By Cindy Schroeder
The Cincinnati Enquirer

As President Bush prepares to announce plans today for making the smallpox vaccine available to all Americans, Tristate public health officials are grappling with protecting 30,000 health care workers and an international airport.

Because the president's plan calls for vaccinations within weeks for 500,000 troops and 500,000 healthcare workers and first responders to emergencies, Greater Cincinnati's nurses, doctors, technicians and emergency workers will soon be offered the risky vaccine, presenting them with a difficult choice.

"The soonest we think we would be asked to give the vaccine to medical personnel would be the end of January,'' said Gwenda Bond, spokeswoman for the Kentucky Department for Public Health. "Exactly who would be vaccinated in this first stage would be decided at the local level by the acute-care hospitals and district health departments.''

Public health officials are also making plans for protection of the region's international airport, which has the fourth-highest number of departures in the world.

"Because the Cincinnati airport is an international hub, we are more likely than some other areas to get a smallpox terrorist event,'' said Jennifer Hunter, R.N. B.S.N., quality assurance manager for the Northern Kentucky Independent District Health Department.

"If a terrorist group wanted to infect (U.S. citizens), they could infect people in Iraq or Afghanistan and put them on international flights to here. Those people could start hacking and coughing on anyone on their planes, spreading the virus."

In that event, the Northern Kentucky health department and the federal Centers for Disease Control would have the authority to keep passengers on the plane, examine the plane's passengers and crew, and quarantine anyone believed to have smallpox, Ms. Hunter said.

Under President Bush's plan, the shots would be mandatory for about a half-million military personnel and recommended for another 500,000 people in hospital emergency rooms and special smallpox response teams.

The general public would be offered the vaccine on a voluntary basis after the government has amassed a sufficient stockpile, possibly in early 2004.

Once one of the most feared diseases on earth, smallpox, a highly contagious virus, killed hundreds of millions of people in past centuries. However, it hasn't been seen in the Tristate since 1948 or in the United States since 1949.

In 1980, the World Health Organization declared it eradicated. Today, the only acknowledged stockpiles of the virus are in government laboratories in the United States and Russia.

However, the Soviet stockpile has never been fully accounted for and there is concern that smallpox could be used for bioterrorism.

"If a confirmed case of smallpox were to occur, it would very likely be an act of terrorism,'' said Bret Atkins, spokesman for the Ohio Department for Public Health.

"Even though the risk of such an event is very low, the consequences could be great, so you've got to make some preparations. Thirty years ago, we had a population that was immunized (against smallpox). Today, we don't."

On Tuesday, all but five U.S. states submitted plans to the federal CDC explaining how many people they planned to inoculate during the first stage. For Ohio, that amounts to as many as 13,000 health care workers. Kentucky would vaccinate up to 10,000, and Indiana would vaccinate another 7,000.

By late January, the Northern Kentucky health department hopes to fill the newly created position of counter-bioterrorist administrator, who would plan and coordinate all counter-bioterrorism related services and programs.

In recent weeks, Tristate health care workers also have learned how to recognize and treat the disease at national teleconferences held by the Atlanta-based CDC, as well as state-sponsored sessions.

"As recently as 30 years ago, (health care workers) had a working knowledge of smallpox," Mr. Atkins said. "But today, you've got a whole generation of doctors and nurses who've never seen smallpox in person. They need to be taught what to look for."

Experts disagree on what residual protection people would have if they received the smallpox vaccination before 1972.

"It's conceivable a person (vaccinated 30 or more years ago) could become ill but not die from it," Mr. Atkins said. "But there are different opinions within the medical community as to what, if any protection, would be offered."

The disease is caused by a virus called variola, which is spread from person to person through close contact. Smallpox can cause a severe rash, which can leave scars when healed, high fever, tiredness, severe headaches and backache, blindness and death in up to 30 percent of cases.

The good news, health care officials say, is that for up to four days after exposure, someone who's been exposed to smallpox can be vaccinated and would not come down with the disease.

The vaccine - made from a live virus distantly related to smallpox - is given by pricking the skin 15 times with a two-pronged needle. Typically, a red, itchy bump develops after three or four days and becomes a fluid-filled blister after a week. A scab forms and falls off after three to five weeks, leaving a small scar.

Health officials say 20 percent to 30 percent of the population -those with a weakened immune system, such as cancer patients or anyone receiving chemotherapy, organ recipients and HIV positive people or those with AIDS - should not get the vaccine.

Others who shouldn't get the vaccine include pregnant or breast-feeding women, children 1 year old and younger, anyone with eczema, atopic dermatitis impetigo, unhealed burns, contact dermatitis or chicken pox, as well as anyone in regular contact with anyone in those groups.

That means health care workers who have young children, such as Ms. Hunter, would have to be isolated or quarantined for a week after receiving their vaccine.

Anyone suspected of having smallpox would be isolated in hospitals or other "appropriate infection control facilities,'' according to the Kentucky Department for Public Health's plan. People who had been exposed but hadn't developed symptoms would be vaccinated. Those who were vaccinated and developed symptoms would be kept in a hospital.

The Louisville Courier- Journal and the Associated Press contributed to this report.

E-mail cshroeder@enquirer.com