Plan helps guide states should mass vaccinations be needed

WASHINGTON -- Federal officials sent states detailed guidelines Monday for rapidly vaccinating their entire populations against smallpox should the deadly disease return through an act of terrorism.

It's been decades since smallpox was seen in this country and the disease has been eradicated from Earth, so officials would assume that a single case of smallpox means the nation is under attack. They would immediately vaccinate those who had contact with the highly infectious patient in hopes of stemming the spread of the disease.

Experts then would assess the scope of the attack -- including the number of patients, circumstances of exposure and details of their disease -- to determine how many others need protection, officials said Monday. It's possible that even a single patient would trigger vaccinations across the entire country, they said.

"Once there is a case of smallpox, what has been theoretical up 'til now suddenly becomes real. We would anticipate many Americans would want to have access to the vaccine," Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said in an interview.

At the same time, a single case suggests there will probably be other cases, increasing the risk and suggesting the need for "a fairly widespread control program," said Dr. Walter Orenstein, director of the CDC's National Immunization Program.

The plan sent Monday offers specific suggestions for a community that must vaccinate 1 million people in 10 days, but officials said Monday that the timing and the scope of vaccinations will depend on the situation.

'There's a ways to go'

Just last month, Dr. D.A. Henderson, a top bioterrorism adviser to the federal government, said many communities are woefully unprepared for the task. Gerberding agreed. "In most jurisdictions, there's a ways to go," she said Monday.

Although smallpox was declared eradicated in 1980, experts fear that hostile nations or terrorist groups may have acquired the virus and could release it on a population that now harbors very little natural immunity. Routine immunizations in the United States ended in 1971.

The new blueprint does not address a thornier issue now under intense discussion within the Bush administration: whom to vaccinate before an attack even occurs. A decision on that issue is expected by month's end.

The smallpox vaccine offers protection against the disease even if administered after someone is exposed, as long as that person gets the shot within a few days.