Thread: Medical Journal: Smallpox Threat Real, Vaccinate Now

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:
Is America safe from a biological or radiological attack? Get the INSIDE story – Click Here Now.
Find the secrets to long life from the Mayo Clinic – Click Here



Read more on this subject in related Hot Topics:


Health Issues


War on Terrorism






102-102-102-111-104

Think I'll skip it



http://healthlink.mcw.edu/content/print ... 1031002205


Smallpox Vaccine Includes a Dose of Risk
ORIGINAL URL: http://healthlink.mcw.edu/article/1031002205.html

Even though the last case of smallpox in the world occurred in 1978, the disease still haunts us through the threat of its use as a weapon of terror. Responding to the possibility that smallpox could be used as a weapon, the federal government has prepared an ambitious vaccination plan that starts with military personnel and hospital first-response teams.

The US and Russia retained small quantities of the virus after smallpox was declared eradicated in 1980. Many now believe that virus samples may have fallen into the hands of other governments, or terrorist groups, who could attempt to reintroduce the disease during military engagements or by exposing civilian populations.

In December of 2002 the federal government announced a plan to provide smallpox vaccinations for first-response teams in hospitals. Vaccinations of tens of thousands of military personnel have already begun, and further planning is underway to vaccinate the entire population of the United States should an outbreak occur.

But the smallpox vaccine itself can cause serious medical complications and even death in rare cases, which is why vaccination planning is proceeding with great caution. Michael J. Chusid, MD, Medical College of Wisconsin Professor and Vice Chair, Department of Pediatrics, and Chief of the Division of Infectious Diseases, discusses some of the ramifications of smallpox vaccination.

Dr. Chusid served as medical consultant to Children’s Hospital of Wisconsin and set up the hospital’s response to the federal vaccination plan. Dr. Chusid said that Children’s, Froedtert Hospital, and nearly every other hospital in Wisconsin volunteered to participate in the plan, which in turn asks for voluntary participation by health care practitioners.

Serious Consequences Demand Serious Consideration
“We have attempted to be very neutral in terms of recommendations regarding whether individuals should or should not receive the vaccine, because it’s a totally voluntary program,” said Dr. Chusid. “Now, as far as we know, there is no smallpox in the world. So, if you’re looking at risk versus benefit ratios, as long as there’s no case of smallpox the risk of the vaccine far outweighs any benefit. As soon as there’s a single case, then everything shifts because smallpox is a very serious and devastating disease.”

Smallpox is caused by the variola virus, which is spread from person to person through close contact. The disease can cause a severe rash that can leave scars when healed, high fever, tiredness, severe headaches and backache, blindness and death. According to the US Centers for Disease Control and Prevention (CDC), up to 30% of those infected with smallpox will die.

Smallpox vaccine is made from the vaccinia virus, which is similar to the smallpox virus but less harmful. According to the CDC, “Getting the vaccine before exposure will protect most people from smallpox. Getting the vaccine within three days after exposure can prevent the disease or at least make it less severe. Getting the vaccine within a week after exposure can still make the disease less severe. Complete protection from infection lasts 3 to 5 years, and protection from severe illness and death can last 10 years or more.”

Because the vaccine works even if given after exposure to smallpox, the federal government is recommending advance inoculation only for military personnel who might be put in harm’s way, and for a few first-response hospital personnel who may be called on to treat smallpox victims after an “event” such as a terrorist attack.

“Most people (in the public) will be in the same boat as the great majority of health care people – that is the post-attack boat – and you have three to four days to get the vaccine after being exposed,” said Dr. Chusid. “The vaccine beats the wild infection to the punch, so if you know you’ve been exposed you have several days in order to get the vaccination.”

Powerful Vaccine Can Cause Severe Complications
The CDC includes the following in its list of the risks that can accompany smallpox vaccination:


Mild rash, lasting 2-4 days.
Swelling and tenderness of lymph nodes, lasting 2-4 weeks after blister has healed (the vaccine almost always results in a blister).
Fever of over 100 degrees in about 70% of children and 17% of adults.
Secondary blisters elsewhere on the body (about 1 per 1,900 inoculations).
Serious eye infection or loss of vision due to spread of vaccine virus to the eye.
Rash on entire body (as many as 1 per 4,000).
Severe rash on people with eczema (as many as 1 per 26,000).
Encephalitis (a severe brain reaction), which can lead to permanent brain damage (as many as 1 per 83,000)
Severe infection beginning at the vaccination site (as many as 1 per 667,000)
Death (1-2 per million, mostly in people with weakened immune systems).
For every million people vaccinated, according to the CDC, between 14 and 52 could have a life-threatening reaction to smallpox vaccine. “Shedding,” the process of passing along reactions to the vaccine to people who have not received the vaccine themselves, can spread the risk. CDC cautions that people who come in direct contact with the vaccination site (usually the arm), or with materials that have touched the site, can have reactions as listed above from exposure to the vaccine virus.

As the government assesses evidence as to the possible possession of smallpox virus by those who would use it as a weapon, there is general agreement that it would be difficult, but not impossible, to spread the virus in quantities sufficient to expose masses of people.

One scenario has terrorists giving themselves smallpox and then entering the US to spread the disease through direct contact. Dr. Chusid noted, however, that the disease carriers would be obviously ill – “on death’s doorstep,” as he put it – during the period in which they could spread the disease, and thus would be fairly easy to spot. Another scenario involves the use of smallpox virus in a liquefied aerosol form to be spread through the ventilation system at a major airport, for example, so that the disease would appear in a variety of locations around the country.

According to the CDC National Immunization Program, there is enough smallpox vaccine in storage to inoculate the entire US population. The stock of vaccine is now stored in Atlanta, Dr. Chusid said, and a widespread public vaccination system could include distributing the vaccine to regional locations or major population centers.

Careful Screening of Vaccination Candidates
There is no immediate recommendation from any government agency to provide the vaccine to the general public. “We have received calls from people who want to be vaccinated,” Dr. Chusid said, “but the vaccine is not available. We don’t have any.” Dr. Chusid said that while a plan for nationwide vaccination is being formulated, implementation could be at least a year away and it is quite possible that general smallpox vaccination will never reappear as part of the American scene.

For now, the inoculation of troops and a small number of health care practitioners will provide new information about the impact of what is a very old vaccine. And new drugs may prove effective against smallpox or at least minimize the dangers inherent in using the current vaccine.

“If you thought there was a credible threat, then everyone should be inoculated,” said Dr. Chusid. “You bite the bullet and take whatever losses you have. Otherwise, why take any risk at all (in the general population) when you can do it after the first case shows up and inoculate everyone in the United States over a three or four day period?”

“There are potential problems with family members of inoculated individuals who get the virus and get some of the complications. The vaccination site, which is really a pustule, continues to shed live virus up to three to four weeks after you receive the vaccination,” said Dr. Chusid. “Say you have someone in your family who has eczema, or a young baby gets it in their eye, then they can get all the complications that we were worried about in the vaccinated person.

“We’re being very careful about the people that we’re vaccinating in this program. They have to have been pre-vaccinated before so they’re unlikely to have a reaction, they can’t have eczema, they can’t have immune-compromised conditions, and so forth. Additionally, no one in their families can have any of these conditions. So we’re looking very carefully at that group.”

Dan Ullrich
HealthLink Contributing Writer

[/quote]