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Smallpox vaccinations urged (MSNBC) - Offer to general population represents a shift in policy
http://www.msnbc.com/news/817382.asp ^ | 10-5-02 | MSNBC

Posted on 10/05/2002 6:34:56 PM PDT by bonesmccoy

WASHINGTON, Oct. 5 — The Bush administration’s top bioterrorism advisers said yesterday they support a voluntary smallpox vaccination program that would begin with 500,000 health care workers, expand to 10 million emergency responders and extend to the rest of the population as early as 2004.

IT WAS THE first time high-ranking administration officials acknowledged they are considering offering the risky vaccine to the public prior to an attack and it represented a profound shift in thinking from the June recommendations of a government advisory panel to inoculate about 20,000 medical personnel.

“We live in a society that values individual choice,” said Julie L. Gerberding, director of the Centers for Disease Control and Prevention. “If we have vaccine and we have data to accurately assess the safety, one school of thought is that informed people may want to have the choice of getting vaccine or not.”

In a 90-minute briefing at the Department of Health and Human Services, the group of officials responsible for implementing a bioterror response plan laid out the options before President Bush, stressing that he has yet to make a decision on who could be vaccinated and when. If a smallpox case were detected, officials would assume the nation was under attack and would quickly move to nationwide vaccination.

Developing a “pre-attack” vaccination policy, however, has proven to be “extremely difficult” because of the challenge in balancing the possible risks of the vaccine against the risks of an attack, said Jerome M. Hauer, assistant secretary for emergency health preparedness.

THREAT OVERCOMES CONCERNS

Although they have no way of knowing the likelihood of a smallpox attack, health experts fear such an attack because the virus is so contagious and so deadly. About one-third of people who get the disease die, yet the vaccine itself can cause serious, sometimes fatal, complications.

Concerns that Iraq or another hostile nation may have acquired the virus have added urgency to the vaccination debate. “We need to be mindful that the context of this decision has changed a bit” since the far more conservative June recommendations, Gerberding said.

Vice President Cheney has speculated that the threat from Iraqi President Saddam Hussein may necessitate mass vaccination. Privately, sources said Cheney has vigorously advocated a broad vaccination policy. White House spokesman Scott McClellan said last night the policy “is under review” but he could not elaborate on a timetable or factors involved in the decision.

Since last fall’s anthrax attacks, federal health officials have moved swiftly to build up the nation’s smallpox vaccine stockpile. If an attack occurred today, they said they could safely dilute the existing supply to inoculate every American. By the end of next year, they expect to have 209 million doses of new vaccine on hand. None of the vaccine has been licensed by the Food and Drug Administration, but officials expect the first batches will be approved by November.

MILITARY FIRST IN LINE

At the request of the Department of Defense, Hauer said HHS will provide the first 1 million doses of licensed smallpox vaccine to the military within the month. Pentagon spokesman James Turner refused to comment.

For civilians, the HHS team favors a policy of “ever-expanding access to vaccine” that could be phased in as more vaccine is licensed and scientists have time to monitor early reactions to it. Using licensed vaccine would be much easier logistically than administering it as an experimental treatment that involves tricky liability issues.

The approach envisions vaccinating the people considered to be at greatest risk if an outbreak occurs. That would include public health investigators, emergency room workers and even janitors and security guards at local hospitals.

The goal in the early stages, Gerberding said, “is to maximize our ability to respond to an attack should one occur.”

In the second phase, as many as 7.5 million medical workers would be offered vaccine, along with the nation’s 3 million firefighters, police officers and rescue workers, Hauer said. Inoculating that many emergency personnel “would make it even easier to respond” to an attack, Gerberding explained. It is possible Bush would combine the first two phases and opt to inoculate the majority of first responders immediately.

At some later date, perhaps in early 2004, vaccine could be offered to every American. “Right now, our thinking is in favor of making vaccine available to the general public,” Gerberding said.

