Even as anthrax attacks grab the national spotlight, public health officials say they are more concerned about America's ability to respond to another potential bioterror weapon: smallpox.

        Smallpox is a viral disease that killed thousands of people a year until global vaccine programs eradicated the disease in the 1970s.

ABOUT SMALLPOX

• What is smallpox?   It's a disease caused by the Variola virus. One out of three people who get the disease have died in the past. Smallpox is spread from person to person, usually after the sick person develops a fever and a rash.   • Are vaccines for smallpox available and should I get vaccinated?   Smallpox disease was stamped out worldwide in 1980 and vaccination stopped everywhere in the world in 1983. The U.S. Public Health Service does maintain an emergency stockpile of doses.   Source: Kentucky Department for Public Health   Learn more about smallpox

        For years, the only existing traces of smallpox virus were believed to be contained in U.S. and Soviet laboratories involved in research and bioweapons pro grams.

        In theory, smallpox could be a devastating bioweapon — the so-called “poor man's atom bomb.”

        Scenarios played out by emergency officials in domestic preparedness programs have envisioned more than 1 million people dying in several states as a result of a terrorist attack in a single U.S. city.

        However, officials and pundits disagree about how well prepared America may

        be for a smallpox attack.

        Some say the nation lacks the communication systems needed to catch an outbreak in its earliest stages, is burdened by outdated quarantine laws and lacks enough vaccine.

        “We are, at best, unprepared to deal with a bioterrorist attack,” said Dr. Mohammad Akhter, executive director of the American Public Health Association in testimony Oct. 9 before the Senate Health, Education, Labor and Pensions Committee. “We are able to deal with small events but are not in a position to deal with large ones. State and local health departments are not fully prepared to deal with an attack.”

        In Ohio, much planning has occurred for possible bioterrorism attacks, but the state still needs to update quarantine laws, said Malcolm Adcock, Cincinnati health commissioner and president of the Association of Ohio Health Commissioners.

        “The issue of quarantine does need to be revisited by state and local legislators. Everybody assumes the authority is there to issue quarantines, but some of the laws are not clear,” Dr. Adcock said.

        Others are much more confident; saying that the nation's smallpox vaccine stockpile is growing fast, that disease surveillance systems are improving, and that state and local governments have clear plans for what to do should an attack occur.

        Efforts have begun to expand the nation's vaccine stopckpile from about 15 million doses now to more than 300 million, Health and Human Services Secretary Tommy Thompson said last week.

        “Smallpox would be a real problem for us. But people do survive smallpox,” said Dr. Rice Leach, commissioner of the Kentucky Department for Public Health. “The thing people need to remember is that we haven't come into this totally unprepared. We have done some planning for this kind of thing and we are learning as we go.”

        Among unvaccinated populations, smallpox is fatal in about 30 percent of cases. Smallpox victims also spread the disease to about 30 percent of household members and other close contacts.

        Stopping a smallpox attack depends on three basic factors: quickly spotting and reporting the early cases, establishing quarantines to limit contact between exposed and unexposed people, and moving in with vaccines.

        For smallpox, stockpiled vaccines can actually treat the disease if given within four days of exposure.

        But in Cincinnati, establishing and enforcing a quarantine could be tricky, Dr. Adcock said, because victims could span numerous state, county and municipal boundaries.

        Depending on the size of an outbreak, a quarantine could range from ordering families to stay at home until an incubation period has passed to closing off streets and shutting down the local airport to prevent the disease from spreading.

Learn more about smallpox

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