- The Washington Times - Wednesday, January 29, 2003

The Virginia Department of Health in Richmond received 10,000 doses of smallpox vaccine from the U.S. Centers for Disease Control and Prevention yesterday to administer to those public health care workers likely to respond to a bioterrorist attack.
The vaccine is not recommended for the general public without a known threat of smallpox, State Health Commissioner Robert B. Stroube said when the vaccine order was submitted to the CDC on Jan. 24.
Protecting health care workers who would be called upon in case there is an outbreak strengthens "our ability to respond to a smallpox outbreak and protect the health of the public," he said.
The doses will be administered to state health care providers who make up the response teams that would administer mass vaccinations in the event of a terrorist attack using the virus.
Dr. Lisa Kaplowitz, deputy commissioner for Emergency Preparedness and Response, said the vaccine would be provided to designated volunteer health care providers as part of the state's emergency-preparedness efforts.
She said the department would distribute the vaccine to local health districts once they "are ready to begin vaccination."
In Fairfax County, the most populous county in the state, officials said they could begin vaccinating emergency workers as early as next week. They said they are nearing completion of a "worst-case scenario" plan involving inoculation of the county's nearly 1 million people within five days of a major outbreak.
The county plan envisages deploying 100 public health care response teams to vaccinate 10,000 people each. Each team would have nine nurses to administer the vaccine, four physicians, two physician assistants, 13 additional nurses and a number of volunteers.
"I wouldn't say we'll be ready tomorrow, but we're really close," said Fairfax County spokeswoman Kathy Simmons.
Miss Simmons said the first confirmed case of smallpox would set the county plan in motion because there have been no cases of naturally acquired smallpox in the world since 1977.
"This disease has been eliminated," she said. "We know that if there is a case anywhere in the country that something is going on."
Miss Simmons said the response to a confirmed report of the highly contagious disease could be small scale, based on the "ring vaccination" theory often used by health department investigators in tuberculosis cases. In this approach, the infected person would be given the vaccine, followed by those he or she came in contact with, and then those they contacted.
"If we have an isolated occurrence, that's where we'll start," Miss Simmons said.
In a worst-case scenario, public schools would be closed while response teams and a pool of 8,000 volunteers drawn largely from school-system employees would begin administering about 1 million vaccinations from the county's 24 high schools.
The Health Department said it would hold seminars at county schools Thursday and Friday to recruit volunteers from the school system to act as nonmedical support staff.
Paul Regnier, a county schools spokesman, said school principals have been instructed to ask their staffs for volunteers.
Dr. Gloria Addo-Ayensu, county assistant health director, says she expects, based on staffing estimates, that the county's population could be vaccinated in three days. But she left open a time window in the event of glitches.
She said the decision to initiate a mass vaccination would be "scenario-driven."
"It really depends on the scenario," Dr. Addo-Ayensu said. "The whole point of a mass-vaccination strategy is to mitigate transmissions, to stop it in its tracks. If the release is such that it's just one case here, one case there, the ring vaccination strategy might be appropriate."
But she said that if there were a confirmed release in a crowded place where 10,000 people were exposed to the virus, the ring strategy would be impractical.
"There's going to be a threshold where it's not going to work," she said.
Miss Simmons added that the task of creating a plan to prevent everyone in the county from showing up at local high schools on the first day of vaccinations has yet to be completed, but suggested appointments through telephone calls or based on alphabetical order.
Other agencies, such as transportation and emergency management, would coordinate access and security at the schools.
State Health Department spokeswoman Trina Lee said the federal government has promised to deliver doses for the general population from the National Pharmaceutical Stockpile within 12 to 18 hours of an outbreak.
Routine smallpox vaccination among the U.S. public stopped in 1972 after the disease was eradicated in the country.
Smallpox is caused by a virus called variola. According to the CDC, the disease is most often spread by close contact with the respiratory discharges of a person who has the disease or contact with objects contaminated by a "carrier."
Vaccination within three days of exposure would prevent or significantly lessen the severity of smallpox symptoms in the vast majority of people, CDC says. Vaccination four to seven days after exposure would offer some protection from the disease or modify its severity.
Health officials stress that the vaccine does not contain the smallpox virus and cannot give a person the disease. The CDC said that when the vaccine was being routinely administered, as many as 1,000 people in a million experienced serious reactions, and 14 to 52 in a million had life-threatening reactions. One or two in a million died.

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