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By Joel Washburn
washburn@mckenziebanner.com |
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Vaccinating 38,000 people against smallpox in a 10-day
period is a daunting task. But that's what the Carroll
County Health Department is facing if cases of smallpox
are diagnosed anywhere in the United States. Local
health department officials and some 200 local
volunteers will be activated to vaccinate everyone in
Carroll and a portion of Benton County in the event of
an outbreak. The local vaccinations will be part of a
nationwide, simultaneous vaccination program.Smallpox has been eradicated from the United States
since 1949 and the world since 1977, when the last case
was diagnosed in Somalia. Vaccinations ended in 1972 for
citizens of the United States. However, the virus has
been retained in laboratories in the United States,
Russia, France, and suspected in Iraq and North Korea.
"If there is a case of smallpox, it is an act of
terrorism," said Dr. Pansy Davis, medical officer for
the health departments in Carroll, Benton, Henry, and
Henderson counties. "Everyone is susceptible to the
disease" regardless of a pre-1972 vaccination against
the disease. Dr. Davis spoke to a group of school, law
enforcement, and medical personnel at a meeting on
Thursday, December 5 at the Carroll County Office
Complex in Huntingdon.
"The Health Department is in the public eye as never
before," said Tim James, director of the Carroll, Henry,
and Benton health departments. He is responsible for
developing a pre-event or post-event plan of action in
case of an outbreak. The local plan calls for the health
department to conduct the mass vaccinations at
Huntingdon High School over a 10-day period. Volunteers
will be performing triage, patient evaluations and
patient education before the patient receives the
vaccination. Other volunteers will be directing traffic,
providing mass transportation, disposing of waste, and
feeding volunteers.
One pending issue is whether or not to vaccinate - in a
pre-event situation - some health care workers, military
personnel, and event volunteers. The White House is to
make that determination soon. Because of the possible
adverse side effects of the vaccine, these workers need
to be vaccinated (pre-event) to eliminate the
possibility of all volunteers simultaneously suffering
from possible side effects of the vaccine.
The vaccination will be given using a bifurcated
(two-pronged) needle that is dipped into the vaccine
solution. When removed, the needle retains a droplet of
the vaccine. The needle is used to prick the skin 15
times in a few seconds. The pricking is not deep, but it
will cause a sore spot and one or two droplets of blood
to form. The vaccine usually is given in the upper arm.
Mr. James said volunteers are desperately needed. The
Health Department will need volunteers with the
following skills and/or credentials: Physicians, Nurses,
Clerical/Secretarial, Data Entry/ medical records
personnel, Pharmacists/ Pharmacy Technicians,
Individuals for traffic control and parking, Individuals
for crowd control, Translators (multiple languages
including sign language), EMT skills, Information
Technology, Mental Health Professionals, Clergy,
Clinical professionals and/or students who are willing
to be trained and assist with immunizations, and general
volunteers to assist with directing patients,
registration, filling out forms, answering phones, etc.
All volunteers will receive a basic two (2) hour
orientation and training. Clinical volunteers will
receive additional training appropriate to their
assigned task.
For more information regarding volunteering, please
contact the County Health Department at 731-986-1990
(8:00 a.m. - 4:30 p.m. Monday - Friday).
Smallpox is a disease caused by variola virus, which was
feared for centuries because it caused serious illness,
disfiguration, and often death. After a successful
public health vaccination campaign, it was declared to
be eradicated from the world in 1980. Although naturally
occurring disease has been eliminated, serious concerns
about smallpox are rising again because of its possible
use as a bioterrorist weapon.
Smallpox is spread from one person to another by
infected respiratory droplets. Smallpox patients are
highly contagious during the first week of illness,
since that is the time when the largest amount of virus
is present in the throat. However, some risk of
transmission lasts until all scabs have fallen off.
Contaminated clothing and bed linens can also spread the
virus. After exposure to smallpox, it takes between 7
and 17 days for symptoms of smallpox to appear (average
incubation time is 12 to 14 days). During this time, the
infected person feels fine and is not contagious.
