Nevada plans for smallpox vaccinations

Jace Radke

Monday, Dec. 16, 2002 | 11:14 a.m.

Preparing against a potential terrorist threat, Clark County officials plan to vaccinate about 1,000 hospital and Health District workers against smallpox early next year.

The smallpox vaccine could arrive in Clark County as early as January, and health officials plan to start vaccinating volunteers from hospitals and the Health District in February and March.

Although the state's three-phase smallpox vaccination plan is awaiting formal approval by the Centers for Disease Control, the plan is being implemented, State Epidemiologist Dr. Randall Todd said. Nevada's plan is expected to be approved soon.

Under presidential order, states have to develop plans to deal with the potential threat and vaccinate health workers and "first responders," such as police, firefighters and paramedics.

Smallpox, a contagious disease that can be fatal, was eradicated in 1980 due to worldwide vaccination programs.

U.S. officials believe smallpox is being stockpiled by terrorists who could try to use it as a weapon.

Nevada Homeland Security Director Jerry Bussell got a call from Tom Ridge, the national homeland security director, to discuss the disease.

"He wanted to make sure that everyone understands that there is a perceived threat of a smallpox release, but there is no information that an attack is imminent," Bussell said.

Nevada's plan calls for a core group of public health staffers and hospital workers to be vaccinated in Phase 1. In Phase 2 first responders will be vaccinated, probably in the spring, and in Phase 3 the vaccine will be offered to the public, probably late next year or in 2004.

Smallpox is characterized by fever, aches, vomiting and a skin rash, kills about 30 percent of those who contract it naturally.

The disease was declared eradicated in 1980 after worldwide vaccination, but the virus can be packaged for use as a biological weapon. The possibility of a bioterrorist attack using smallpox has led states to implement vaccination plans.

Because smallpox was eradicated, and no longer occurs naturally in the United States, there is some question as to how the vaccine will effect those that are vaccinated, said Jim Najima, Nevada's public health preparedness coordinator.

Some health officials predict two people of the 500,000 initially vaccinated in the United States could die from side effects of the vaccine.

"There is not a lot of research out there as to what would or would not happen with the vaccine," Najima said. "Since it was eradicated the only place smallpox has existed is in a laboratory, and there wasn't much research done on it because there wasn't much of a need.

"Now we really don't have a baseline."

Screening of potential volunteers will be employed in an effort to weed out those who would be most susceptible to complications from the vaccine. For example a female who could be pregnant would take a pregnancy test first, or someone suffering from immune deficiency illness would take an HIV test before being vaccinated, Najima said.

"There are always possibilities for problems, but there are going to be interviews and extensive screening," Najima said. "The military, which will be the first group getting the vaccine, will be going through screening, and that should give us an idea of what to expect."

The smallpox vaccine is made from a virus called vaccinia, which is another "pox"-type virus related to smallpox. The vaccine does not contain the smallpox virus and cannot spread smallpox, according to the U.S. Department of Health and Human Services.

Getting smallpox vaccine before exposure to smallpox will protect about 95 percent of people from getting the virus. Routine vaccination of the American public against smallpox stopped in 1972 after the disease was eradicated in the United States.

In Clark County, all vaccinations will be voluntary, with about 1,000 people expected to be vaccinated in the first phase, said Dr. Donald Kwalick, the county's chief health officer.

The vaccine does not contain the actual smallpox virus but can cause a rash, a fever and body-aches and headaches.

"All historical data suggests that there are one or two fatalities per million, so with the vaccination plan set for 500,000 in the first phase I wouldn't expect to see any," Kwalick said. "We know a lot more today then we did 30 years ago, and any side effects should be picked up early on."

In Clark County those who volunteer to be vaccinated will be monitored and contacted regularly by the Health District to assess any side effects early on.

"If we start to see side effects and we catch it early on we can treat it," Kwalick said.

Bill Welch, president of the Nevada Hospital Association, said the state's hospitals are planning how to best initiate the plan because "we can't have a whole department volunteer, then be out sick, so we're working to stagger it,."

However, Welch said, "there hasn't been one hospital that has said they and their staff would be unwilling to participate."

The vaccine is administered by dipping a two-pronged needle in the vaccine and pricking the skin with it 15 times.

"At the local level we are working to identify the people who will be vaccinated in Phase 1," Kwalick said. "We are also sending two Health District workers to the Centers for Disease Control and Prevention in Atlanta to be trained on how to administer the vaccine."

The two Health District workers, expected to leave for Atlanta this week, will teach others how to administer the vaccine when they return.

Kwalick estimated that as many as 10,000 people will be vaccinated in Phase 2 next spring. Phase 3 will have to wait until more vaccine is made available next year or early 2004, Kwalick said.

"There is not enough vaccine out there right now for the additional phases, but it is being made," Kwalick said.

Those depressed immune system illnesses, such as AIDs or HIV, will not get the vaccination, because of their increased susceptibility to side effects, Kwalick said.

Those most likely to experience side effects of the vaccine include people who have had skin conditions, especially eczema or atopic dermatitus, and people with weakened immune systems.