There is a small but real chance that smallpox could be spread by contact if officials decide to carry out widespread inoculations to counter the threat of a biological attack, experts said on Tuesday. Federal health officials have gone so far as to hire a psychiatrist trained in mass panic, and are sending doctors detailed guides about smallpox vaccine as they prepare to handle future bioterrorist threats.
The head of the Centers for Disease Control and Prevention has said the United States has enough vaccine for every American.
“The available data from the 1950s and 1960s show that there is a risk of ... transfer from a primary vaccine to an unimmunized individual in contact with the vaccinee, but the risk is not large,” the experts said in a commentary published in this week’s Journal of the American Medical Association. The overall contact transmission rate was in the range of two to six for every 100,000 primary vaccinations, and in all of the studies this required close contact, rarely happening outside the home, the report said.
Health officials are weighing a possible mass inoculation program following last year’s attacks on New York City and Washington, D.C. The guide for doctors, which includes graphic photographs of people who have had reactions to the vaccine and explains how to treat them, comes as the Bush administration makes final decisions about how soon to offer the smallpox vaccine to the public.
VACCINATIONS FOR HEALTH WORKERS?
The head of the federal Centers for Disease Control and Prevention has said the United States has enough smallpox vaccine for every American now, but officials are still weighing whether to vaccinate everyone just in case of a biological attack.
A contingency plan under consideration by the CDC calls for the vaccination of some 10 million U.S. health care workers, police and emergency technicians. Britain is planning a similar plan to vaccinate key health care workers as a first line of defense. Vaccinations ceased after smallpox was eradicated from the world’s population in 1979, but bioterrorism experts have said for years the United States is vulnerable to a biological attack using the disease.
“THE WORRIED WELL”
Serious adverse reactions are more common with smallpox vaccinations than with any other kind, according to the JAMA commentary. Jerry Hauer, assistant secretary for public health preparedness at the federal Department of Health and Human Services, said he was in the final stages of hiring a psychiatrist who will specialize in communication and mass panic. “The ‘worried well’ can bring the health care system to its knees,” he said.
Hauer said his department is also preparing for a massive campaign to educate doctors and the public about smallpox, a highly contagious disease not seen in this country for half a century. The JAMA essay primarily addressed the contact-spread issue and not the risks to those being vaccinated, but it said serious adverse reactions are more common with smallpox vaccinations than with any other kind.
ECZEMA COULD CAUSE ADVERSE REACTION
It also said there are more people with eczema and other skin conditions and compromised immune systems than there were in the 1960s who may be more susceptible to adverse reactions from contact. Skin problems can cause a smallpox rash to spread.
“An orderly, systematic approach along with careful screening to identify potential ... susceptible individuals and household contacts and close monitoring for adverse effects are essential to reduce the risk of transmission ... following smallpox vaccination,” the report concluded.
The JAMA commentary was written by John Neff of the University of Washington School of Medicine, Seattle; J. Michael Lane, formerly of the Smallpox Eradication Program at the CDC, Atlanta; Vincent Fulginiti of the University of Arizona School of Medicine, Tucson; and Donald Henderson of Johns Hopkins University Center for Civilian Biodefense Strategies, Baltimore.