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This weeks Biological Weapons stories for Tuesday, July 30, 2002.
Smallpox: London Purchased Wrong Vaccine, Report SaysA report prepared by a U.S. research group says the United Kingdom has purchased the wrong type of smallpox vaccine to use as a defense against a biological weapons attack, BBC Online reported today (see GSN, April 15). The British firm Powderject Pharmaceuticals was awarded a contract worth more than $50 million to provide the United Kingdom with millions of doses of smallpox vaccine based on a strain of smallpox called the Lister strain, according to BBC. Powderject received the contract shortly after its chief executive had donated more than $78,000 to the governing Labor Party, according to BBC. The United States, however, has ordered doses of the smallpox vaccine developed by the New York City Board of Health, which is designed to counter a different strain of smallpox that scientists believe terrorists would be more likely to use, according to BBC. The report, which was prepared by the Potomac Institute, supports the U.S. decision, BBC reported. British Shadow Health Secretary Liam Fox said the report should prompt an investigation into the vaccine purchase. Ministers should resign if it is found they purchased the wrong type, he said. “It is imperative that we have a full independent inquiry into the whole sordid affair of the smallpox scandal,” Fox said. “If these allegations are true, heads must roll” (BBC Online, July 30).
Smallpox: Administration, Critic Trade Fire Over Smallpox Vaccination StrategyBy David Ruppe An expert advisory panel, the Advisory Committee on Immunization Practices (ACIP), last month recommended to Health and Human Services Secretary Tommy Thompson against mass vaccination (see GSN, June 21). Instead, the panel favored vaccinating certain U.S. healthcare workers and using selective vaccination through a containment strategy in the event of an outbreak (see GSN, July 8). Thompson’s decision is pending. The debate centers on whether that “ring vaccination strategy,” which involves vaccinating an infected person’s immediate contacts and household members, would be sufficient to contain the spread of the disease in the event of a smallpox attack. The strategy was used to eradicate smallpox globally during the 1960s and 1970s and is considered beneficial since it minimizes exposure to the smallpox vaccine’s side effects, estimated to kill three people per million vaccinations. A prominent proponent of that ring strategy is D.A. Henderson, who led the successful eradication effort and is now Thompson’s principal science advisor for public health emergency preparedness. “Let’s say we’ve got a case, and that individual is going to be in contact with a lot of people, and what you want to do is to vaccinate those contacts. If you get to them with in the first two to three days, you can prevent the disease,” Henderson said, speaking on a panel Friday intended to provide information on the pending decision. The ring strategy was challenged earlier this month when Yale University professor Edward Kaplan co-authored a study suggesting a mass vaccination would be a better alternative to deal with a terrorist attack using smallpox. “Dr. Henderson is treating a bioterror attack as if it were a historical, natural smallpox outbreak. It is not wise to prepare for a smallpox bioterror attack — where terrorists are trying as hard as they can to kill as many of us as possible — in this fashion,” Kaplan said. Judging the Spread of Infection Specifically, Henderson and Kaplan differ on how quickly the disease would spread through the population. Kaplan’s study, modeling a hypothetical attack on a major city with an initial 1,000 people infected, projected the ring strategy would allow 367,000 people to become infected and 110,000 to die before eliminating the disease after 350 days. Mass vaccinations administered quickly after an attack, it estimated, would allow 1,830 cases and 560 deaths over 115 days. Henderson, in an interview Friday, argued Kaplan’s study gave short shrift to the ring strategy by using extreme assumptions about the spread of the disease. He criticized the model’s assumption that a single infected person would come into sufficiently close contact with 50 people before the initial case is detected. “You’ve got to see some of these patients ... These are people that are sick, they’re not wandering around the country.” Kaplan agreed in an interview that his analysis modeled a worst-case scenario, but argued such a strategy is preferable since terrorists would likely aim to cause the worst amount of damage. “We believe that when planning a bioterror response policy, it is important to develop a robust approach that can succeed in situations much worse than history has provided,” he said. Kaplan said Henderson is too conservative about estimating the spread of the disease, saying data suggests infectious people could circulate in society. Historically, he