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CDC Gears Up for Smallpox Outbreak

Sets up teams to fight potential new attack of old scourge

THURSDAY, Nov. 8, 2001 (HealthDayNews) -- In case smallpox becomes the next weapon to emerge from the bioterrorists' arsenal, the Centers for Disease Control and Prevention (CDC) is gearing up for action.

"We're taking steps to protect the public's health in case of an intentional release of smallpox," says CDC spokeswoman Mary Kay Sones. The full CDC guidelines are still in draft form, but there are already signs of what the final version will contain.

Part of the plan involves setting up teams of physicians, epidemiologists and laboratory workers who have already been vaccinated against the virus. These teams are attending training sessions at the CDC to learn how to identify and contain smallpox outbreaks, and they will be dispatched around the country to help local and state health departments should an outbreak of the virus occur.

The plan will also include vaccination guidelines (who should be inoculated and who shouldn't), as well as protocols for tracking confirmed and suspected cases and investigating where the virus might have come from.

The potential for a smallpox outbreak is of great concern to health officials for several reasons.

"Overall, smallpox is more dangerous from a public health point of view than anthrax, because smallpox is contagious and anthrax is usually not," says Dr. Tareg Bey, associate clinical professor at the University of California, Irvine Medical Center in Orange, Calif., and one of about 200 board-certified medical toxicologists in the country.

The smallpox virus has no proven treatment (unlike anthrax) and spreads easily and quickly from person to person via saliva and even contaminated clothing or bedding. It can also be invisible.

"Smallpox is an insidious disease because you can spread it without knowing you have it," says Thomas J. Reilly, assistant professor of biology at Ball State University in Muncie, Ind. The disease can take up to two weeks to manifest.

Thanks largely to the vaccine, smallpox was eradicated in 1977 but stores of the virus are known to exist in two laboratories in the United States and Russia. Fortunately, stores of the vaccine also exist, and this will be critical in the effort to contain any future epidemics. Vaccinations not only can prevent infection, but also can lessen the severity of the illness, if an infected person gets the shot within four days after exposure.

Existing supplies of the vaccine in the United States are in short supply. According to the Center for Civilian Biodefense Studies at Johns Hopkins University in Baltimore, the CDC has in storage only about 140,000 vials of vaccine, each of which would inoculate 50 to 60 people. That would be enough, at maximum, for almost 8.5 million people. However, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last month that the government has 15 million doses of smallpox vaccine in its reserve. An additional 50 million to 100 million doses are estimated to exist worldwide.

The fact that the virus has been out of circulation for more than 20 years creates additional problems. Millions of people have not been vaccinated at all, and it's not clear how effective the vaccines still are in those who were inoculated decades ago. Also, doctors will probably have a difficult time recognizing the disease because most of them have never seen it before.

The government is investigating whether it can stretch the existing supply of vaccine by diluting it. Volunteers are swarming to participate in a National Institutes of Health-funded study currently under way at four sites around the country. Test subjects will be given full, one-fifth and one-tenth dilutions of the vaccine. A similar study last year showed that 70 percent of subjects inoculated with the one-fifth dilution were effectively immunized against the disease, compared with 95 percent for the full vaccine and a mere fraction for the one-tenth formula.

Anyone unlucky enough to contract smallpox has to be isolated upon being diagnosed or displaying such symptoms as a high fever, fatigue and aches, which progress to a rash and pus-filled lesions. The fatality rate for smallpox is about 30 percent.

What To Do

For more information on what the government is doing to protect its citizens, visit the Centers for Disease Control and Prevention.

For in-depth information on biological weapons and the threat they pose, visit the Center for Civilian Biodefense Studies at Johns Hopkins University.

SOURCES: Interviews with Mary Kay Sones, spokeswoman, Centers for Disease Control and Prevention, Atlanta; Tareg Bey, M.D., associate clinical professor, University of California, Irvine Medical Center, Orange, Calif.; Thomas J. Reilly, Ph.D., assistant professor of biology, Ball State University, Muncie, Ind.; CDC press release
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