Federal health officials rejected the advice of its advisory panel to designate certain smallpox hospitals because Hauer said it was unrealistic to think patients would follow those guidelines.

America stopped routine vaccination in 1972, which means about 45 percent of the population has never been inoculated. It is unclear how much immunity remains from vaccines given 30 or 40 years ago.

Between 30 million and 50 million Americans should not be given the vaccine because they have weak immune systems, said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. That includes people who have received chemotherapy, have eczema or are infected with the AIDS virus. For every 1 million vaccinated, 15 people are likely to suffer life-threatening complications and one or two would die.

Because there is limited scientific data, it is difficult to predict the risks of a person spreading the virus in the vaccine to others. Administration aides are still grappling with the liability issues of reviving a vaccination program.

State health officials have until Dec. 1 to file plans for mass vaccination within five to 10 days of an attack, Hauer said. In the event of an attack, he observed, “Five days might be a luxury.”

(Excerpt) Read more at msnbc.com ...


TOPICS: Activism/Chapters; Announcements; Breaking News; Business/Economy; Foreign Affairs; Front Page News; Government; Miscellaneous; News/Current Events
KEYWORDS: bioterrorism; wmd
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To: bonesmccoy
It's based on previous experience with DryVax by Wyeth during the 1970's.

You seem knowelegable about this. Could you explain to me why the reactions to the DryVax would be the same as the Smallpox vaccine? I keep remembering swine flu for some reason, when I think about this.

61 posted on 10/05/2002 9:55:42 PM PDT by templar
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To: Miss Marple
The chief of the Soviet Union's smallpox weaponization program defected to us. His anglicized name is Ken Abilek. The enhanced, bioengineered, weaponized smallpox developed under his direction is terrifying. Here are its effective differences from natural smallpox:

Natural: 7-15 day incubation period (typically 10-12 days), 40-60% morbidity (40-60% of those exposed will contract it - say an average of 50%), 10-30% of those who contract it will die assuming enough medical care to keep them from dying of something else (20% average lethality).

Enhanced weaponized: 1-5 day incubation period (typically 3 days), 60-90% mordidity (average of 75%), 30-50% lethality (average of 40%).

So weaponized smallpox is about 50% worse than that found in nature and worse, its incubation period is only about three days. The latter means that vaccination won't save you if you've already been exposed. This stuff is a fucking disaster!

62 posted on 10/05/2002 9:58:01 PM PDT by Thud
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To: bonesmccoy
Read Ken Abilek's _Biohazard_ and Jonathan Tucker's _Scourge_.
63 posted on 10/05/2002 10:03:17 PM PDT by Thud
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To: templar
yup...

I posted an article... didn't say I agreed with it...
64 posted on 10/05/2002 10:26:00 PM PDT by Robert_Paulson2
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To: templar
flamethrowers would probably work.

roflmao... indeed.
65 posted on 10/05/2002 10:27:23 PM PDT by Robert_Paulson2
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To: dd5339
vaccine ping!
66 posted on 10/06/2002 5:39:19 AM PDT by Vic3O3
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To: templar
You may be confusing the vaccines. Swine flu is definitely different than cox pox (which is the virus in the small pox vaccine). Dryvax is a live virus, which is why the public health guys are concerned about side effects). DryVax is the small pox vaccine.
67 posted on 10/06/2002 7:51:55 AM PDT by bonesmccoy
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To: Thud
I am familiar with Alibek's comments.
68 posted on 10/06/2002 8:05:26 AM PDT by bonesmccoy
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To: Robert_Paulson2
Thought I heard they cut the regular vaccine dosage in half or thirds. They may not know the effectiveness of this diluted vaccine.

I found it interesting that those treated by chemotherapy are not eligible for the vaccine due to a weakened immune system.

Sure is ironic, how chemo can help treat cancer, but is a detrement when it comes to smallpox.

