Health officials learn from smallpox alarms

WASHINGTON -- Once or twice a month, federal health officials mobilize to investigate a patient who might have smallpox, a case so suspicious it cannot be ruled out immediately. All false alarms so far, but excellent practice for the real thing, says the director of the Centers for Disease Control and Prevention.

"We regard these false alarms as a very good thing," Dr. Julie Gerberding said Wednesday in an interview with The Associated Press. "Every one of these is an opportunity to learn something."

Gerberding, who took over the CDC last summer, has spent much of her tenure developing and now putting in place a smallpox vaccination program aimed at preparing the nation should the virus return in a bioterror attack.

In the first phase, the CDC had hoped to vaccinate as many as 450,000 people on smallpox response teams and in hospital emergency rooms.

But the program has met stiff resistance from several quarters, and complaints were voiced Wednesday at a Capitol Hill hearing.

Gerberding sought to lower expectations, saying she will not be disappointed if the final number of people vaccinated in the first phase does not reach 450,000. The ultimate question, she said, is: "Are you prepared?"

"That's what we will be monitoring," she said.

So far, CDC officials said, 38 states, plus Los Angeles County and Cook County, Ill., which includes Chicago, have requested 205,700 doses of vaccine for their programs, and 127,200 doses have been delivered to 40 states and counties. Just one state, Connecticut, began inoculations last week; several others are expected to begin this week.

In the end, the total is not likely to reach 450,000 people and could be significantly lower, an administration official said Wednesday.

The vaccine carries rare but serious risks. Experts believe that out of every million people being vaccinated for the first time, between 14 and 52 will face serious, life-threatening reactions, and one or two will die. People who come into close contact with vaccines also can be injured.

Health care unions complain that people who are injured will get little if any compensation for their time lost from work and medical expenses, a problem that federal officials acknowledge but have not solved.

Some hospitals complain that the risks of the vaccine are too great, given that there is no imminent threat that smallpox, which was eradicated, will return.

States complain they do not have enough money to run their programs without cutting into other priorities.

In the AP interview, Gerberding said she expects the numbers to grow as people learn more about the vaccine and after the administration announces a way to compensate those injured.

Gerberding, an infectious disease physician, added that she will be vaccinated when the program moves to its second phase and includes health care workers outside the emergency room and emergency responders.

She also has worked on other bioterroism threats. For instance, she said, the federal government is seeking to purchase additional doses of the antidote for botulism. But smallpox has dominated the past six months.

The key to detecting a smallpox attack will be an astute clinician who notices the distinctive rash, she said, and her agency regularly is called by doctors who believe they may have a case. Usually, she said, experts can rule out smallpox after hearing the symptoms by phone or seeing a picture.

"Having a digital photograph sent to us over the Internet has proven to save us many trips out of the CDC in the middle of the night with our response teams," she said.

An actual case of smallpox would prompt a massive response. The CDC and the state health department would vaccinate anyone who the patient had come into contact with, helping to stop spread of the contagious disease. Depending on the circumstances, officials might begin a regional or national vaccination campaign for the general public.

Once or twice a month since fall 2001, a case has been suspicious enough to "rev up" people at CDC and to send specimens to labs for analysis. At the height of the 2001 anthrax attacks, there were five or six times that CDC sent teams to investigate smallpox cases in New York, West Virginia, Florida and elsewhere.

"It tells us that people are alert and they're concerned (and) it allows us to practice," she said.

Gerberding remains frustrated and on edge that the anthrax attacks, which killed five, remain unsolved.

"I just want so want the perpetrator of the anthrax attacks to be caught because we cannot really relax our vigilance until they are," she said. "The fact that it could happen again at any moment at any time is something that still affects all of us at CDC on a day-to-day basis."

At the same time, she said, she worries others have become complacent.

"Many people have put that issue in the back of their mind. We've relaxed," she said. "Complacency is the enemy of preparedness. And we really have to keep reminding people: They're still out there."