Regional health office prepares for mass smallpox vaccination

By Abby Morris

Following orders handed down from the Tennessee Department of Health, the Regional Public Health Office in Johnson City is currently planning the set up of clinics to mass vaccinate the public against the smallpox virus in case of a breakout of the disease.
   The TDH announced last week that plans are in the works statewide to be prepared to vaccinate the residents of Tennessee in the event of a smallpox outbreak and said that the orders had been handed down to them by the Centers for Disease Control and Prevention.
   "Initially, President Bush is the one who ordered all the states to plan for clinics," said Beth Rader, public information officer for the Regional Public Health Office. "It came down from the federal government."
   Like the state office, the regional office is still in the planning stages. The statewide plan calls for 117 mass vaccination clinics to be created across the state. The clinics would operate in two shifts a day and be able to vaccinate 5,000 people a day. The clinics would be run by trained health care professionals and community volunteers.
   It is estimated that 25,000 people would be needed to operate these clinics.
   Northeast Tennessee will receive seven of those clinics and will require approximately 1,400 volunteers to operate them, according to Rader.
   "Our public health region covers seven counties," Rader said. "However, each county will not have its own site. The sites will be located based on population."
   The Regional Public Health Office is currently beginning the planning phase of developing the clinics "with key individuals from the communities," Rader said.
   According to preliminary plans, the vaccination will be offered free of charge in the event of a breakout and will be given on a voluntary basis.
   All plans currently in the works deal only with mass vaccination in the event a case of smallpox is confirmed by the CDC. No plans are designed to make the smallpox vaccine available to the public before an outbreak, according to Dr. Fredia S. Wadley, commissioner of the Tennessee Department of Health.
   According to the CDC, "One suspected case of smallpox is considered a public health emergency."
   Plans for mass vaccination began as a precautionary measure in the event that a nation decided to release the virus in a terrorist attack, according to Wadley.
   According to CDC information listed on the organization's Web site about the smallpox virus and vaccine, "The deliberate release of smallpox as an epidemic disease is now regarded as a possibility, and the United States is taking precautions to deal with such an eventuality."
   The last case of smallpox in the United States occurred in 1949, and the last naturally occurring case in the world came in 1977 in Somalia. In the 1980s, the World Health Organization declared the disease eradicated.
   At that time, the United States and Russia were the only known countries to have strains of the virus in labs. In recent months, the United States government announced that it believed as many as four other countries also had samples of the virus.
   "Iraq is one of the four countries that we're pretty sure has the smallpox virus," said Wadley. "Needless to say, that stirs you to want to have a plan for mass vaccination."
   The vaccine is made from a virus called vaccinia which is a "pox-type virus" related to smallpox, according to the CDC. The smallpox vaccine contains the live vaccinia virus, not a dead virus like many other vaccinations.
   The smallpox vaccine is not given with a hypodermic needle. The vaccine is given using a bifurcated (two-pronged) needle that is dipped into and holds a droplet of the vaccine. The needle is used to prick the skin 15 times in a few seconds. The poking is not deep, but will cause a sore spot. The vaccine is usually given in the upper arm.
   There are risks associated with the vaccine. The CDC estimates that 1,000 out of every one million people who receive the vaccine will experience serious but not life-threatening reactions to the virus. Less than 60 out of one million will suffer serious life-threatening reactions. It is also estimated that one or two people out of one million who are vaccinated will die as a result of the vaccine.
   The key to avoiding such reactions is careful screening of patients receiving the vaccine. Certain factors increase the risk of reaction from the vaccine. Pregnant women, those who suffer from eczema or atopic dermatitis, those undergoing treatment for cancer or who are HIV positive or have had an organ transplant are encouraged not to get the vaccine.
   However, the CDC states that individuals who have been exposed to the smallpox virus, regardless of their health condition, should receive the vaccine. If given to a patient within four or five days after exposure to the virus, the vaccine can still prevent smallpox.