Originally created 09/26/02

Smallpox vaccinations plan prepared



WASHINGTON -- State health officials are armed with a federal plan to vaccinate everyone in America against smallpox within days of a terrorist attack unleashing the deadly disease.

Since the disease had been eradicated worldwide, officials would assume that a single case of smallpox means the nation is under attack and immediately vaccinate those who had contact with the patient.

They would then decide how many others to vaccinate, officials said, adding that it is possible a single case could trigger nationwide vaccinations.

"Once there is a case of smallpox, what has been theoretical up 'til now suddenly becomes real," said Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention. "We would anticipate many Americans would want to have access to the vaccine."

Dr. Walter Orenstein, director of the CDC's National Immunization Program, added that a single case would suggest the likelihood of other cases of the highly contagious disease popping up and therefore suggest the need for "a fairly widespread control program."

The smallpox vaccine offers protection against the disease even if administered after someone is exposed, as long as that person gets the shot within a few days.

The plan sent Monday offers specific suggestions for a community that must vaccinate 1 million people in 10 days, but officials said the timing and scope of vaccinations would depend on the situation.

"The decision around mass vaccination would be dependent on particulars of the outbreak we were facing," said Dr. David Fleming, the CDC's deputy director for science. "We've got to develop the plans right now."

The 48 pages of guidelines are meant to help states confront a host of logistical problems.

Although smallpox was declared eradicated in 1980, experts fear that hostile nations or terrorist groups may have acquired the virus and could release it on a population that now harbors very little natural immunity. Routine immunizations in the United States ended in 1971.

The disease swept through entire populations centuries ago, killing up to 30 percent of its victims and leaving survivors scarred and sometimes blinded. The vaccine was discovered in 1796.

The new blueprint does not address whom to vaccinate before an attack occurs. Administration officials tentatively have settled on a staged approach, beginning with health care workers and emergency responders who face the greatest risk of seeing a contagious smallpox patient. A decision on that issue is expected by month's end.

Because the vaccine carries significant risks, including death, officials are trying to balance the risk of the side effects against the risk of the disease's return.

The blueprint gives states considerable information about how to deliver shots to large number of people all at once. It includes:

-Ready-to-go medical screening, consent forms and information for distribution about smallpox and the side effects of the vaccine.

-Details about how to store and prepare the vaccine for use.

-A list of places where security or crowd control will be needed, including clinics and vaccine storage sites.

-Types and numbers of workers needed per clinic, per 8- and 16-hour shifts. Among the required workers: volunteers to run an informational video, nurses to give the shots and translators to assist non-English speakers.

-Messages to deliver to people waiting for shots, including how long the wait is. And messages for the media, including immediate public service announcements.

-Criteria for choosing a vaccine clinic site before a smallpox attack.

-Issues to consider in transporting people to the site, including buses and parking.

-A long list of needed routine and emergency supplies, from tape and rubber bands to cots and blankets to fax machines and VCRs.

-Information about who should not receive the vaccine due to heightened risk of side effects.