Posted on 12/20/2002 6:56:54 AM PST by Dog Gone
AP Medical Editor
BOSTON (AP) -- Americans are deeply confused over just about every aspect of smallpox, including the risks of vaccination, whether it can be treated and even whether people still catch it.
A newly released survey found that a majority actually believes smallpox cases still occur in some parts of the world, even though the disease was eradicated 25 years ago in one of the greatest public health victories in history.
``It's staggering,'' said Robert J. Blendon, who directed the survey at the Harvard School of Public Health.
Like several other recent surveys, this one found that about two-thirds of Americans say they would like to be vaccinated, though that willingness would plummet if people found their own doctors avoided the vaccine.
The survey will be published in the Jan. 30 issue of the New England Journal of Medicine, along with several other reports on smallpox. The journal posted all of the smallpox papers on its Web site Thursday.
Three decades after the U.S. smallpox vaccination program was retired, it is to resume in January because of the risk that terrorists could introduce the disease, using virus stockpiled after person-to-person spread was eliminated.
The vaccine will be mandatory for about 500,000 military personnel and recommended for another half-million who work in emergency rooms and on special smallpox response teams. The government will make the vaccine available to anyone else who wants it beginning late next spring or early summer, though it will not encourage ordinary people to get the shots.
The government's policy of targeting doctors and nurses is supported by a detailed analysis in the journal, sponsored by the RAND Center for Domestic and International Health Security, that examines various scenarios of smallpox release.
``We show there would be a net benefit to vaccinating health workers, even if there is a low probability of an attack, because health workers are at greatly increased risk,'' said the study's director, Dr. Samuel Bozzette of the Veterans Affairs San Diego Healthcare System.
Blendon's survey was based on calls to 1,006 randomly selected adults over the past two months. It carried a sampling error of plus or minus 3 percentage points.
Among the findings:
-30 percent believe there has been a smallpox case in the United States in the past five years, and 63 percent think there has been one somewhere in the world. Actually the last U.S. case was in 1949 and the last in the world was in 1977.
-25 percent said it was likely they would die from the vaccine. The actual death rate from the shots is estimated to be less than three per million.
-78 percent said they thought medical treatment for smallpox would prevent death or serious illness. Actually, there is no proven treatment after symptoms start.
-16 percent think the country has enough vaccine to give everyone in case of a smallpox attack. The government says it has enough for all.
-58 percent do not believe that vaccination within a few days of exposure will prevent people from contracting smallpox. Actually, it will.
The Centers for Disease Control and Prevention has largely focused on educating doctors about smallpox, assuming they will then communicate with patients. ``If and when a licensed vaccine is made available to the general public, the plan here is to embark on a mass-media education campaign that could include posters, advertisements and public service announcements,'' said CDC spokesman Tom Skinner.
The possibility of rare but potentially serious side effects is the main drawback of widespread smallpox vaccination. The Bush administration estimates that one to two people per million would die from the shots. After reviewing about 14,000 medical articles going back 100 years, Buzzette's team chose a somewhat higher estimate of about 2.7 deaths per million.
If 60 percent of the 290 million Americans were vaccinated, that would mean nearly 500 deaths, even if smallpox never reappears. However, in any outbreak, health care workers are the ones most likely to catch the virus. They make up 3 percent of the population but would account for 20 percent to 60 percent of all smallpox cases, depending on which scenario of disease spread is used.
Smallpox could be spread by terrorists in various ways. One scenario would be to let three smallpox-infected terrorists ride mass transit in a large city. The researchers estimated that fewer than 20 people would die before the disease was contained through a vaccination campaign.
The worst scenario imagined was turning 40 terrorists loose on a busy day in 10 large airports with portable nebulizers spraying smallpox into the air. Unless most of the population had already been vaccinated, between about 40,000 and 55,000 people would die.
EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.
