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Smallpox: Israel Should Produce Vaccine, Health Officials Say The Israeli Health Ministry should immediately begin mass-producing the smallpox vaccine and consider acquiring the vaccine from commercial sources as well, several Israeli health officials wrote in this month’s Israel Medical Association Journal (see GSN, July 8). It is “likely” that terrorists have already obtained smallpox and are prepared to use it in aerosol form against population centers, said the authors, Paul Slater of the Health Ministry’s Epidemiology Department, Emilia Anis of the Infectious Diseases Department and Alex Leventhal of Public Health Services (see GSN, Nov. 30, 2001). Israel, which would need 9 million vaccine doses to inoculate the Israeli population and the Arab residents of the Palestinian territories, would probably not receive the vaccine from other countries in the near future and so should prepare itself now, they wrote (see GSN, April 25). The Health Ministry’s Central Laboratories have produced the vaccine in the past. “Vaccine production capability already exists, but it needs to be reactivated and expanded,” the authors wrote. Israel would also need 65,000 milliliters of vaccinia immune globulin, which is used to treat complications caused by the vaccine, to cover the estimated number of Israelis and Palestinians who would probably develop complications, according to the authors. Authorities should recruit 2,500 volunteers who were inoculated before the vaccination program ended in 1980 and revaccinate them to produce 65,000 milliliters of vaccinia immune globulin from their antibodies, the authors wrote. To start revaccinating volunteers, officials should acquire a small amount of the globulin from the U.S. Centers for Disease Control and Prevention, the authors wrote. Priorities: Who Gets the Vaccine? If a smallpox case occurs, Israel would need to establish priorities, the authors wrote. Medical, laboratory, emergency, first-responder and burial personnel should receive the vaccine first. The second priority would be anyone who had to face-to-face contact with a smallpox victim, followed by household members of those contacts. Active duty soldiers would receive the vaccine next, followed by residents in the area where the case occurred and finally the entire population. Personnel who would be involved in caring for smallpox patients, administering the vaccine and conducting interviews with the patients and contacts would have to receive the vaccine before beginning those tasks, the authors wrote. “We must assume that in the event of a smallpox outbreak, no matter how small, vaccination of the entire Israeli population will need to be carried out,” the authors wrote. Israeli authorities should also seriously consider resuming routine smallpox vaccination of the population “as improved vaccine becomes available,” according to the authors. Isolating Patients While initial smallpox cases would inevitably be taken to a hospital, “suspect smallpox cases must not intentionally be admitted to any open general medical facility” since they might infect other patients, the authors wrote. Some smallpox victims could be cared for in military-style field hospitals or in a single hospital or isolated hospital wing, according to the authors. An alternative for moderately ill patients would be to establish hospices, which should be prepared far in advance of an actual outbreak. Eventually, if the number of patients surpassed the health system’s capacity for smallpox cases, the patients would have to be isolated at home. Forcing a “large-scale quarantine” would be “undesirable” and probably unenforceable, the authors wrote. When a smallpox case is first discovered, authorities should quickly set up vaccination centers in the area of the case to lessen public panic and encourage people in the area to remain at home to receive the vaccine. Israel has the resources to overcome a smallpox attack, the authors wrote. “A new smallpox outbreak in Israel must not be regarded as a doomsday event,” they wrote. “If we make the necessary commitment now to vaccine production and stockpiling, laboratory preparation, planning, professional training and public education, the losses, although substantial, can be minimized” (Israel Medical Association Journal, July). For further information, see: Journal of the American Medical Association Background on Smallpox
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