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Smallpox: U.S. Plans to Vaccinate 500,000 Health Care Workers The United States plans to vaccinate 500,000 first responders and health care workers against smallpox, according to a U.S. official cited by the New York Times yesterday (see GSN, June 26). Previously, officials had said they planned to vaccinate only a few thousand. Rapid increases in supplies of smallpox vaccine have made it possible to boost the number of people vaccinated, officials said (see GSN, May 16). Studies have also discovered that the vaccine can be diluted several times and still remain effective, according to the Times. “Now we can act differently because we have more vaccine,” said D.A. Henderson, senior science adviser to Health and Human Services Secretary Tommy Thompson (William Broad, New York Times, July 7). U.S. officials are still exploring the best strategy for carrying out the vaccination program, according to the Washington Post. Each vial of smallpox vaccine contains 100 doses, which can be diluted five times (see GSN, March 29). That means, however, that 500 people would have to be given the vaccine at once since it loses effectiveness when opened, the Post reported. Most health care workers would have to be taught how to administer the vaccine, which requires about 15 quick injections to the arm. To prevent infecting patients with live vaccine, health care workers would have to leave work for 10 days after they are vaccinated, said Jerome Hauer, acting assistant Health and Human Services secretary for emergency preparedness. The U.S. Centers for Disease Control and Prevention will monitor all vaccine recipients for adverse reactions, Hauer said. Because the vaccine can be harmful to immunocompromised people, Health and Human Services is examining the possibility of requiring an HIV test before administering the vaccine, according to the Post (Ceci Connolly, Washington Post, July 8). The United States is also attempting to increase supplies of vaccinia immune globulin, which is used to reduce adverse vaccine effects in people with immune system problems, according to the New York Times (see GSN, Nov. 21, 2001). Currently, 700 doses are available and 3,000 doses are expected to be on hand by the end of the year, officials said. Strategies The United States also plans to increase preparations for a possible mass vaccination strategy if needed, according to the Times (see GSN, June 21). Health and Human Services is expected to distribute guidelines on conducting mass vaccinations to cities and states within the next two weeks, Hauer said. There are also logistical changes planned at CDC for conducting a mass vaccination campaign, he added. Other details of a mass vaccination strategy still need to be approved by Thompson, officials said. The United States has not given up on its plans to conduct a ring vaccination strategy — vaccinating those who came into contact with an infected person, health officials said. Preparations for mass vaccination, however, will enable workers to respond more quickly to an outbreak that infects more than 100 people, officials said. Critics of the ring vaccination approach have said the plan would do little against terrorists set on conducting a smallpox attack. “Unless the initial attack is very small and the infectiousness of the agent is quite mild, ring vaccination is not going to do much good,” said Edward Kaplan, a Yale University public health specialist (Broad, New York Times). A new study prepared by Yale University and the Massachusetts Institute of Technology says that a mass vaccination strategy would be a better response to a smallpox attack, according to Wall Street Journal. The study, expected to be released tomorrow, says that 4,000 people would die if a ring vaccination plan were used after a smallpox outbreak in a major U.S. city. The United States’ dense and mobile population would result in a larger outbreak that would cause fear and take too long to bring under control without a mass vaccination plan, according to the study (Lueck/Chase, Wall Street Journal, July 8). The increase in criticism of the ring vaccination strategy has had no role in the increased preparations for carrying out a mass vaccination plan, U.S. officials said. “The key to responding to any public health emergency is flexibility,” Hauer said. “You listen to critics, but you can’t let that drive policy. You have to do what’s best for public health and national security” (Broad, New York Times). Israel Stockpiles Vaccine Meanwhile, Israel has begun building a smallpox vaccine stockpile to prepare for a possible biological weapons attack, Clalit Health Services Chairman Dan Michaeli said today. “I know that decisions have been taken that have led to provisions for all the residents of the country,” said Michaeli, a former director general of the Israeli Health Ministry. “If and when it is decided to vaccinate, I hope they will do so quickly” (Ha’aretz, July 8). For further information, see: Journal of the American Medical Association Background on Smallpox
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