69 posted on 10/06/2002 9:51:24 AM PDT by janeliberty
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To: Robert_Paulson2
any prophylactic antibiotic that is effective? Is it something a five day regimen of antibiotics would possibly prevent the spread of?

Ebola = virus. Antibiotics to not treat/prevent viral diseases.

70 posted on 10/06/2002 12:55:44 PM PDT by BearCub
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To: BearCub; All
We are at risk for an abundance of threats, there is no doubt. We have to live with it from now on until the war on terror succeeds in disabling all the anti-American evil and Satanic animals in the world. All types of bio-chemical hazards are out there that could be used against us. We must keep praying for our courageous President, brave relentless military, and frontline defense personnel in security and healthcare, and be ever alert. God Bless Us All.

Check this out .. and here's the URL: Botulism Study

"Botulinum Toxin as a Biological Weapon ............

.........Objective The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if botulinum toxin is used as a biological weapon against a civilian population.

Participants The working group included 23 representatives from academic, government, and private institutions with expertise in public health, emergency management, and clinical medicine.

Evidence The primary authors (S.S.A. and R.S.) searched OLDMEDLINE and MEDLINE (1960–March 1999) and their professional collections for literature concerning use of botulinum toxin as a bioweapon. The literature was reviewed, and opinions were sought from the working group and other experts on diagnosis and management of botulism. Additional MEDLINE searches were conducted through April 2000 during the review and revisions of the consensus statement.

Consensus Process The first draft of the working group's consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group convened to review the first draft in May 1999. Working group members reviewed subsequent drafts and suggested additional revisions. The final statement incorporates all relevant evidence obtained in the literature search in conjunction with final consensus recommendations supported by all working group members.

Conclusions An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours after exposure.

((NOTE: diplopia = double vision; dysarthria = a motor speech disorder; dysphonia = neurologic voice disorder that is characterized by jerky, strained, strangled and sometimes unintelligible speech; dysphagia = difficulty or discomfort when swallowing.)

Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting, and epidemiological investigation. Persons potentially exposed to botulinum toxin should be closely observed, and those with signs of botulism require prompt treatment with antitoxin and supportive care that may include assisted ventilation for weeks or months. Treatment with antitoxin should not be delayed for microbiological testing.

JAMA. 2001;285:1059-1070 This is the fourth article in a series entitled Medical and Public Health Management Following the Use of a Biological Weapon: Consensus Statements of The Working Group on Civilian Biodefense.1-3 This article is the only one in the series to feature a biological toxin rather than a replicating agent.

Botulinum toxin poses a major bioweapon threat because of its extreme potency and lethality; its ease of production, transport, and misuse; and the need for prolonged intensive care among affected persons.4, 5 An outbreak of botulism constitutes a medical emergency that requires prompt provision of botulinum antitoxin and, often, mechanical ventilation, and it constitutes a public health emergency that requires immediate intervention to prevent additional cases. Timely recognition of a botulism outbreak begins with an astute clinician who quickly notifies public health officials.

Botulinum toxin is the most poisonous substance known.6, 7 A single gram of crystalline toxin, evenly dispersed and inhaled, would kill more than 1 million people, although technical factors would make such dissemination difficult. The basis of the phenomenal potency of botulinum toxin is enzymatic; the toxin is a zinc proteinase that cleaves 1 or more of the fusion proteins by which neuronal vesicles release acetylcholine into the neuromuscular junction.8 ...."

71 posted on 10/06/2002 1:41:01 PM PDT by STARWISE
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To: Miss Marple
Trusting the administration on this issue may be fine, yet, the government itself keeps bringing the accountability issue of how risky the vaccinations may be. And then, the terrorists may use something else which is not fought by smallpox vaccines.
72 posted on 10/06/2002 5:41:22 PM PDT by Hila
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To: bonesmccoy
If American citizens are vaccinated, there's almost no chance they'll bother using smallpox as a weapon. Why bother? On the other hand, if it could kill millions of us, they'll use it.

