiology' 20th Edition. Editors: G. F. Brooks, J. S. Butel and L. N. Ornston. Published in 1995.
'1. Primary take - In the fully susceptible person, a papule surrounded by hyperemia appears on the third or fourth day. The papule increases in size until vesiculation appears (on the fifth or sixth day). The vesicle reaches its maximum size by the ninth day and then becomes pustular, usually with some tenderness of the axillary nodes. Dessication follows and is complete in about 2 weeks, leaving a depressed pink scar that ultimately turns white. The reading of the result is usually done on the seventh day. If this reaction is not observed, vaccination should be repeated.
2. Revaccination - A successful revaccination shows in 6-8 days a vesicular or pustular lesion or an area of palpable induration surrounding a central lesion, which may be a scab or an ulcer. Only this reaction indicates with certainty that viral multiplication has taken place. Equivocal reactions may represent immunity but may also represent merely allergic reactions to a vaccine that has become inactivated. When an equivocal reaction occurs, the revaccination should be repeated using a new lot of vaccine known to give "takes" in other persons.'
This quote was from an American medical textbook, so it should be referring to reactions commonly seen in vaccinees using the standard American Smallpox vaccines.
The voluntary take up rate would have to be very high to give any useful "herd immunity". We have a problem in Britain at the moment with the take up of the MMR vaccine. The optimum vaccine take up rate is 97% or above, but in some areas it is below 80%. This has caused some isolated outbreaks of measles in these low take up areas. To prevent an uncontrollable Smallpox epidemic we would need over 80% of the population to be vaccinated. Its very unlikely that this could be done quickly by a voluntary vaccination campaign.
A key question is whether or not people who want voluntary vaccination will have to pay for the vaccine? Is there enough vaccine available to do volunary vaccinations and still vaccinate people in communities that are exposed after an attack? If there isn't enough vaccine and people have to use privately sourced vaccines for voluntary vaccination, then some impoverished groups will be left unprotected.
I often hear ignorant people in Britain say that children are the most at risk from a Smallpox attack. I don't know when routine Smallpox vaccination ended in the USA, but in Britain it ended in the 1960s. Therefore, people in their mid-30s are fully susceptible to it. Apparently, the Russians continued routine vaccination into the late 1970s. They weaponised Smallpox of course, so they had to make sure their population was immune.
Its funny the number of people who have told me that they are confident that they are safe even though they were vaccinated back in the 60s. I have a Russian colleague who was vaccinated in 1974 and she told me she wasn't worried about a Smallpox attack. I informed her that the Smallpox vaccine is only guaranteed to prevent infection for 5 years and 10 at the outside, although the disease suffered is usually less severe if Smallpox is contracted within 20 years. Oh well, whatever gives people hope!
If Al Qaeda has Smallpox, they are most likely to have the extremely deadly India-1967 strain of Smallpox, which the Soviets apparently gave to North Korea and goodness knows who else. Apparently, they manufactured 20 tons of it for use in their ICBMs and other weapons systems. Thus it certainly would be the most likely strain to have been stolen and sold to the highest bidder. This strain has caused Smallpox in people who were vaccinated more than 10 years before exposure, although the mortality rate is much lower than for non-vaccinees. The mortality rate with this strain is at least 50% for non-vaccinees and not the usual 30%, which is seen with most other strains.
Your observation regarding "herd immunity" is interesting. Calculation of herd immunity is related to the virulence and the vectors of infection. In a bioterror attack, the strain you describe would be most concerning. Yet, I am still left questioning the conclusion of ACIP.
Instead of permitting dilution of existing vaccine and instead of permitting families to voluntarily pay for the vaccine privately, the ACIP chooses to withhold the vaccine.
This is most peculiar given the responsibility of the federal gov't to "Provide for Common Defense". Clearly, this vaccine falls into the realm of "common defense".
Your comments appear to support release of the vaccine more than withholding. Am I correct in conclusion?
Prior to banning OPV, the ACIP should have undertaken analysis of the combined regimen which they had recommended for several years. Until 1999-2000, ACIP had equal recommendations behind full OPV, full IPV, and partial IPV/OPV regimens.
I still feel that initial immunization with IPV twice, followed by OPV later in life would prevent the cases of VAPP. This is relevant because OPV is much cheaper and easier to use than IPV (OPV is an oral drop, but IPV is injectable).
Regarding the future eradication of Measles or Polio, the regimen for immunization would likely change once the disease is exterminated. Instead of giving so many injections, you would likely given one vaccine at 4-6 years of age for MMR and IPV. You would probably be able to eliminate 3 doses of polio vaccine and 1 dose of MMR. That will save our nation $160.00 per child.
Dilution of Smallpox vaccine could be hazardous given that the stocks are probably old, and so the viability could be below optimal levels already. The currently available Vaccinia stocks in Britain date back to the 1970s. The number of failed vaccinations with diluted vaccine would therefore increase, so a careful experiment would have to be done to determine a safe dilution factor, this might not be as high as we would like.
This is most peculiar given the responsibility of the federal gov't to "Provide for Common Defense". Clearly, this vaccine falls into the realm of "common defense".
It is always possible that the intelligence they have received suggests al Qaeda don't have access to Smallpox at the moment.
Your comments appear to support release of the vaccine more than withholding. Am I correct in conclusion?
If vaccine from a source which doesn't impinge on the emergency stocks can be made available to people voluntarily, then I believe it should be. If there is intelligence which suggests a reasonable threat from a terrorist Smallpox attack, then mass vaccination should be begun as soon as possible. This is because the potential loss of life in such an attack could be very large.
A smallpox attack would be the "holy grail" for al Qaeda, thus a mass vaccination campaign would have a powerful deterrent effect. After all, al Qaeda will probably be around for a few more years and it won't be possible to maintain 100% levels of vigilance against bioterrorist attacks for years.
Also smuggling microorganisms is extremely easy. I have a former colleague who managed to smuggle 0.5 Kg of freeze-dried bacteria past two sets of suspicious Customs, by putting it into a tea box. I also heard about a Microbiologist who soaked a sterilised handkerchief in a solution of fungal spores to allow him to take the fungus abroad without doing all the excessive paperwork!
You are incorrect regarding dilution of vaccine stockpiles. The US gov't has already completed dilution experiments and the vaccine was still viable.
It is the CDC who is focusing on adverse events. This is particularly ironic given the existance of the Vaccine Adverse Events Reporting system.
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