When President Bush announced a plan in December to vaccinate volunteer state and local smallpox response teams, the Michigan Dept. of Community Health realized there were some key questions to answer before they could administer the vaccine.
"If a person had side effects or injuries as a result of the vaccine, what would the health coverage be for that person? Or if a person who was inoculated got a family member sick, what's the compensation for that?" asked Geralyn Lasher, MI Dept. of Community Health.
While the Department of Community Health waits for answers on the workers compensation issue, regional smallpox teams are planning what to do in the event of a smallpox outbreak. And with the possibility of war with Iraq, team members are anxiously waiting.
"We've been frustrated that they haven't resolved those issues yet. We'd be less than honest to say we'd hoped they'd resolve those some time ago," said Dr. Don Edwards, Region 1 Smallpox Team.
"We continue to plan for how to deal with patients, proper isolation, other protection for healthcare workers, and way to educate the public in the event of a bioterrorism attack," said Jon Baker, Ingham Regional Medical Center.
Neither the Regional Smallpox Team nor the Dept. of Community Health have an idea when they'll begin vaccinating, but the federal government has given Connecticut the thumbs up, and hopes Michigan can start in the next two weeks.
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Smallpox Vaccination Q & A
Q: What is smallpox? Why is it so worrisome?
A: Smallpox is a highly contagious virus that is spread from person to person, historically killing 30 percent of its victims. People can prevent infection if they are vaccinated within four days of exposure, before symptoms even appear; afterward, it is too late, and there is no known treatment. The last case of smallpox in the United States was in 1949. Routine vaccinations ended in 1972. That means that some 45 percent of the public is totally unprotected. People vaccinated decades ago may have some residual protection; health officials are not sure.
Q: Who will be offered the vaccine?
A: First, about a half million military troops. For civilians, those people most likely to encounter a highly contagious smallpox patient. That includes workers in hospital emergency rooms and people on special response teams who would investigate suspicious smallpox cases. About a half million civilians are expected to be offered the vaccine during this first stage.
In a second stage, vaccinations would be offered to all other health care workers plus emergency responders such as police, fire and emergency medical technicians. That is likely to total roughly 10 million people. Eventually, after enough vaccine is licensed by the Food and Drug Administration, the vaccine will be made available to all Americans.
Q: Is it mandatory?
A: For the military, yes. For civilians, no. Even in the middle of a smallpox attack, there are no provisions to force civilians to be vaccinated. People exposed to the disease who refuse to be vaccinated could be quarantined.
Q: Wasn't smallpox wiped out?
A: In 1980, the disease was declared eradicated worldwide. All samples of the virus were to have been destroyed except those held by special labs in Atlanta and Moscow. Experts fear some of the Russian sample could have escaped to hostile nations.
Q: Does Iraq have the virus?
A: U.S. intelligence officials believe Iraq has a small amount of smallpox left over from the last outbreak in the 1970s. U.N. inspectors have not singled out smallpox as a threat.
Q: Why not just vaccinate everyone right now?
A: The vaccine itself, made with a live virus called vaccinia, carries rare but serious risks. Based on studies from the 1960s, experts estimate that 15 out of every million people vaccinated for the first time will face life-threatening complications, and one or two will die. Reactions are less common for those revaccinated.
For the approximately 130 million Americans never vaccinated, experts would expect nearly 2,000 to face life-threatening complications and 125 to 250 of them to die. For about 158 million people being revaccinated, experts expect nearly 800 life-threatening complications and about 40 deaths.
Q: What sort of reactions and complications?
A: Typical reactions include sore arms, fever and swollen glands. In an experimental trial under way in Nashville, Tenn., about 10 percent of people experienced extreme discomfort, with fatigue, fever, loss of appetite and other flu-like symptoms that lasted a day or two.
The most common serious reaction comes when vaccinia escapes from the inoculation site, often because people touch the site and then touch themselves or someone else. The virus transferred to the eye can cause blindness.
More deadly is encephalitis, which can cause paralysis or permanent neurological damage. Also fatal though very rare: progressive vaccinia, where the vaccination site does not heal and the virus spreads, eating away at flesh, bone and gut.
Q: Who is at greatest risk of complications?
A: People with weak immune systems — those with HIV, cancer and transplanted organs — face much greater risk, as do pregnant women. People with eczema risk a serious, permanent rash.
Q: How do these side effects compare with other vaccines?
A: Smallpox vaccine is more dangerous than any other.
By comparison, the measles-mumps-rubella shot can cause reactions including anaphylaxis, marked by swelling inside the mouth and difficulty breathing. But just 11 cases of anaphylaxis have been reported since 1990, out of more than 30 million vaccinations, and no one has died.
Q: If the vaccine is effective four days after exposure, why not just vaccinate after an attack?
A: Delivering mass vaccinations within days is incredibly complicated, and an attack would be much less deadly if there is more vaccination now. Planning is also under way for post-attack vaccinations.
Source: The Associated Press contributed to this report.