said, “It is true that more cases were transmitted within households or hospitals than by ‘casual’ transmission — but this does not mean that transmission in the workplace, or via casual contacts (e.g. on a bus, in a marketplace) was insignificant.” Kaplan cited a slide used by Centers for Disease Control and Prevention officials suggesting at least one-fourth of all smallpox transmissions in Europe did not occur in the home or hospital. “This [was] in situations of natural outbreaks, and in populations with relatively high levels of immunity (due to past vaccination campaigns or survival from prior smallpox outbreaks), and in much less mobile populations than, say, New York City in the 21st century.” “Dr. Henderson’s experience involved natural smallpox outbreaks in much less mobile populations that already had moderate to moderately high levels of immunity,” he said. Kaplan also cited a paper that appeared in the magazine Nature last fall, which provided mathematical models of historical smallpox outbreaks. The models assumed random interactions between infected and susceptible in the population. “This ‘free mixing’ is what Dr. Henderson objects to — he argues that febrile, bedridden infectious individuals could not possibly be mobile, mixing and spreading disease — and yet these ‘free mixing’ models provide excellent fits to historical data,” Kaplan said. Response Capabilities Kaplan also faults the advisory panel for not addressing the probable state of readiness of U.S. authorities to respond to an attack and to contain it effectively using the ring strategy. “The issue was not addressed because the panel did not perform any analysis of their own ring vaccination response plan. They simply assumed that ring vaccination would work via historical analogy,” said Kaplan. In recommending against mass vaccination, the panel weighed two primary risks, the side effects of mass vaccination and the probability of an attack. The advisory committee concluded, “Under current circumstances, with no confirmed smallpox, and the risk of an attack assessed as low, vaccination of the general population is not recommended, as the potential benefits of vaccination do not outweigh the risks of vaccine complications.” The calculation should have included another factor, Kaplan said, U.S. response capabilities. When weighing the consequences of mass vaccination versus those of an attack on a society that is not mass vaccinated, the latter “depends critically on what the response policy is” he said. “The basic lesson is this,” he writes, “If you harbor serious doubts regarding the ability of whatever response policy is employed to control the epidemic, then you should be more willing to vaccinate pre-attack. On the other hand, if you are highly confident that whatever response policy is employed can contain the epidemic, then the pressure to vaccinate before an attack is reduced.” ACIP Chairman John Modlin said he believes U.S. authorities would respond well if an outbreak occurs today. “I would just point out that there are no guarantees in life, but the best estimate is that with communication, with knowledge of an outbreak, that even a relatively large initial number of cases could be dealt with.” Other experts say the nation is generally not yet prepared to deal with a massive biological weapons attack. “We have seen how much suffering and disruption ensued from 18 cases of anthrax — a treatable disease. In the absence of significant improvements in our public health infrastructure, the country is vulnerable to the potentially calamitous consequences of a large bioterrorist attack,” said Tara O’Toole, director of the Center for Civilian Biodefense Strategies at Johns Hopkins University in testimony earlier this year. O’Toole has praised significant increases in funding passed by Congress in the fiscal 2002 and 2003 appropriations bills. Analysis Included Mississippi State Health Officer Ed Thompson who was involved in preparing the panel recommendation, acknowledged the panel had done no such analysis of response capabilities. “What you were describing was a massive task that would take an enormous length of time,” he said in an interview. “We’re having to make these decisions and recommendations based on a lot less information than we would like to have. Almost every decision that we’ve made with respect to bioterrorism out of necessity has been made with too little information,” he said. Other officials say there was no problem with a lack of analysis, and that the issue of readiness was discussed. “We’ve got more models than we could possibly imagine,” said Henderson. The question “was of course extensively discussed by the committee,” says Modlin, a professor of pediatrics and medicine at Dartmouth Medical School. “It’s one of those areas where there inevitably are more questions than there are answers.” Modlin said the committee did have the benefit of a CDC draft technical assessment of what would likely happen if an attack did occur.
