'ER' finale may boost awareness of smallpox

By Anita Manning
USA Today

For scientists trying to develop a plan to prepare for a bioterrorist attack with smallpox, this week's season finale of the TV drama "ER" exemplifies the need for better communication.

In tonight's episode, two children come into the emergency room with fevers. They're treated and sent home with their parents, who serve in the foreign service. But they soon return to the ER, this time with pox-like lesions all over their bodies. Smallpox is suspected, and tissue samples are dispatched to the Centers for Disease Control and Prevention for testing. If smallpox is confirmed, it would signal the return of one of the great scourges.

Some public health officials are bracing for the phone calls to come.

Public health departments should be ready "to say, no, foreign service families are not at risk, and no, immigrants are not bringing this here," says George Hardy, director of the Association of State and Territorial Health Officials. "We're going to have to be able to respond."

Natalie Smith, chief of the immunization branch in California's Department of Health Services in Berkeley, says her department's press office had advance notice of the "ER "story and has prepared fact sheets on smallpox and smallpox vaccine to help answer an anticipated flurry of questions from the press and public.

Hardy and Smith recently attended a meeting in Atlanta of smallpox experts who have been asked by federal health authorities to investigate strategies to protect Americans against a potential bioterrorist release of smallpox. They'll present a proposal June 19-20 to the Advisory Committee on Immunization Practices, which recommends vaccine policy to federal health agencies.

While there seemed no consensus on the risk of a smallpox attack or on who should be vaccinated, the experts agreed on one thing: the need for clear, accurate and consistent information that can be quickly disseminated to a worried public.

So far, communication about smallpox doesn't seem to be getting through. There is "widespread misunderstanding" about the disease and the vaccine, even among physicians, says Glen Nowak of the CDC, who reported results of a study conducted in April consisting of 160 people in focus groups, and in-depth interviews with 17 physicians.

They found that some doctors thought smallpox was still occurring in the world — the last case was in 1977 — and few knew much about how to give the vaccine. In the focus groups, many people thought, erroneously, that smallpox was always fatal (it killed about 30 percent of victims).

Knowledge of the dangerous side effects of the vaccine was spotty in all groups, he says. It is these side effects, including encephalitis, and a rare, deadly disease called progressive vaccinia, that concern experts most about any national smallpox vaccine plan. A recent study by University of Michigan researchers predicts smallpox vaccine given to Americans ages 1 to 65 would cause 4,600 serious illnesses and 285 deaths.

While smallpox was circulating in the world, the threat of the disease outweighed the risk of the vaccine. But smallpox was eradicated more than two decades ago, and no one knows how likely it is that a terrorist will unleash it again. Stocks of the virus exist in labs at the CDC and the former Soviet Union, but fears persist that terrorists have obtained samples.

There's no evidence that there is an increased risk of a smallpox outbreak, says Michael Osterholm, liaison to the CDC for Health and Human Services Secretary Tommy Thompson.

"We have to be careful of saying the sky is falling, and having people question our credibility and suggest we're overreacting," he says.