U.S. to expand smallpox vaccinations

About a half-million health care, emergency workers to be inoculated


The federal government will soon vaccinate about a half-million health care and emergency workers against smallpox as a precaution against a bioterrorist attack, federal officials said. The government is also laying the groundwork to carry out mass vaccinations of the public - a policy abandoned 30 years ago - in the event of a large outbreak.

Until last month, officials had said they would soon vaccinate a few thousand health workers and would respond to any smallpox attack with limited vaccinations of the public. Since 1983, only 11,000 Americans who work with the virus and its related diseases have received vaccinations, according to the Centers for Disease Control and Prevention.

The plan to increase the number of "first responders" who receive the vaccinations to roughly 500,000 from 15,000 and to prepare for a mass undertaking of vaccinations in effect acknowledges that the government's existing program is insufficient to fight a large outbreak.

The new vaccination safeguards come amid continued talk in Washington of war against Iraq, which terrorism experts suspect of maintaining stocks of the virus, as well as growing criticism of the government's limited plan. Only Russia and the United States have declared stocks of the virus.

A highly contagious disease, smallpox was declared eradicated globally in 1980, eight years after the United States stopped routine vaccinations.

Until its eradication, smallpox killed about one in three infected people who were not vaccinated. Because immunity is believed to diminish with time, most people alive today are considered vulnerable to smallpox. But federal officials have long resisted the resumption of mass smallpox vaccinations, noting the risk of serious side effects, even death, in a small number of cases.

Last month, a federal advisory panel backed a plan for "ring vaccinations," in which health workers would isolate infected patients and vaccinate people in close contact with them, forming a ring of immunization around an outbreak and a barrier to its spread. In theory, such a strategy can work because the vaccine, if given within four days of exposure to the virus, protects people from the disease.

Less vaccine required

Some experts on infectious diseases said the plan's main virtue was that it required little smallpox vaccine.

The government's more aggressive plans are possible because vaccine supplies are rapidly increasing as a result of crash manufacturing and stockpiling efforts begun soon after last fall's terrorist strikes, officials said. Also, studies have found that existing vaccine doses can be diluted without loss of effectiveness.

"Now we can act differently because we have more vaccine," Dr. Donald A. Henderson, senior science adviser to Tommy G. Thompson, the secretary of health and human services, said in an interview. Henderson, who led the global smallpox eradication effort, added that in a crisis "we can make vaccine available on request throughout the community."

Officials said that about 100 million doses of the smallpox vaccine (160 million if diluted) are in hand and that by late this year or soon thereafter enough will be available for every American, more than 280 million people.

Health and military experts, noting new models of how the contagion can spread and new disclosures about how the weaponized virus can sail on the wind, have recently argued that thousands if not millions of needless infections and deaths could result if only limited, local vaccinations were carried out. Most critics of the ring vaccination plan advocate mass vaccinations of the U.S. population - but before a smallpox attack, not after, as the government is now planning.

In addition to vaccinating more "first responders," the government plans to develop ways to speed vaccine deliveries around the country and help states plan how to carry out mass vaccinations after an attack.

Officials said the vaccinations of hospital workers and smallpox response teams, to begin fairly soon, would help train health professionals in smallpox vaccination and educate the public to the attendant risks.

Jerome M. Hauer, acting assistant secretary for emergency preparedness at the Department of Health and Human Services, said the agency hoped to send outlines for mass vaccinations to cities and states in the next week or two. Hauer said that the logistics were being handled by the CDC, which oversees the production, safekeeping and distribution of the nation's stockpile of smallpox vaccine.

Other details of the plans, such as who would receive peacetime vaccinations, have yet to be approved by Thompson, officials said.

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