Although they have no way of knowing the likelihood of a smallpox attack, health experts fear such an attack because the virus is so contagious and so deadly.

"Although they have no way of knowing the likelihood of a smallpox attack, health experts fear such an attack because the virus is so contagious and so deadly."

73 posted on 10/06/2002 7:53:32 PM PDT by GOPJ
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To: Miss Marple
I will get the small pox vaccination ASAP. No point in ignoring the potential problem. When they start spreading diseases why let one easily thwarted bring us down??
74 posted on 10/06/2002 8:04:24 PM PDT by southland
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To: GOPJ
Yep... ready the physicians and nurses of this country for bioattack... I'm getting our office prepared and ready for a January assault. This is no joke. I think doctors are the worst prepared people for this war. I'm even thinking of joining the US Public Health Service so I can get into uniform and speak at the hospital meetings with more authority than the old-liberal lunkheaded HMO stooge physicians (who still don't realize that there is a war on... those doctors are too busy driving Porsche's and thinking they can smoke their way to enlightment).
75 posted on 10/06/2002 8:26:20 PM PDT by bonesmccoy
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To: Robert_Paulson2
This article is nonsensical garbage and you put your mental stability at risk by reading such dribble. The President and his administration are not interested in scaring the American people into submission, and I have heard several assertions that Saddam has smallpox. Give it a rest...George W Bush is not Bill Clinton, if he thinks there's a serious risk to our population I'm willing to accept that at face value.
76 posted on 10/06/2002 9:17:23 PM PDT by pgkdan
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To: Robert_Paulson2
tests show any residual is plenty effective... even up to 45 years I read last week...

Where did you read that??? On that same whack job website you posted from earlier? The CDC and other sources say that you're wrong on that score. Ever see pictures of a smallpox victim? Are you willing to bet your vaccine is still effective with that as the ante?

President Bush deserves our support on this. I'll bitch and moan and complain every single time I think he's caving to the dims on their social agenda, but I'll never give an inch of ground to anyone who claims that W is anything less than an honorable, decent and good man who has the best interest of his country at heart...period.

77 posted on 10/06/2002 9:23:36 PM PDT by pgkdan
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To: pgkdan
please take a look at:

http://www.freerepublic.com/focus/news/763775/posts?page=17#17

I said, and I quote...
"I don't agree with Reese."
got it? that is what I said.

we post articles here... and discuss them, even if we don't agree with them at times.

POSTING does NOT equal AGREEMENT... thanks for understanding.

and I never said Bush was Clinton. sheesh.
or that there is NO RISK of small pox...

78 posted on 10/07/2002 2:29:06 AM PDT by Robert_Paulson2
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To: pgkdan
Study: Smallpox Vaccine Protects For 50 Years
Microbiologist Says Revaccination Unnecessary
Updated: 9:46 a.m. EDT August 29, 2002

New research says people who received smallpox vaccinations at birth can rest assured in the event of an outbreak.



SMALLPOX
Smallpox FAQs
Smallpox Diagnosis Online
CDC Smallpox Resource Center


Dr. Jeffrey Frelinger, a microbiologist at the University of North Carolina at Chapel Hill, observed that people who received the smallpox vaccine years ago still had a high level of immunity.
In the fall of 2001, Frelinger and his team conducted a formal study to determine how long the vaccine protects people. The results are published in the Aug. 29 issue of the New England Journal of Medicine.

"When Sept. 11 happened, we realized somebody might care about this," Frelinger said. "With the whole anthrax thing, this might be useful information to have out there in the world."

The team tested blood samples from 13 laboratory workers who had been vaccinated they work with the weakened virus in the vaccine. Four had been vaccinated less than five years ago. Another nine individuals had been vaccinated either between five and 35 years earlier or more than 35 years ago.

He tested immune response and discovered that people who were vaccinated up to 35 years ago had enough immunity to protect them. Even after 50 years, there is protection.

