Mass vaccinations could thwart a bio-terrorist bent on infecting America with a smallpox virus, but Tristate researchers and health officials warn that, for some, the cure could be worse than the disease.

        “Some people could die,” said Dr. Richard Greenberg, an infectious disease expert at the University of Kentucky who is conducting a clinical trial of a new smallpox vaccine for the Defense Department.

        “The first thing for the medical community is to do no harm,” said Dr. Greenberg, who began testing the new vaccine Tuesday on the first of a group of 150 volunteers. “We must be very careful.”

ABOUT SMALLPOX

Smallpox, which is caused by variola virus, is spread between people by infected saliva droplets from face-to-face contact with an ill person.     People are most contagious during the first week of having the disease, but they can infect others throughout their illness.     Initial symptoms include fever, fatigue, head and back aches. A rash covers the infected person's body — especially their arms, face and legs — and turns into lesions that crust into scabs. Up to 30 percent of cases end in death.     People should get a vaccine within four days of exposure to prevent serious side effects. People getting the vaccine are pricked about 15 times.     Those with immune system abnormalities — such as people with HIV — or people with chronic skin disorders are recommended not to get the vaccine because of severe complications, said Curtis Allen, spokesman for the Centers for Disease Control and Prevention in Atlanta.     The vaccine's mild side effects include redness, swelling and fever. But about one of every 10,000 people vaccinated would require a doctor's care, Mr. Allen said.     An estimated 300-600 people would die if a vaccine was given to everyone in the country.     Source: Centers for Disease Control and Prevention

VACCINATIONS

If the United States faced a smallpox outbreak today, even people who had been vaccinated before would need another one.     “Most likely, those who were vaccinated 30 years ago would have to be revaccinated if there were a smallpox outbreak,” said Curtis Allen, a Centers for Disease Control and Prevention spokesman.     Routine smallpox immunizations stopped in 1972. Before then, vaccinations would cause a scab, which would be the sign that the vaccination had taken, Mr. Allen said.     But since the vaccine wears off over time, even those bearing the scar of a smallpox vaccination would probably need to be revaccinated, he said.     In 1980, the World Health Assembly said the world was free of naturally occurring smallpox.

        Smallpox had not been a concern for Americans over the past 25 years, after a mass, government vaccination drive in the 1960s all but eliminated it.

        Vaccinations stopped in the United States in 1972, and world health officials declared the highly contagious disease to be eradicated eight years later.

        Then came the terrorist attacks of Sept. 11.

        Federal officials began debating whether mass vaccinations of the American people with existing supplies of smallpox vaccines should begin immediately or should wait until there is a reported case of the disease.

        They began laying the groundwork for a mass vaccination program this week with the announcement by the Centers for Disease Control and Prevention in Atlanta that 500,000 health care and emergency workers around the country will be vaccinated as a precaution against a bio-terrorism attack.

        Locally, Michelle Halloran, an emergency room nurse at St. Elizabeth Medical Center North in Covington, said she and her colleagues are well aware that they would be on the front lines if there were an outbreak of smallpox.

        “But none of us has shared any concerns about it with each other,” she said. “I'd hate to see any panic or major concern where there was none. We should be concerned and aware, but not panicked.”

        Smallpox vaccine supplies are plentiful now because manufacturers began turning out the vaccine after Sept. 11 in anticipation of possible mass inoculations.

        Some researchers, too, say that existing supplies can be diluted without losing effectiveness; and might carry less risk in diluted form.

        According to the Centers for Disease Control and Prevention, smallpox vaccinations given today would involve 15 needle injections, with possible side effects of swelling and fever.

        About one in 30,000 would get sick enough to see a doctor. Clinical tests and medical research into smallpox vaccines have also been ratcheted up at research facilities around the country, including two in the Tristate.

        At UK, Dr. Greenberg and his colleagues are testing a vaccine developed by DynPort Vaccine Co. LLC, a Maryland firm that supplies bio-defense vaccines to the military.

        And, in Cincinnati, at Children's Hospital Medical Center, where the oral polio vaccine was developed in the 1950s, researchers are using a five-year, $21.7 million grant from the National Institutes of Health to study vaccines for smallpox and other viruses that might be used as terrorists' weapons.

        At both institutions, researchers are working to minimize or eliminate the side effects of illness or even death from the vaccines. In the earlier mass vaccinations, thousands of people with immune system disorders or even skin diseases such as eczema suffered severe side effects or died from the vaccinations.

        The Centers for Disease Control estimates that if there were a mass vaccination program today using the existing supplies of vaccine, anywhere from 300 to 600 people nationwide would die from the inoculation.

        “That's probably the best reason not to inoculate everybody immediately,” said Dr. Malcolm Adcock, Cincinnati's health commissioner. “It's too big a risk.”

        Dr. Adcock said that if there were a reported, confirmed case or cases of smallpox and federal officials ordered mass vaccinations, the delivery system would be in place.

        “We do that sort of thing with flu shots every year,” Dr. Adcock said. “We could do it through the clinics, through the rec centers, the schools; and we'd try to recruit as many private physicians to administer it as possible. We'd muster manpower wherever we could.”

        People over the age of 31 who were inoculated in the 1960s and early 1970s would have to be inoculated again.

        “There has always been a lot of debate about how long that inoculation would be effective — 10 years, maybe 20 years,” Dr. Adcock. “But certainly they would need it again now.”

        But there are about 140 million people in the United States — the youngest Americans — who have never had any kind of smallpox vaccine.

        “The one thing I am seeing that concerns me is that there is a lot of complacency out there, particularly among young people, about the threat of a bio-terrorist using the smallpox virus,” Dr. Greenberg said. “We have to start educating the public. We have to start taking this seriously.”

        One threat scenario being considered by the CDC is the possibility of an infected passenger on an aircraft.

        “Our basic plan is to isolate the aircraft in a remote part of the airfield and contact the appropriate local agencies,” said Chad Everett, assistant director of operations at Cincinnati/Northern Kentucky International Airport in Hebron.

        “They would make the determination as to what would happen to the passengers.”

        Dr. Greenberg said that public health officials would have to be “extremely careful” in screening out people who might be at risk of harm from the existing stocks of smallpox.

        “We have to ask ourselves, "How many people are we willing to make sick or die to accomplish this?'” Dr. Greenberg said.

        But the Cato Institute, a think tank in Washington, D.C., recently issued a study urging federal officials to make the vaccine available to everyone and to do it now — before there is an outbreak of the infectious disease.

        “You make it a voluntary thing, and people can make their own decisions about whether or not they are at risk,” said Charles Pena, a defense policy analyst who co-authored the Cato study. “Doctors shouldn't be making these decisions; their patients should.”

        Mr. Pena said recent polls have shown that 60 percent of the American people say they would take the vaccine if offered.

        “The American people seem to be concerned enough that, if given the opportunity, they would choose to be vaccinated,” Mr. Pena said.

        People with immune-deficiency disorders or certain skin diseases can reasonably be expected to opt out of the inoculation program, Mr. Pena said.

        “I think the vast majority of people who are HIV-positive might say, "I don't want any part of this, because I could die,'” Mr. Pena said. “But that should be their choice to make.”

        Dr. Adcock said he believes that, for now, the plan to inoculate 500,000 emergency and health care workers, is a good starting point.

        “We could begin a mass campaign today,” he said, “but only if we are willing to accept the risks.”

       Erica Solvig contributed to this report.
       
       

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