- The Washington Times - Tuesday, September 24, 2002

Federal officials sent states detailed guidelines yesterday for rapidly vaccinating their entire populations against smallpox should the deadly disease return through an act of terrorism.
Decades have passed since smallpox was last seen in this country and the disease was eradicated from Earth, so officials would assume that a single case of smallpox means the nation is under attack.
They would immediately vaccinate those who had contact with the highly infectious patient in hopes of stemming the spread of the disease.
Authorities then would assess the scope of the attack including the number of patients, circumstances of exposure and details of their disease to determine how many others need protection, officials said yesterday. Routine immunizations in the United States ended in 1971.
Even a single patient could trigger vaccinations across the entire country, they said.
"Once there is a case of smallpox, what has been theoretical up until now suddenly becomes real. We would anticipate many Americans would want to have access to the vaccine," Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said in an interview.
At the same time, a single case suggests there will probably be other cases, increasing the risk and suggesting the need for "a fairly widespread control program," said Dr. Walter Orenstein, director of the CDC's National Immunization Program.
The plan sent yesterday offers specific suggestions for a community that must vaccinate 1 million people in 10 days, but officials said the timing and the 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. But he added, "We've got to develop the plans right now."
Just last month, Dr. D.A. Henderson, a top bioterrorism adviser to the federal government, said many communities are woefully unprepared for the task. Dr. Gerberding agreed. "In most jurisdictions, there's a ways to go," she said yesterday.
The 48 pages of guidelines are meant to help states confront a host of logistical problems. 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 mass vaccination planning is meant as a supplement to the "ring vaccination" plans that have been circulating since last year. If a smallpox patient were discovered, authorities would first deliver shots to those closest to the contagious patient.
They would then work away from the central smallpox patient, vaccinating people the patient may have exposed and then others whom those people may have exposed.
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.

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