Anthrax: “Sloppy Methods” Explain Releases at AMRIID; Other IssuesAt the U.S. Army Medical Research Institute of Infectious Diseases at Fort Detrick, Md., anthrax spores discovered outside of secure facilities in April were the result of an accidental release, the Army said Friday (see GSN, April 26). “The scenario that people thought was the likely cause of those spores being outside the lab was just sloppy methods,” said USAMRIID spokesman Charles Dasey. “The sense of the institute is that it was poor laboratory techniques and not an intentional act.” In response to the accidental release, USAMRIID officials have begun weekly sampling for contaminants both inside and outside containment laboratories, Dasey said. The sampling, which has never been previously conducted, is part of improved USAMRIID procedures, he said. The spores discovered in April were found by a scientist conducting unauthorized sampling, according to the Associated Press (David Dishneau, Associated Press/Yahoo.com, July 27). Link Between Vaccine, Illnesses Meanwhile, growing evidence might link several lots of anthrax vaccine used to inoculate U.S. troops with types of ailments reported by some Gulf War veterans, the Air Force Times reported this week (see GSN, July 1). Researchers at Tulane University and Autoimmune Technologies LLC, both in New Orleans, discovered antibodies that indicate the presence of a vaccine-enhancing compound called squalene in certain U.S. troops. Health officials had used four particular lots of anthrax vaccine to inoculate those troops under the Defense Department’s mandatory vaccination program, according to the researchers. In June 1999, the Food and Drug Administration had discovered traces of squalene in three of those four lots, as well as two others, Air Force Times reported. The results of the current study are similar to those found in a study on Gulf War illnesses released in February 2000, Air Force Times reported. In the 2000 study, 95 percent of participants who had Gulf War illnesses also exhibited antibodies to squalene, but none of the veterans who did not report symptoms of Gulf War illnesses had the antibodies, said Autoimmune Technologies President Russell Wilson. Squalene can be found naturally in the body and has been used experimentally to boost immune reactions that vaccines are meant to create, according to Air Force Times. Pentagon officials, however, have said they did not add squalene to the anthrax vaccine. “What needs to be done is an epidemiological study in concert with a determination of antibodies to squalene so that the observation of the linkage between (Gulf War illnesses), the antibodies and lots of anthrax vaccine can be confirmed,” Wilson said (Deborah Funk, Air Force Times, Aug. 5). Brentwood Can Be Cleaned In Washington, U.S. Postal Service officials said Saturday that they will be able to safely reopen the anthrax-contaminated Brentwood Road postal facility in Washington after it has been decontaminated (see GSN, July 26). The Postal Service is expected today to conduct a small-scale test of the chlorine dioxide fumigation process that will be used to decontaminate the facility, according to the Washington Post. If the full Brentwood decontamination is successful, the facility’s 2,500 workers would return to work after several months of renovation work, said Thomas Day, Postal Service vice president for engineering. While officials plan to install a detection system for biological agents, it probably will not be ready by the time the facility reopens, Day said. Representatives from the American Postal Workers Union, which represents about 1,500 Brentwood workers, said they do not believe the decontamination effort will be as successful as predicted. “Because the employees have not been regularly briefed about the progress and procedures (of the decontamination process), they are less than confident of the results,” said Roy Braunstein, American Postal Workers Union legislative director. Christine Armstrong, a mail clerk at Brentwood, said she does not plan to return to the facility, regardless of what precautions were put into place. “Who would want to go back in there?” Armstrong said. “We have been treated unfairly from the get-go, and they have no idea what we’re going through” (Monte Reel, Washington Post, July 27). Irradiation Slows Congressional Mail The irradiation process used to sterilize mail sent to members of Congress has led to delays in responding to constituents, the Philadelphia Inquirer reported today (see GSN, July 2). Mail sent to members of Congress is routed through an irradiation center in Logan, N.J., according to the Inquirer. There, letters are divided into two categories based on their thickness. An electronic beam uses negatively charged ions to sterilize legal-sized letters. Larger-sized packages undergo an X-ray process, which is weaker but can cover more area, the Inquirer reported. After mail sent to members of Congress has been sterilized, it is delivered to a special sorting facility in Washington. From there, it goes to the mailrooms of individual federal agencies and then to the addressed member of Congress, according to the Inquirer. Postal officials have said the entire delivery process should take about a week, but congressional staff members have said the process appears to take much longer, the Inquirer reported. An aide to a Pennsylvania senator said his office stopped delivery of time-sensitive publications. Some members of Congress have altered their Web sites to make it easier to contact them via e-mail, while others have requested that mail be sent to their home district offices, the Inquirer reported. “The mail is considerably slower than it used to be,” said Representative Robert Andrews (D-N.J.). “It’s unfortunate, but I think it’s necessary” (Jake Wagman, Philadelphia Inquirer, July 29). For further information, see: CDC Frequently Asked Questions About Anthrax Journal of the American Medical Association Background on Anthrax GSN Anthrax Attack Chronology (Dec. 12, 2001)
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