September 11 changed the world forever, especially the U.S. The fear generated by recent anthrax attacks has faded into a nearly distant memory for most Americans. Yet, the AMI building in Florida -the tabloid newspaper chain attacked by anthrax sent through the mail-remains closed due to contamination. And emergency rooms across the nation are undergoing extensive remodeling to get ready to deal with biological, chemical and nuclear material situations, if one should occur.
As most of you now know, we are in the midst of an unprecedented public health and safety effort to begin voluntary smallpox vaccinations. You will have the option of being voluntarily vaccinated, along with your family members. This voluntary vaccination will begin sometime in 2004. I believe that the most vital part of deciding whether to receive the vaccination or not is education and communication . With that in mind, here are some facts and information that will, hopefully, better inform you so that you can make a rational decision on whether to be vaccinated or not.
( NOTE: YOUR DECISION TO BE VACCINATED OR NOT WILL OCCUR SOMETIME IN 2004. No one is asking you to make that decision now or in the next few months, as no clinic is equipped to administer the vaccine at this time. Your decision is voluntary. If you decide you don't need it or want it, then you don't have to receive the vaccine.)
Routine vaccinations against smallpox ended in 1972. In 1980 the disease was declared eradicated from the world. The last naturally occurring U.S. case of smallpox was diagnosed in 1949. Smallpox exists today only in a handful of laboratories around the globe, and more than likely some is in the hands of terrorist.
The smallpox vaccine is a live virus vaccine, as are the measles/mumps/rubella and chickenpox vaccines used in the U.S. today. The virus activates the body's immune system to protect against infection. The vaccine contains the vaccinia virus, similar to smallpox but not as dangerous. The vaccine will not cause smallpox, but will cause its own set of symptoms and problems.
Protection develops 8-14 days after vaccination (faster if the person was vaccinated in childhood). 91-95% are protected after the first dose. The vaccine is 95% effective for up to five years and then protection fades. Since routine vaccination stopped approximately 30 years ago, no one is currently considered immune.
Vaccine side effects are more common in people receiving their first dose. The side effects include lymph node swelling and tenderness around the immunization site, fever, head and body aches. A rash may develop 10 days after vaccination and also encephalitis. Up to 25% of people vaccinated for the first time may be unable to work for a few days (approximately 8-10 days after vaccination) due to systemic signs and symptoms of illness. There is a higher rate of side effect/complications than other vaccines used today. Complications rates are significantly lower among people who were vaccinated in childhood (revaccinated). Historically, for every 1 million people given the vaccine for the first time, 15-52 will have life-threatening side effects and 1-2 will die.
After the vaccine is given, it is very important to follow instructions for care of the vaccination site. Live virus is shed from the site and can be spread to other parts of your body or even to other people.
Screening out people at highest risk of developing complications can reduce the number of vaccine side effects. Here are the contraindications to vaccination: pregnancy, nursing mothers, eczema/dermatitis, less than one year old, household/close contacts to individuals who have contraindications, and people with weakened immune system, such as HIV, leukemia, post-transplant, and cancer chemotherapy.
The available data from the 1950's and 1960's show that there is a risk of vaccinia transfer from a primary vaccinee to an unimmunized individual in contact with the vaccinee. But the risk is not large, and this risk needs to be kept in perspective. The U.S. studies indicate that transfer of vaccinia virus from contacts that resulted in EV (eczema vaccinatum-a severe skin rash) occurred at a frequency of about one to two per 100,000 primary vaccinations, and the overall transmission of contact vaccinia occurred in the range of 2 to 6 per 100,000 primary vaccinations. The authors noted that "in all of the studies, contact vaccinia required close contact, was an unusual occurrence outside of the home, and occurred rarely as a result of hospital-related contact." They noted that it is impossible to predict the likelihood of adverse events. They indicated, however, that there are more people with eczema and other skin conditions and compromised immune systems than there were in the 1950's and 1960's who may be more susceptible to adverse reactions to a smallpox vaccine.
An orderly, systematic approach along with careful screening to identify potential vaccinia-susceptible individuals and household contacts and close monitoring for adverse effects are essential to reduce the risk of transmission of vaccinia following smallpox vaccination.
IF YOU HAVE BEEN EXPOSED TO A KNOWN CASE OF SMALLPOX, THERE ARE NO CONTRAINDICATIONS TO THE VACCINE.
The incubation period for smallpox is 12 days. One is considered contagious to others when the rash erupts until all scabs fall off. The death rate from smallpox, not the vaccination, was 30% in the 1970's.
If there is an actual outbreak of smallpox and you have not been vaccinated or revaccinated, then you still can be vaccinated. Vaccination within 3 days of exposure will completely prevent or significantly modify smallpox in the vast majority of persons. Vaccination within 4-7 days of exposure will also likely offer some protection from disease or modify the severity of the disease.
Once there has been an outbreak of smallpox, if you have not been vaccinated, you will be asked to gather at one of the collection sites (sites are not identified yet). At the collection site, health care personnel will arrange for your transportation (by mass transportation, such as MATA) to one of the 20 clinics (clinic sites also are not yet identified), where you will receive the vaccination. There will be one clinic for each 50,000 population. They will be open 24/7 for up to 10 days. They will treat up to 6,000 people per clinic per day. There will be more than 200 public health staff and volunteers at each clinic.
Additional information can be obtained from the following website: www.cdc.gov/smallpox or call the CDC Public Response Hotline at (888) 246-2675 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY). I hope this will help you make an informed decision!
While we are the subject of smallpox vaccination, to help implement the smallpox vaccination program, 10,000 volunteers are needed who will staff vaccination clinics where all Shelby County residents could be voluntarily vaccinated if a smallpox case is confirmed anywhere in the United States. Some of these volunteers will be offered smallpox vaccination in the coming months. If you would like to volunteer, call the Memphis and Shelby County Health Department at 725-4687 or (fax) 725-1119. You do not have to be in the medical or nursing profession to be a volunteer.