State reviews plan for smallpox crisis

By Robbie Dingeman
Advertiser Health Writer

State health officials yesterday began poring through new federal guidelines that call for vaccinating a million people here within 10 days of a smallpox outbreak, perhaps one caused by a bioterrorism attack.

"There is no increased threat of smallpox that we know of," said State health director Bruce Anderson. Advertiser library photo

The Centers for Disease Control and Prevention issued a manual to each state yesterday with detailed instructions on how to rapidly respond.

Smallpox has been around for at least 3,000 years and early epidemics swept across populations. It has the potential to kill 30 percent of those infected and leave survivors scarred or blind. But a vaccine that was developed prompted health officials to declare the disease eradicated in 1980.

Widespread vaccination ended in 1971. But some of the smallpox virus still exists, leading officials to fear that terrorists could use it as a weapon with the potential to spread rapidly through a modern, mobile population that is not immunized and unfamiliar with the disease.

"The biggest problem associated with smallpox is likely to be the panic that would ensue from a case," Anderson said. "Smallpox is actually less infectious than the flu. If you can vaccinate someone within a few days of exposure, the vaccination is effective in preventing illness."

Smallpox is transmitted through close contact with an infected person. It begins with flu-like symptoms: fever, tiredness, back pain, followed by a rash that begins on the face and hands. The bumps become round and raised as the fever continues on the fifth through 10th day of the disease.

Bart Aronoff, manager of the bioterrorism program of the state Health Department, said the costs of such a program have yet to be detailed but he expects that the federal government would provide the vaccine. "We're going to base our plan on what needs to be done."

Aronoff stressed that the disease would be easier to control than people's fear of exposure. "It does incite a lot of concern and panic in people that are normally rational," he said.

Anderson said the plan calls for 20 or so sites for vaccination, staffed 16 hours a day by professionals and expert volunteers. Because Hawai'i's population is split among seven islands, Anderson said there may be a need for more sites.

Anderson said a single smallpox case discovered in another state is unlikely to trigger a mass vaccination here. "It would be irresponsible without any credible threat."

There are side-effects to the vaccine, Anderson said, and because it's a live vaccine it can cause death in one per million people, usually those in poor health. He said the federal government is still considering whether it will recommend vaccination of health-care workers and emergency responders.