Reprinted from NewsMax.com

Medical Journal: Smallpox Threat Real, Vaccinate Now
Jim Meyers, NewsMax
Tuesday, June 27, 2006
A respected medical journal warns that the U.S. is highly vulnerable to a bioterror attack using the smallpox virus – and the best defense would be voluntary mass vaccination before such an attack.

The alarming report appears in the summer 2006 edition of the Journal of American Physicians and Surgeons, the publication of AAPS, the Association of American Physicians and Surgeons, one of the nation's leading doctors' groups.

Smallpox was responsible for 300 million deaths worldwide in the 20th century before the World Health Organization declared that it was completely eradicated in 1980.

But the U.S. government has reported that "rogue nations" such as Iran and North Korea have stocks of the smallpox virus.

"Ominously, in 1998 North Korean military defectors were found to have been recently vaccinated against smallpox," writes F. Matthew Mihelic, M.D., in the Journal's featured article. Milhelic is an assistant professor at the Center for Homeland Security Studies at the University of Tennessee's Graduate School of Medicine.

Smallpox has already been used in biowarfare in previous centuries, according to Mihelic's report.

The British purposely supplied Native Americans with smallpox-infected blankets during the French and Indian War. Confederate sympathizers during the Civil War sold smallpox-infected clothing to Union troops. And during the 1930s the Japanese experimented with smallpox in Manchuria.


"The United States is probably the most likely target for a bioterrorist attack, but the effects of such an attack would not be limited to this country alone," Mihelic writes. "Given the availability of rapid international travel, an infectious bioterror outbreak could quickly spread throughout the world."

Current response plans call for isolating any cases of smallpox, quickly vaccinating those closest to the infected persons – known as "ring" vaccination – and then vaccinating the rest of the population.

This approach, however, is not likely to work, the expert believes, "because of such factors as the rapid and extensive travel of the American population and the absence of any herd immunity. By the time a single case of smallpox is diagnosed anywhere in the United States, it would mean that the entire nation has potentially been exposed, and that the whole world is at risk."


Deadly Scenarios

Mihelic's analysis of the smallpox threat is chilling. He says that given the contagiousness of the disease, it is reasonable and conservative to expect that one infected person would infect three others on average, between an initial bioterror attack and the time the disease is first diagnosed.

Bioterrorists could initially expose 1,000 people to smallpox in an attack involving a group of terrorists who become infected with the virus before entering the U.S. and then disperse themselves across the country.

Aerosolized dissemination of the virus could also be used, exposing the terrorists to less risk and their command structure less exposure, Mihelic points out.

"Assuming the traditionally accepted likelihood that a third of those exposed contract the disease, then at least 300 people would become infected. It might be conservatively, and optimistically, hoped that the disease will be diagnosed during that first epidemiologic cycle of exposure."

In that best-case scenario, only one additional person would contract the disease from an infected individual after the first epidemiologic cycle, meaning 300 new cases for a total of at least 600.

"Further assuming the traditionally accepted likelihood that a third of those who contract the disease would die, then at least 200 deaths would result from the first two epidemiologic cycles in such a conservative scenario."

The U.S. is well aware of the problem. In 2001, a bioterrorism exercise conducted by the federal government, dubbed "Dark Winter," revealed that because it takes up to two weeks for smallpox to produce recognizable symptoms, the disease was able to spread to 25 states in that short period of time.

The scenario resulted in the theoretical death of one million and incapacitation of two million others. The ensuing epidemic quickly overwhelmed the medical system and vaccinations were too late for many people. The U.S. economy ground to a halt, as frightened citizens shut themselves indoors.

Dr. Stephen Cantrill, the head of Emergency Medicine in Denver, said: "Due to multiple pressures ... our hospitals have no 'surge' capacity. They could not adjust to a sudden increase in patient load without degenerating into chaos."

A germ warfare attack "would make our 1918 influenza epidemic, with a case-fatality rate of 2 percent and more than 67,000 deaths, truly look like a walk in the park," he added.

Sen. Arlen Specter, R-Pa., said at the time that he believed the risk of a smallpox attack is so great that he would immediately get his four grandchildren vaccinated.

Specter said he also believes the government shouldn't stockpile the vaccine but give citizens the right to decide themselves if they want to get the vaccination.

The last time that fears of a smallpox attack received widespread press coverage came in the run-up to war in Iraq, when the U.S. – fearing Saddam Hussein might arm terrorists with deadly germs before a U.S. attack – ordered 40 million doses of smallpox vaccine from a British company.

The following year, Israel – expressing those same fears – began vaccinating its citizens, starting with 1,500 health care workers.


Low Risk From Vaccination


There is no question about the need for immunization against smallpox if the virus is to be used as a biological weapon, according to Mihelic. The question is: Should we wait for an outbreak before beginning vaccinations, or should we institute a voluntary vaccination program before a potential outbreak?

Mihelic argues for the latter course. He notes that there is a relatively low risk to the controlled vaccination of the U.S. population before an outbreak – in 1968, the last year of universal vaccination here, 14.2 million people were vaccinated and only nine deaths were attributed to vaccination-related complications. Also, recent medical advances have made complications more unlikely and easier to treat.

Vaccination before an outbreak would be far preferable to the "confusion of a panicked rapid mass vaccination" following an attack.

As Mihelic puts it, "Any potential complications of smallpox vaccination would be much better handled in the calm situation of controlled vaccination over an extended period, rather than within the crisis of a bioterror attack."

Mihelic concludes: "I believe that medical, geopolitical, and psychosocial factors determine that fewer disease casualties and vaccine complications would occur with preemptive vaccinations than with mass vaccination after an outbreak, and that reliance on the 'ring' vaccination concept alone is almost certain to fail."


Editor's note:
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