Health officials debate large-scale smallpox vaccinations

By Kathy Helms-Hughes

STAR Staff
khelms@starhq.com

   The threat of a flood or tornado in Carter County is familiar ground. It's something many residents have witnessed first-hand and lived through, so they have some idea of how to prepare for a similar event in the future. But talk about the threat of a smallpox epidemic, and the whole scene suddenly seems very surreal.
   Following a meeting Tuesday of the Elizabethton-Carter County Local Emergency Planning Committee, county executives from Carter and Johnson counties, city and county leaders, law enforcement officials, emergency workers, and state and local health officials began laying the groundwork to handle large-scale smallpox vaccinations should the need arise.
   Shirley Hughes, bioterrorism director from the Northeast Tennessee Regional Health Office in Johnson City, said that if a case of smallpox were identified within the state, local communities must be ready to spring into action.
   Within 12 to 24 hours, clinics would be set up at Hampton and Elizabethton High Schools and all health care workers and volunteers would have been vaccinated. Next, Carter and Johnson Counties must be prepared to load approximately 73,000 persons on buses from designated pickup points and shuttle them to the two high schools to receive the vaccine. There are 66 school buses available in Carter County, 37 in Johnson County, and six in the City of Elizabethton which would be used for transportation.
   Once this mass plan is activated, health care workers have 10 days to vaccinate the entire state population. However, before those 73,000 persons can be vaccinated, they first must go through a health screening to ensure that every passenger who boards a bus is smallpox-free, to alleviate the risk of contaminating fellow travelers.
   Each person must have some form of identification before they can receive the vaccine. Persons without proper identification would have to wait until day 10 to receive the vaccine.
   Once transported to the schools, residents must get their paperwork and see a video about smallpox before receiving the vaccine. It is possible that Johnson County residents could go through some of the education process before being bused to Hampton, thus, speeding the process for all involved.
   There are also approximately 1,500 prison inmates in Mountain City and Roan Mountain who would need to receive the vaccine. It is proposed that the inmates and prison personnel be vaccinated at those facilities, thus alleviating the need for transport.
   "We're going to have a massive amount of people to move. The police and sheriff's departments are going to have to provide some security. I think we're pretty good as long as we don't get somebody saying there's a case out there. If you do, you're going to get an outbreak -- and we're dreading that," said Jim Burrough, Elizabethton/Carter County Emergency Management Agency director.
   Johnson County Executive Dick Grayson said Doe Elementary, Roan Creek Elementary and Johnson County High School probably will be the designated pickup points for his county. As it now stands, residents could carpool to the schools and then be transported to Hampton High.
   Caroline Hurt, director of the Carter County Health Center, said the idea was to establish two or three places in Johnson County that people would be familiar with in case they didn't know their way around Carter County.
   "We're trying to refine a process by which people could get into and out of the clinic with as few individual cars clogging up the entrance and exit as possible. I think that all of the details in between are still to be hammered out. We've still got some planning to do," Hurt said.
   Johnson and Carter County represent a "unique situation" because Johnson County's nearest clinic, geographically, will be Hampton High School.
   "This means that in a relatively small road system, we're going to have to get a lot of residents down the mountain," Hurt said. "I don't think we can get away from the fact that no matter what we try to do, some people will be afraid, naturally, and they'll get in their car and head down the mountain as quickly as they can," creating a potential traffic nightmare for local law enforcement officials.
   Hughes said the vaccinations would be carried out alphabetically, according to Nashville officials, with the oldest family members being first to receive the vaccine. Nashville officials will determine three days before the clinic situation which letters of the alphabet will go first.
   Tennessee officials also are working with bordering states in the event residents cross state lines to receive the vaccine. "We're meeting with North Carolina, Kentucky and Virginia, and we're hoping everybody will kind of play along the same lines, but that may or may not occur," Hughes said.
   While the states currently are focused on smallpox planning, it is hoped that communities would adhere to the same master plan should some other type of biological event occur, she said.
   Despite fears voiced about the smallpox vaccine, Hughes and district health officer Patricia L. Eachus, M.D., said the vaccine is the same as the type administered to schoolchildren during the 1960s.
   "We lined up in school, got it, and went about our business. I guess as youths, we didn't think about it. But it's the same thing," Eachus said.
   According to Hughes, the vaccine is the same one that has been used over the years - the New York Board of Health strain.
   "Right now, if we go into a vaccination situation for the general population, they would dilute the vaccine somewhat, but it would still be effective. We know the vaccine has 'contraindications' -- that there are folks, because of different reasons, who cannot take the vaccine. We don't have an outbreak at this time, so we're encouraging those folks to not take it.
   "If we did have an outbreak, then we would look at those types of situations and try to determine whether or not we would still vaccinate some of those folks. That's why we do a lot of medical counseling in the event we have an outbreak," she said.
   Most of the information on the smallpox vaccine comes from data compiled from observations during smallpox situations in the '60s," according to Hughes. "We do have some new medications today that we hope, in the event folks did have problems with the vaccine, would be used to help treat these situations."
   Local and state officials will meet again in the near future to continue hammering out details.