Smallpox would be handled with five-day plan

BIOTERRORISM

By Scott Moyers ~ Southeast Missourian

Five days. That's how long state and local health officials would have to vaccinate the more than 60,000 Cape Girardeau County residents if smallpox were discovered here as part of an act of terrorism.

Those same officials concede it would be difficult and done under the most extreme conditions. But they also insist it can be done.

"It might be chaotic, but I think 60,000 is very do-able in five days," said Pam Walker, director for the state's Center for Emergency Response and Terrorism. "The last mass vaccination was in New York City in the late 1970s. They vaccinated 3 million people in five days, so we can do 60,000."

Five days after an initial exposure to smallpox, the vaccine -- a form of cowpox that makes the recipient immune to smallpox -- becomes less effective in fighting the virus in the body. So from a strategic perspective that's the time frame the center is focusing on as part of its planning process should the worst happen.

Walker received guidelines this week from the Centers for Disease Control and Prevention about how to provide mass vaccinations should the country come under a bioterrorism attack. The plan provides technical details and information about what should happen if a case of smallpox were discovered in Missouri.

"It's basically giving us some support and framework for what we can do," Walker said. "Much needed framework."

According to the plan, if a case of smallpox were discovered locally, the vaccine would be shipped by the CDC -- which keeps 100 million doses hidden at 10 different sites in the United States -- to the area. It would take about 12 hours to get here, Walker said.

A national emergency would be declared, even if it were only one case, Walker said. The media would be contacted to get the word out. Local law-enforcement would be notified. The CDC and state officials would be in constant communication with local health officials.

"We'd want to find out what resources you need and how to get them to you," Walker said. "We'd call out the National Guard. Our first assumption would be this is a terrorist act. Smallpox is not naturally occurring. We would have to assume it was intentional."

After the person diagnosed with symptoms of smallpox had been inoculated, emergency personnel and other first-responders would be given the shot. A team of epidemiologists would be sent from the state's Department of Health and Senior Services to monitor the patient and to recommend who else should get shots. The closest such state expert is in Poplar Bluff.

Inoculations would be given to those who had come into contact with that person who was first diagnosed -- relatives, health-care workers and even whole towns, as deemed necessary, Walker said.

If it did come to that, then vaccination stations would be set up around the county and health officials and volunteer health-care providers would begin to give shots as quickly as possible, round-the-clock if necessary, she said.

Once the Missouri version of the plan gets state Department of Health approval, which is set for Oct. 15,local health agencies will be asked to begin detailing vaccination station sites, volunteer lists and necessary preliminary training.

Walker is working with the National Guard to determine the availability of its medical personnel. She has even asked the CDC that some of the vaccine be stored in Missouri. Currently, none of the vaccine is in the state, she said.

They are also planning some public information seminars and drills.

The possibility may be small, but Walker said that with the talk of war with Iraq, the United States needs to be on its toes. Iraq is one of the countries said to be experimenting with smallpox and other viruses.

"Nobody ever thinks it's going to happen until it does," she said. "We are the heart of the country and the crossroads. It could start here and spread both ways if we don't stop it. But I'm convinced we can."

Locally, emergency and health officials were unaware of the plans specifics but said they are eager to implement it.

"I knew a plan was imminent," said Charlotte Craig, director of the Cape Girardeau County Public Health Center. "We're glad to know it's here, because we're going to be right on the front lines."

Craig said her staff and other health-care providers are going to have to retrain themselves on smallpox, which has not been found in the nation since 1980.

But Craig said she was confident that the community would respond.

"The learning curve would be rapid," she said. "It's just a matter of gearing up and shoring up, finding partners."

Walker said that the state will be much better prepared in six months or a year.

"But we've got enough of a framework in place, we could do this if we had to," she said. "We're doing all this work hoping we never have to use it."

smoyers@semissourian.com

335-6611, extension 137