Officials prep clinic sites for possible bio-terror attack

By Thomas Wilson

   Two local high schools could become makeshift smallpox vaccination clinics if President Bush issues an order activating health department to inoculate the U.S. population against smallpox or other biological agent unleashed as an act of terrorism.
   "If the president gives the order, we have three days to prepare and 10 days to complete," said Jim Burrough, director of the county's Emergency Management Agency.
   Burrough, along with officials with the Tennessee Department of Health and local public safety departments, conducted a logistics walk through Wednesday afternoon at Elizabethton High School, one of two sites in the county designated as a smallpox vaccination clinic.
   "We would do it in alphabetical order based on the name of the head of the household," said Burrough. "We're going to do the whole county in ten days to do the whole state, so we'll have ten days to get our county done.
   Citizens would be required to present an identification card before they can receive the vaccination.
   Dr. Patricia Eachus, District Health Officer with the Northeast Tennessee Regional Health Department, said the location of the nation's smallpox vaccine remained a secret for obvious reasons. She added the National Pharmaceutical Stockpile program had amassed more than enough smallpox vaccination doses for the entire nation.
   "We do know there is a sufficient amount to inoculate everyone in the United States," said Eachus.
   Elizabethton High School and Hampton High School have been designated the two emergency clinic locations in Carter County. The greatest majority of county residents would be vaccinated at EHS while most residents from eastern Carter County and Johnson County would receive inoculations at Hampton High School.
   The two clinics would be tasked with smallpox vaccinations of Carter County's 56,000 residents and Johnson County's 17,000 residents.
   "We are following a great model from the U.S. Centers for Disease Control (CDC) and Tennessee Department of Health to try to arrange the fill of the clinic," said Caroline Hurt, director of the health departments for Carter and Johnson counties.
   "We are planning for the emergency activation of smallpox clinics," she said.
   Hurt said if the clinic activation was ordered, preparation work to establish the clinics, vaccinate clinic volunteers and receive the smallpox vaccine from the state health department would likely take "a couple to three days".
   Once a citizen arrived at a clinic, he or she would fill out paperwork including identification and screening for potential health problems or objections to taking the vaccine. Citizens are not forced or required to receive the smallpox vaccine based on health and medical problems.
   Services for non-English speaking citizens or those with physical impairments would also be available to assist the flow of people through the clinic, said Hurt.
   "Finally, they will receive instructions on the proper care and treatment of the vaccination itself before they leave the clinic," said Hurt. "That is an important part of the whole vaccination process due to the possibility of the vaccination site becoming infected if it is not treated properly."
   The vaccine is given using a bifurcated (two-pronged) needle that is dipped into the vaccine solution. When removed, the needle retains a droplet of the vaccine. The needle is then used to prick the skin a number of times in a few seconds.
   According to the CDC, the last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. Routine smallpox vaccinations ended in 1972.
   Smallpox vaccination provides high-level immunity for 3 to 5 years and decreasing immunity thereafter. Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing.
   There are two clinical forms of smallpox. Variola major is the severe and most common form of smallpox, with a more extensive rash and higher fever. Variola minor is a less common presentation of smallpox, and a much less severe disease, with death rates historically of one percent or less.
   People with various medical conditions are urged not to get the smallpox vaccination unless they have been exposed to the virus. Those conditions include:
   - Eczema or atopic dermatitis; skin conditions such as burns, chickenpox,
   shingles, impetigo, herpes, severe acne, or psoriasis.
   - Weakened immune system including persons undergoing cancer treatment,
   those undergoing an organ transplant, living with HIV, Primary Immune Deficiency
   disorders, some severe autoimmune disorders and medications to treat
   autoimmune disorders, and other illnesses that weaken the immune system.
   - Pregnancy or plans to become pregnant within one month of vaccination.
   The CDC acknowledges that the smallpox vaccine does have some risks. In the past, about 1,000 people for every 1 million people vaccinated for the first time experienced reactions that, while not life-threatening, were serious.
   These reactions include a vigorous (toxic or allergic) reaction at the site of the vaccination and spread of the "vaccinia" virus (the live virus in the smallpox vaccine) to other parts of the body and to other people.
   Burrough said earlier in the week that 200 people have signed up to volunteer at the emergency vaccination clinics if the needs arises. He said training dates are April 4 from 1 p.m. to 2:30 p.m. at the Carter County Health Department Annex; April 5 from 9:30 to 11:30 a.m., and April 7 from 7 a.m. to 8:30 p.m..
   Citizens who have signed up as volunteers will be notified of a date for training. Emergency and health officials plan a walk through at a later date with officials from Johnson County at Hampton High School.
   Elizabethton Police Chief Roger Deal said if the clinic opened, police officers would be working 12-hour shifts to provide security and logistics planning for citizens to get to and from the clinics. The Tennessee State Guard has been enlisted to assist any such operation under the authority of local law enforcement agencies.
   Citizens would not be allowed to drive onto the campus of either high school once they were activated as clinics. All citizens would be transported to the clinic using schools buses or shuttle bus. Deal said various K-12 school campuses around the county had also been designated as staging areas to transport county citizens to the clinics.
   The chief verbalized the thoughts likely on the minds of public safety and health personnel involved in the clinics' planning.
   "We all hope and pray it doesn't come to this," said Deal. "But it is possible it could."