- NEW YORK (Reuters
Health) - The Centers for Disease Control and Prevention (CDC) on Monday
released its plans to cope with smallpox if it is used as an agent of bioterrorism.
The plan does not call for mass vaccination in advance of an outbreak,
because the risks associated with vaccination are deemed to outweigh the
risks of exposure to the variola virus, which is used in the vaccine.
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- "Although smallpox was eradicated 21 years ago,
we've had such a plan in draft for many years," Dr. Lisa Rotz, an
Atlanta-based CDC bioterrorism preparedness expert said during a teleconference.
The plan was developed in conjunction with state epidemiologists, bioterrorism
coordinators, immunization program managers, and other health officials.
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- In recent years, the CDC and the public health service
have expended considerable effort to expand connectivity nationwide for
rapid communications, Rotz told Reuters Health.
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- "With our HealthAlert network, we are in much better
shape than we were several years ago to handle a bioterrorism attack,"
she said.
-
- "We're releasing this interim plan so that state
and local health departments can begin to think about state- and community-wide
responses" in the event of an outbreak, Rotz added. For example, "planners
can think about increasing their rapid response capability, identify personnel
who would go immediately to help implement the guidelines, identify contacts
of the cases and who would need vaccinations, as well as enhancing surveillance.
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- "At the heart of this plan is 'ring vaccination,'
or search and containment," she continued. "The idea is to identify
individuals infected with smallpox and identify those who have been in
contact with the patient and vaccinate those in outward rings of contact.
This strategy will produce a buffer of immune individuals."
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- The guidelines note that current supplies of smallpox
vaccine are limited, but vaccine would be available "within hours"
of a case being detected anywhere in the country, Rotz said.
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- Dr. D. A. Henderson, director of the Office of Public
Health Preparedness at the Department of Health and Human Services in Washington,
DC, mentioned reassuring results from recent studies regarding methods
to stretch supplies of the current vaccines.
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- "We've been getting some early reports from dilution
studies, including from one site where they have vaccinated 77 individuals
with diluted vaccine. Each person had a 'take,' so it looks encouraging
for a 1-to- 5, perhaps even a 1-to-10 dilution," he said.
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- Dr. Harold Margolis, CDC senior advisor for smallpox
preparedness, pointed out that the vaccines have been used periodically
over the years for laboratory workers. "The manufacturers have continued
to conduct a battery of tests looking at potential microbial contamination
and potency. All the vaccines have maintained their potency for over 20
years," he said.
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- Henderson wants to allay public fears regarding the potential
consequences of a bioterrorism attack with the variola virus. "People
are afraid that someone who is infected could spread the infection widely
by traveling on an airplane."
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- That's not realistic, he pointed out, because there is
an incubation period of 10 to 12 days, followed by 2 to 3 days of high
fever and prostration with severe headache and backache. "It's only
after that point, when the rash begins, that the individual can transmit
the disease. However, people are likely to feel quite poorly and to be
staying in bed, not traveling around the country."
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- In the guidelines, the CDC notes that the overall mortality
rate associated with smallpox is approximately 30%. Two rare forms of the
infection have a nearly 100% mortality rate, however: flat-type smallpox,
which is characterized by severe toxemia and confluent lesions, and hemorrhagic-type
smallpox.
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- http://news.excite.com/news/r/011126/17/health-smallpox
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