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Last Updated

03 Dec 2002

Source: Los Angeles Times, December 3, 2002.

Smallpox Readiness Plan Detailed

L.A. County initially will request 20,000 doses of vaccine, mostly for emergency health-care workers. Critics say far more is needed.

By Lisa Richardson and Charles Ornstein, Times Staff Writers

Los Angeles County is requesting up to 20,000 doses of smallpox vaccine to inoculate emergency health-care workers, as well as some police officers and firefighters, in the first phase of a national effort against possible bioterrorism, health officials said Monday.

The county is finalizing a plan that must be submitted to the U.S. Centers for Disease Control and Prevention by Monday. Every state must prepare a similar proposal, along with Los Angeles County, New York City and Chicago (because of their size).

The California Department of Health Services is requesting 40,000 to 50,000 doses for areas outside of Los Angeles County, spokesman Ken August said.

While the county did not give a firm timetable for vaccinations to begin, the speed with which the CDC has demanded a plan indicates impending action, said Dr. Jonathan Fielding, director of public health for the Los Angeles County Department of Health Services. The idea is to make sure that the disease does not infect health-care providers or emergency response teams who may aid a smallpox victim.

"The immediate goal is to have a significant number of people available in the hospital to treat somebody if they had the problem," Fielding said.

The smallpox virus, which is highly contagious, was eradicated worldwide in the 1970s, but officials are worried that vials of the virus kept in storage in the former Soviet Union may have fallen into the hands of Iraq or North Korea. The concern took on new urgency after the terrorist attacks and anthrax scares last year.

Fielding said he had no information about any new threat or risk of a smallpox attack.

Before vaccinations can begin, President Bush must sign off on a nationwide immunization plan. The president is expected to give the go-ahead as soon as this week to vaccinate military forces and front-line health workers, administration officials said.

National health officials have estimated that about 500,000 health workers would be vaccinated in the first round of inoculations. The Pentagon has requested another 500,000 doses for its troops.

Of the 20,000 smallpox doses requested by Los Angeles County, 15,000 would be used to inoculate emergency room personnel in hospitals and public health workers.

The remainder would go to those who respond to 911 calls and a small number of police officers and firefighters who are part of early warning terrorism teams.

The county's request to immunize these so-called first responders differs from national recommendations that would delay immunizing this group until a second round.

But the number of people transported to hospitals in L.A. County through the 911 system -- about 300,000 a year -- make police and firefighters a logical addition, Fielding said.

Widespread inoculation of police and fire officials would follow in a second phase as would the immunization of the remaining hospital personnel, Fielding said.

That's when the vaccine should be offered to all of the nation's 7 million health care workers and 3 million police, fire and other emergency workers, national health officials have recommended.

In the first round, the 80 public and private hospitals in the county with emergency rooms would be allocated the vaccine -- stored in 100-dose vials -- based on their size, Fielding said.

Vaccinations would be voluntary, and county officials estimate that about 30% of those eligible would be unable to take it because of pregnancy and medical conditions such as HIV and eczema that would make them more susceptible to complications.

Death as a reaction to the vaccine occurs in one to three people per million.

The county's plan was criticized by the Hospital Assn. of Southern California because officials worry that hospitals could be held liable for not offering the vaccination to all personnel or for side effects after the vaccine is administered.

"Here we are asking employees to work where we know now that there is a hazard, and we're only inoculating certain employees and not others," said Jim Lott, the group's executive vice president. "Who is going to play God here?"

Dr. William Bicknell, former director of the Massachusetts Department of Public Health, said all hospital personnel should be offered the vaccine, along with other workers who keep society running. These could include employees of the telephone company, power grid and water supply.

Los Angeles' proposal is "not making it worse, but it's a day late and a dollar short," said Bicknell, a Boston University professor.

Bicknell estimated that Los Angeles County would need 80,000 to 200,000 doses to adequately inoculate all those people whose services would be needed in the event of an outbreak of smallpox.

Fielding called the plan to vaccinate some hospital workers but not others a good first step but emphasized that the county has little choice in how to proceed.

"I understand their concerns, but this is not our choice," he said.

The CDC and Bush administration officials say there is an important distinction between plans needed to vaccinate a population after a smallpox outbreak has been detected and planning efforts aimed at preparing for a possible outbreak.

After confirming a case of smallpox, the government will implement an emergency response plan to vaccinate as many people as possible as quickly as possible.

Shortly after the Sept. 11 terrorist attacks, the Bush administration began building a stockpile of vaccine and developing plans to get it anywhere in the country within 12 hours.

Times staff writer Vicki Kemper in Washington contributed to this report.