SMALLPOX PREPARATION IS REASONABLE



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Last Updated

01 Jan 2003

Source: Seattle Post-Intelligencer, January 1, 2003

COMMENTARY/OPINION

Smallpox preparation is reasonable

By MARY SELECKY AND ALONZO PLOUGH, PUBLIC HEALTH OFFICIALS

These are interesting and challenging times for public health. Now more than ever, agencies such as Public Health -- Seattle & King County and the Washington State Department of Health have key roles in homeland security.

We have always worked to protect the health of people in our communities, but that work is changing. We'll continue to work to make sure water is safe to drink, food is safe to eat and people have access to accurate information to help protect and promote their health. Now we're also preparing for diseases terrorists may spread intentionally -- such as smallpox, anthrax or plague. It's a huge responsibility.

In December, President Bush announced plans to begin vaccinating some people against smallpox. The initial stage includes military, public health and hospital workers. In Washington we have identified about 7,000 public health and hospital positions that would be a part of this first group. This vaccination is entirely voluntary. The public health and hospital workers would form Smallpox Response Teams that can provide critical services to the public in the event of a smallpox attack.

The federal government has not given us a timeline or asked us to begin vaccinating yet, but we're preparing so that King County and the state of Washington will be ready when asked. Be assured, we're approaching this task with appropriate caution. Vaccinating even a small number of people for smallpox is a serious matter.

The smallpox vaccine does not contain the smallpox virus; it contains a closely related live virus. It's very different from the standard vaccines that we all have become accustomed to. Unlike vaccinations for flu, tetanus or measles, the smallpox vaccine can have a range of side effects, some of which may be quite serious. For every million people vaccinated, one or two may die.

People with skin conditions such as eczema, weakened immune systems and women who are pregnant or are planning to become pregnant are at greatest risk for side effects and should not be vaccinated. People living with someone with one of these conditions should not be vaccinated, because of the risk of spreading the vaccine virus to them. Also, breastfeeding women should not receive the vaccine.

Both of us and other public health leaders around the country have struggled with concerns over the safety of this vaccine. We have never been in a situation quite like this. No one has had smallpox since the 1970s, but most of us are no longer immune. If terrorists spread this disease, having a small number of people vaccinated would be our first line of defense, yet some of those people may die from the vaccination. Our plan strikes a balance between the need for preparedness as well as a cautious and conservative vaccination program.

The people who volunteer will be taking a risk, but we in public health will do everything we can to limit that. These volunteers will be your friends, neighbors and family members. They are stepping up to serve their country, and we'll do our best to take care of them. Each volunteer will be carefully screened to make sure they do not have any of the risk factors that can result in a serious reaction to the vaccine. We'll make sure they are well informed of the risks and receive proper follow-up after being immunized.

Questions about liability and compensation for those who have a serious reaction to the vaccine are unanswered. These issues are being worked out on a federal level, and we will not vaccinate until decisions are made.

Although it's important for our communities to have vaccinated teams of people ready to respond, we do not recommend the vaccine for the general public. Right now the risk of side effects from the vaccine outweighs the known smallpox threat to the general public. Our state does not yet have any smallpox vaccine, and when we receive it, it will be used to vaccinate public health and hospital-based response teams. We will not be vaccinating members of the general public in the near future.

It's important to us that everybody is well informed about smallpox and the vaccine. Both of our agencies have information on our Web sites, as does the Centers for Disease Control and Prevention. The Washington State Department of Health site is www.doh.wa.gov. Public Health -- Seattle and King County is at www.metrokc.gov/health. The CDC Web site is www.bt.cdc.gov/

CDC has a phone number for the public -- 1-888-246-2675.

We have no information that smallpox poses an imminent threat, but we believe our plan will help all local communities in our state be better prepared, while limiting the number of people who take the vaccine.

We continue our commitment to protect and promote the health of people in this state, and this limited initial stage of smallpox vaccination is a reasonable action at this time.

Mary Selecky is Washington secretary of health. Dr. Alonzo Plough is director and health officer for Public Health -- Seattle and King County.