"It might not be enough protection to keep you from getting sick. It's almost certainly enough protection to keep you from getting killed," Frelinger said.

If a smallpox outbreak occurred, Frelinger believes the government may not need to revaccinate.

"Instead, worry about people who were born after 1972, who've never been vaccinated," he said.

New government proposals do not call for mass vaccinations; however, in the event of an outbreak, people who are not vaccinated are expected to quickly use up the stockpiled doses.

The government has enough vaccine in hand for 75 million people, with more on the way.




next time dan, please do be a little more polite and knock off with the "whack job" insults... This by the way... IS a CDC source... the New England Journal of Medicine published the study, and they say, fifty years. This is hardly a "whack job" article. And we discuss reese pretty often around here... posting one of his articles is "fair game" and does not indicate agreement with its content... fair enough?

79 posted on 10/07/2002 2:35:13 AM PDT by Robert_Paulson2
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To: pgkdan
Old Smallpox Vaccine Shows Resiliency
A small study finds it generates an immune response even 35 or more years after it was given.

By Adam Marcus

WEDNESDAY, Aug. 28 (HealthScoutNews) -- People who received the smallpox vaccine more than three decades ago still appear to have substantial protection against the deadly virus.

Researchers have found that while a fresh inoculation may offer the best defense against smallpox, even immunization that occurred 35 years ago or longer retains most of its potency. They report their findings in a letter appearing in tomorrow's issue of The New England Journal of Medicine.

The durability of the vaccine has been a wild card for health officials, who are considering a return to widespread smallpox vaccination to blunt a possible terrorist strike with the microbe. The United States abandoned routine immunization against the virus in 1972, and the World Health Organization declared the infection eradicated in 1980. However, the United States and Russia have preserved samples of the virus, and intelligence experts fear that rogue states like Iraq and North Korea may have obtained supplies of it to use as a bioweapon.

To meet that threat, the Bush administration has set about stockpiling enough smallpox vaccine to cover every American.

Earlier this year, an advisory panel for the Centers for Disease Control and Prevention (CDC) recommended that mass vaccination wasn't necessary and could lead to hundreds of deaths from complications of the inoculation, which involves scratching the vaccinia virus underneath the skin with a tiny pitchfork-like device.

Instead, the group's guidelines produced an estimate that roughly 15,000 health and emergency workers first to respond to a smallpox outbreak might need the vaccine most. Yet, some officials reportedly are urging that as many as half a million people receive it.

The government has yet to announce its decision regarding the panel's recommendations. Bill Pierce, a spokesman for the Department of Health and Human Services, which oversees the CDC, said his agency had given itself a deadline of the end of September to determine its course.

"We're still in the time frame we said we'd be in," he said.

Pierce said officials were aware that smallpox vaccine could remain effective for many years, and would use that information in its decision-making.

In the new study, which fell out of an HIV experiment, University of North Carolina immunologist Jeffrey Frelinger and a colleague looked at the durability of the smallpox vaccine in 13 lab workers who handle the inoculation.

Of those, four were immunized not more than five years ago, while nine received the vaccine six to 35 years ago and longer. Looking at the response of immune agents called CD8 cells to the vaccinia virus, the researchers saw that people who were immunized recently tended to have the strongest reaction to the vaccine. Yet, those vaccinated more than 35 years ago had only about a third less reactivity, on average, than the recent recipients.

"That's actually pretty resilient to [a virus] you haven't been exposed to for 30 years," said Frelinger, who bared his arm for the study as a volunteer.

Frelinger said policy makers may want to consider his results in prioritizing how smallpox vaccine is distributed, should that prove necessary. "You would want to vaccinate unvaccinated people first," he said.

The study also may be of some comfort to those who've already had at least one round of smallpox vaccine in the past, he added, since their risk of an adverse reaction to the inoculation likely is lower than that of someone naive to it.

80 posted on 10/07/2002 2:40:16 AM PDT by Robert_Paulson2
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