Area doctors learn to vaccinate for smallpox

Monday, Nov. 26, 2001 | 9:34 a.m.

National health officials are distributing training videos that show local practitioners how to administer the smallpox vaccine, a move Clark County's top doctor called an essential step toward bioterrorism preparedness.

"It's a more complex procedure than the basic shot," said Dr. Donald Kwalick, chief health officer for Clark County. "If the CDC is putting together 300 million doses, those are 300 million doses that are going to have to be administered by someone who knows what they're doing."

The proper method of administering the smallpox vaccine has been an obsolete skill for more than 20 years. Doctors and nurses are no longer taught the procedure as part of their basic training.

Hundreds of copies of the training video have been sent to help individual states improve bioterrorism readiness, said Dr. Jeffrey Koplan, director of the Centers for Disease Control and Prevention in Atlanta. For now the vaccines are being limited to military members and certain health and laboratory workers.

To give the vaccination, a drop of the vaccine is placed on a two-pronged needle, which is then pricked into a person's arm 10 to 15 times, Kwalick said. Most vaccinations involve drawing the dose from a vial and into a hypodermic needle. No dressing is put over the small sore that forms at the vaccination site.

The World Health Organization in May 1980 reported that smallpox had been eradicated. The last reported cases of the highly contagious disease were in Somalia in 1977, followed by a laboratory worker in the United Kingdom who became contaminated in 1978.

Dr. Mary Guinan, who resigns Dec. 7 as Nevada's state health officer, said the training videos would likely be distributed statewide through Nevada's Health Alert Network. Guinan, who worked with the World Health Organization and is considered an expert on smallpox, said millions of older Americans vaccinated when they were younger are not likely to still be immune. No one knows exactly how long the vaccines last, Guinan said.

The vaccines aren't without potential dangers -- serious side effects can cause illness and even death. In New York City in 1947 -- the most recent smallpox scare in the United States -- more than 8 million people were vaccinated against the disease. No one died of smallpox, but several people died as a result of adverse reactions to the vaccine, Guinan said.

Some of the CDC's health workers, the same people who would respond and investigate any possible bioterrorist attack, already have been vaccinated against smallpox. Millions of Americans older than 30 have a vaccination scar. The United States stopped routine smallpox vaccinations in 1972, because the chances of contracting the disease didn't outweigh the risk of serious side effects.

Smallpox symptoms include a rash of pustules and a high fever. The death rate is high, and there is no treatment or cure. Unlike anthrax, which isn't contagious, smallpox is easily transmitted from person to person.

Health districts were formed in the United States to control infectious diseases such as cholera, influenza and smallpox. As diseases such as polio and smallpox were conquered, public health officials shifted their focus from infection control to education and social services.

Since Sept. 11 the pendulum has swung back, Kwalick said.

"We have organizations out there that are interested in wreaking havoc and spreading disease," Kwalick said. "It's a whole new ballgame."

In addition to learning how to give the smallpox vaccine, the health district needs to re-evaluate how it would handle an outbreak of smallpox or other highly infectious disease, Kwalick said.

"We haven't changed our laws as they relate to quarantines and epidemics in 50 to 75 years," Kwalick said.

As the regulations stand Kwalick would need a court order to quarantine anyone suspected of carrying an infectious disease. In the event of a bioterrorism attack, which could involve thousands of people, Kwalick would still need to get each person's name and an individual court order.

"We need a mechanism in place for responding quickly and preventing the flow of infection," Kwalick said.