Initially, patients experience high fever, fatigue,
headache and backache. Severe abdominal pain and
delirium are sometimes present. A rash appears within
two or three days, first in the mouth and throat,
spreading to the face and forearms, and then to the
trunk and legs. Within five to seven days, the rash
develops into pus-filled lesions which later crust into
scabs. A person with smallpox is sometimes contagious
with onset of fever (prodrome phase), but the person
becomes most contagious with the onset of rash. The
infected person is contagious until the last smallpox
scab falls off. Vaccination within 3 days of exposure
will completely prevent or significantly modify smallpox
in the vast majority of persons. Vaccination 4 to 7 days
after exposure likely offers some protection from
disease or may modify the severity of disease. How long does a smallpox vaccination last? Past experience indicates that the first dose of the
vaccine offers protection from smallpox for 3 to 5
years, with decreasing immunity thereafter. If a person
is vaccinated again later, immunity lasts longer. How is smallpox treated?
There is no proven effective treatment for smallpox, but
research to evaluate new antiviral medications is
ongoing. Patients with smallpox can benefit from
supportive treatment such as intravenous fluids and
medicine to control fever or pain, as well as
antibiotics for any secondary bacterial infections that
occur. In the 1970s, smallpox was fatal in 30 percent of
cases.
Vaccine can lessen the severity of or even prevent
illness in people exposed to smallpox if given within
three to four days of exposure. The United States has an
emergency supply of smallpox vaccine.
Routine vaccination against smallpox ended in 1972. The
level of immunity, if any, among persons who were
vaccinated before 1972 is uncertain; therefore, those
persons are assumed to be susceptible.
Under current circumstances, with no confirmed smallpox
and the risk of an attack assessed as low, vaccination
of the general population is not recommended because the
potential benefits of vaccination do not outweigh the
risks of vaccine complications. Following a confirmed
outbreak of smallpox within the U.S., rapid voluntary
vaccination of a large population may be conducted as
part of an overall national vaccination strategy. The
decision to do mass vaccination will be dependent upon
an assessment of the magnitude of the attack, the
potential duration of the attack, and the mode of the
attack. How much smallpox vaccine is available? Currently, we have a stockpile of 85 million doses of
vaccine. A recent National Institute of Health study
found that the existing supply could be increased to
make enough for the entire population in the event of an
outbreak. A contract has been issued to produce an
additional 210 million doses this year. It is
anticipated that a total of 286 million doses of
smallpox vaccine will be available at the end of this
year. The CDC's National Pharmaceutical Stockpile has
developed protocols to allow for the rapid, simultaneous
delivery of smallpox vaccine to every state and US
territory within 12-24 hours. State and local
governments are developing response plans to provide for
the rapid distribution of vaccine on a large-scale
basis. Who is at highest risk for side effects from the
vaccine? People most likely to have side effects are people who
have, or even once had, skin conditions, (especially
eczema or atopic dermatitis) and people with weakened
immune systems, such as those who have received a
transplant, are HIV positive, or are receiving treatment
for cancer. Anyone who falls within these categories, or
lives with someone who falls into one of these
categories, should not get the smallpox vaccine unless
they are exposed to the disease. Pregnant women should
not get the vaccine because of the risk it poses to the
fetus. Anyone who is allergic to the vaccine or any of
its components should not get the vaccine. Vaccination
of persons less than 18 years of age is not recommended
in non-emergency circumstances. The smallpox vaccine helps the body develop immunity to
smallpox. The vaccine is made from a virus called
vaccinia which is a "pox"-type virus related to
smallpox. The smallpox vaccine contains the "live"
vaccinia virus-not dead virus like many other vaccines.
For that reason, the vaccination site must be cared for
carefully to prevent the virus from spreading. Also, the
vaccine can have side effects (see the section "Smallpox
Vaccine Safety" in this fact sheet). The vaccine does
not contain the smallpox virus and cannot give you
smallpox.
Currently, the United States has a big enough stockpile
of smallpox vaccine to vaccinate everyone who might need
it in the event of an emergency. Production of new
vaccine is underway. Length of Protection Smallpox vaccination provides full immunity for 3 to 5
years and decreasing immunity thereafter. If a person is
vaccinated again later, immunity lasts even longer.
Historically, the vaccine has been effective in
preventing smallpox infection in 95% of those
vaccinated. In addition, the vaccine was proven to
prevent or substantially lessen infection when given
within a few days of exposure. It is important to note,
however, that at the time when the smallpox vaccine was
used to eradicate the disease, testing was not as
advanced or precise as it is today, so there may still
be things to learn about the vaccine and its
effectiveness and length of protection. |
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