On the Net:
Journal: http://content.nejm.org
CDC: http://www.bt.cdc.gov/agent/smallpox/vaccination/facts.asp
| 1 in 3 Troops Exempt From Smallpox Vaccine |
And in Israel, more than half of 42,000 health and emergency workers offered the vaccine have declined for medical and other reasons, with doctors among the most reluctant, the chief of Israel's program told an expert panel reviewing U.S. plans to resume vaccinations among civilians next month.
It highlights the need for education about both the disease and the vaccine. Routine inoculations ended in 1972, the last natural case of smallpox was in 1977, and Americans know little about smallpox today.
Yet a poll published Thursday found a majority believe the deadly disease still breaks out naturally throughout the world and can be cured.
Misconceptions like these suggest a deep public misunderstanding of smallpox, despite many months of news reports and discussion about the possibility of a bioterrorist release of the virus.
``It's staggering,'' said Robert J. Blendon, who directed the survey at the Harvard School of Public Health, published on the New England Journal of Medicine's Web site.
For the U.S. military, vaccinations began a week ago. In the first five days of the program, 276 people have been screened for the vaccine, with 102 -- 37 percent -- exempted for medical conditions, said Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs. The others got the inoculation.
Nearly half of those exempted live with someone who would be at risk for a side effect. The vaccine is made with a live virus, and it can escape the inoculation site and infect people who come into close contact with the person vaccinated.
The most common medical conditions were skin conditions, such as eczema.
So far, there have been no serious complications, and Winkenwerder is hoping that careful screening will mean far fewer problems than were found in the U.S. smallpox program in the 1960s. During that time, there were one or two deaths for every million people vaccinated and at least 15 life-threatening complications per million.
``We're paying a whole lot more attention to screening,'' he said.
The vaccinations began last Friday, targeting about 500 people who would serve on smallpox response teams. In the next stage, beginning in January, the Pentagon will vaccinate about 25,000 medical teams in hospitals and large clinics, and up to a half-million troops in high-risk areas, particularly southwest Asia.
In Israel, 17,500 people have been vaccinated so far, with about 20,000 expected before the program is complete, said Dr. Yehuda L. Danon, a pediatrician at Tel Aviv University who is running the program and was the first to get the smallpox shot in Israel's new program.
About half the doctors have declined to get the vaccination, he said, adding that hospital staff decline the shot as well when the chief physician says no.
``The medical personnel (are) the most difficult to educate. The ignorance is really unbelievable,'' Danon told the panel convened by the Institute of Medicine.
So far, Danon said, four Israelis have been hospitalized with conditions that may have been related to the smallpox vaccination, though only two of them were clearly reactions to the vaccine.
Less serious reactions have been common. Nearly one in three experienced fatigue or weakness, 28 percent had headaches and 18 percent had muscle pain. About one in 10 were nauseated.
The data from Israel and the early experience in the military are helping U.S. health officials prepare for civilian vaccinations to resume after three decades.
First up will be about 440,000 people on hospital and health care response teams. To help educate them, officials are busy preparing detailed information about the smallpox vaccine and its risks, including graphic photographs.
``I think, realistically, a picture is worth a thousand words,'' said Dr. Julie Gerberding, director of the federal Centers for Disease Control and Prevention.
But she added that people will also be told that the risk of these complications is quite low, particularly for people who do not have skin conditions, compromised immune systems or other risk factors.
CDC officials have asked the Institute of Medicine panel for advice on their education and screening plans, as well as their plans to train doctors about smallpox and to educate the general public.
For the military, where inoculations are mandatory, some half-million troops are likely to be vaccinated, although those at risk for side effects are exempted.
Copyright © 2002 Associated Press
These people and their destinations are documented and can be tracked.
People on subways, busses etc. are not.
I think the 40,000-50,000 fatality rate is way low. JMHO.
Those stupid Doctors. What do THEY know about medicine, anyway? We should all run out and get innoculated just to show them that we know more about medicine than they do.
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