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Mass Vaccination Not Needed to Contain Smallpox Outbreak, Researchers Say
http://www.nti.org/d_newswire/issues/2004_2_17.html#F5F00E0F

Mass Vaccination Not Needed to Contain Smallpox Outbreak, Researchers Say
Conducting a mass vaccination against smallpox in the United States could save some lives in the event of an outbreak, but the risks of vaccine side effects would outweigh most benefits, researchers announced Friday (see GSN,Jan. 30).
Presenting a paper in at an American Association for the Advancement of Science conference in Seattle, Emory University researchers said that rapid detection and isolation of smallpox cases would effectively contain an outbreak, although delays of even one or two days could hamper control of an epidemic.
Although mass vaccination during or before a smallpox attack would result in fewer cases and deaths than would surveillance and containment, the researchers concluded that such a vaccination effort would cause an increased rate of vaccine-related serious illness and death that would offset the slightly lower number of smallpox illnesses and deaths.
In an earlier study the researchers concluded that targeted vaccination of the close contacts of infected individuals during a smallpox outbreak following a small attack could rival the effectiveness of mass vaccination, given a sufficiently high level of immunity within the population. Although routine smallpox vaccinations were stopped in 1972, recent studies have shown that previously vaccinated individuals retain substantial immunity.
In the current study, the Emory investigators constructed a model that simulated the spread of smallpox in a hypothetical community of typical contacts, using a population of the approximate age and household distribution of the United States, following a larger smallpox attack deliberately introduced through aerosolized virus. They found that containment and surveillance would be effective in containing a moderately large smallpox attack.

"This demonstrates the necessity for preparedness in our public health system. A rapid and efficient means of detecting cases and isolating them in case of an attack would be an essential component of the strategy of surveillance and containment," according to Emory researcher Elizabeth Halloran (Emory University release, Feb. 14).

A couple of points to note....

The report states that radid detection and isolation of smallpox cases would contain an outbreak, but a delay of one or two days could hamper control of the epidemic. That is not a lot of margin for error.

People over the age of 32 may have some immunity left from their Smallpox vaccinations. People under this age have no immunity. In a terrorist attack, chosing the right target based on this could make all the difference. Terrorists tend to research their targets.

In relation to a Smallpox outbreak, the terms rapid detection, isolation, containment, and surveillance all result in the exact same course of treatment. The course of treatment for a Smallpox infection is death.

The issue over Smallpox vaccinations being reinstated is one of body counts and acceptable losses. Vaccinating everyone will result in some number of deaths due to reactions to the vaccine. A real Smallpox outbreak will result in death for all the infected, how fast they are isolated determines how many others die. The question is which one causes a higher body count. If there is no outbreak, the vaccine is the worse choice. If there is an outbreak, we'll see what containment means.

Ricin and Anthrax have already been mailed in the United States with malicious intent. Could there be a Smallpox danger or is it imagined?

It is not hard to attack large amounts of people with Smallpox because it is highly contagious. With other biological weapons or even chemical weapons it is hard to attack large numbers because they aren't contagious. With a contagious desease for which there is no cure and the outcome is always death, all you have to do is start a small outbreak and watch it spread.

On a positive note, Smallpox is considered eradicated from the planet and the last known case was in 1977. The virus only exists in a few select labs, like the Center for Disease Control.

On a negative note, if some of that virus got out and was cultivated, much of the world's population is susceptible to it since vaccinations have stopped.

On another positive note, the US has a containment plan. There are enough Smallpox vaccines stockpiled for the entire country to be vaccinated. Once the outbreak happens and the deaths start, it will be headed off quickly if we can move the vaccines out of warehouse and into the hands of medical staff quick enough.

Once this is done and it has run its course, the families of the dead will ask while we didn't vaccinate everyone sooner and we'll have a inquiry as to why the nation wasn't vaccinated as a preventative measure when we had the vaccines all along. Some will say the justice department can't conduct the inquiry because they are biased. Others will say a congressional inquiry would be partisan and that an independent council should be set up. Many politicans will grandstand over the issue. Some politicians will insinuate that the government had warning a Smallpox attack was coming and yet did nothing. The opposition party will use the issue as a reason to try oust the sitting president. The dead will be forgotten.