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Smallpox: Should Everyone Be Vaccinated?

Study Says 'Yes' -- If Biological Terrorist Attack Has Occurred
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WebMD Health News

July 10, 2002 -- America is gearing up for the worst-case scenario -- a deadly smallpox attack. The best defense is mass inoculation, with all U.S. residents rolling up their sleeves as soon as there's evidence of exposure, says one Yale epidemiologist.

The Yale report comes on the heels of a new federal announcement -- one calling for vaccination of emergency personnel and healthcare workers, some 500,000 people. Each state would designate teams to receive the shots, teams that will consist of doctors, disease trackers, nurses, lab workers, and law enforcement officers -- the first to respond in case of bioterrorism attack, according to the Department of Health and Human Services.

Volunteers at four sites around the country are already being inoculated with diluted doses of two vaccines to test their effectiveness. A vaccine known as Dryvax was made 20 years ago; 15 million doses of it are available. Another vaccine by Aventis Pasteur, Inc., was donated to the government; the company has stockpiled it for decades.

"I think it makes sense to vaccinate emergency responders pre-attack, precisely so that there will be a pool of persons who can protect the rest of us," says Edward H. Kaplan, PhD, professor of management science and public health at Yale School of Medicine, in an email interview with WebMD.

However, Kaplan takes issue with the CDC's overall plan for handling deadly outbreaks, which is known as "ring vaccination." It means vaccinating those who are exposed and others they have come in contact with -- as well as contacts of those contacts -- all of which constitutes the ring of infection.

Relying on ring vaccination would be "a huge error ... [and] will fail in all but the most meager outbreaks," Kaplan says.

Mass vaccination of the U.S. population -- on the other hand -- would result "in far fewer deaths and much faster epidemic eradication," he writes in his study of the issue, which appears in this week's Proceedings of the National Academy of Sciences.

But "ring vaccination and mass vaccination are not mutually exclusive," Jim Hughes, MD, director of the CDC's National Center for Infectious Diseases, tells WebMD.

"Ring vaccination will be part of any response in case of an attack [using an infectious agent]," he says. "It's a strategy that has been used around the world and has worked."

Smallpox was indeed eradicated worldwide in 1979, although some countries have experimented with the virus as a potential biological warfare weapon.

"Depending on the nature of the attack, the outer ring could be small or quite large," Hughes says. "It could be an entire community or -- in worst-case scenario when there's a large release in an international airport or multiple simultaneous releases -- it could mean a very large and very quick mass vaccination."

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