Doctors: Rethink smallpox shot plan

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Ken S.

Friday, March 29, 2002 9:04 AM

Doctors: Rethink smallpox shot plan

 

 

Doctors: Rethink smallpox shot plan

Don't wait for bioterror attack, some argue

By M.A.J. McKENNA, Atlanta Journal-Constitution Staff Writer

3/29/02

- http://www.accessatlanta.com/ajc/news/0302/0329smallpox.html -

 

Some prominent health officials are urging re-examination of a federal policy

that smallpox vaccinations be reserved for use after a bioterrorist attack.

 

In articles published electronically Thursday by The New England Journal of

Medicine, one public health expert recommends beginning voluntary vaccinations.

Two others -- including the government's top bioterrorism researcher -- advocate

additional debate on the current policy.

 

The articles were scheduled to be published in the weekly journal April 25 but

were placed on the Web a month early because of their timeliness, the journal

said.

 

" An open and public dialogue on the advantages and disadvantages of universal

voluntary vaccination . . . should be initiated before any attack occurs, " Dr.

Anthony Fauci said in one of the articles.

 

Fauci is director of the National Institute of Allergy and Infectious Diseases,

the division of the National Institutes of Health that is preparing to conduct

$1.5 billion of research into bioterrorism.

 

Dr. Jeffrey Drazen, the journal's editor, said in an accompanying article: " I

strongly agree. "

 

Smallpox was eradicated worldwide in 1979. The virus is known to exist in only

two places: a lab at the Centers for Disease Control and Prevention in Atlanta,

and one in Russia. But fears persist that rogue groups or states may have

obtained the virus as well.

 

If the highly infectious disease were used as a weapon, much of the population

would be vulnerable: Vaccination against smallpox ceased in the United States in

1972 and in the rest of the world by 1980.

 

After eradication, the U.S. government retained 15.4 million doses of the

vaccine. Federal policy -- carved out by a panel called the Advisory Committee

on Immunization Practices and written into the CDC's bioterror plans -- calls

for restarting vaccination only after a case of smallpox is discovered.

 

The plans call for " ring vaccination, " a strategy used in the eradication

campaign that when sketched out looks like the rings around a bull's-eye. At the

center are the people exposed to the virus who can be vaccinated because the

shot prevents the disease from developing if given within a few days. The second

ring of shots protects family members, health care workers and others in close

contact with the first group. The third ring takes in the contacts of the

previous ring.

 

Inside and outside the CDC, though, experts have questioned whether public alarm

over a smallpox attack would short-circuit smooth execution of that strategy.

 

That challenge is voiced by one of the journal articles, written by Dr. William

J. Bicknell of Boston University, the former health commissioner of

Massachusetts.

 

" Post-exposure containment of a terrorist-induced smallpox outbreak is unlikely

to be successful, " he said. " Widespread, voluntary vaccination before exposure

will greatly reduce the number of victims, if an attack occurs. "

 

Federal authorities are willing to reconsider smallpox vaccination planning, the

CDC said Thursday evening. Two working groups who advise the CDC and the

assistant secretary for health will meet in Atlanta on May 8 and 9, said Dr.

Harold Margolis, head of the CDC's smallpox preparedness program. If they agree

the policy needs re-examination, they will take it before the immunization

advisory committee at its quarterly meeting in June.

 

" The groups are going to address the kinds of issues brought up in the

editorials, " he said Thursday.

 

" We're putting the forum out there to see if there are other data to suggest we

need to have changes. "

 

The government supports the ring concept because, by limiting the amount of

vaccine distributed, the strategy solves two problems: side effects and short

supplies. The vaccine can cause severe reactions not only in those who get it,

but in adults and especially children in close proximity to recipients. Experts

fear the vaccine also could threaten people such as AIDS patients and transplant

recipients, who are living with fragile immune systems; there were few such

people in the population when vaccinations ceased.

 

Conducting a controlled campaign before panic sets in would allow careful public

education about the shot's serious side effects, Bicknell said. He calculates

that deaths from side effects might reach 180 nationwide -- " approximately the

number of deaths from traffic accidents every 1.5 days, " he wrote.

 

The second problem of vaccine scarcity may have been solved, NIH-funded

researchers said Thursday. In the same journal issue, they report that the

vaccine can be diluted at least five times and still provide protection. That

means the stockpile could protect 77 million people.

 

If an additional 70 million doses recently discovered by its manufacturer are

bought by the government and diluted, there would be more than enough vaccine on

the shelf to inoculate the entire U.S. population -- even before the delivery of

an additional 155 million doses ordered by the Department of Health and Human

Services to be manufactured by next year.

 

" We hope our smallpox vaccine stockpile will serve as a deterrent to those who

may consider using smallpox as a weapon, " HHS Secretary Tommy Thompson said in a

briefing Thursday on the dilution research.

 

" We will have the necessary medicine to save and protect every American should

there be an outbreak. "