Posted on 06/24/2002 5:36:24 PM PDT by bonesmccoy
Only if parties besides those who don't want the vaccine try to make the decision.
I'd hate to be in Bush's shoes. He would be-and should be-impeached after a successful smallpox attack, successful because he failed to release vaccine which is completely within his discretionary authority to do.
As far as bones's qualifications-I am a board-certified and practicing Infectious Diseases specialist and epidemiologist, and I agree with bones completely.
Dr. James Koopman (U of Michigan). Science, volume 296, number 31, May 2002. "Smallpox is a barely contagious and very slow-spreading infection." Do you actually want to engage in a comparison of the risks of invasive Streptococcal Pneumonia and Prevnar's side effect profile vs. the risk/benefit ratio of smallpox immunization and Wyeth's old vaccine? While the disease is barely contagious, the issue is not entirely one of public health issues. The issue is also one of international strategic threat and terrorism. In this case, we have the defensive missile shield already in our possession. The only factor defeating protection for most people is fear of litigation!
From AP, June 16. Dr. Paul Offit, chief of infectious diseases at Children's Hospital in Philadelphia: "I would not give that [smallpox] vaccine to my children now."
Please review the funding of Dr. Offit's office at CHOP. Post the sources of his grant funding for us to see please. You should also clarify which vaccine Dr. Offit is referring to.
Dr. Anthony Fauci, chief of infectious diseases at the National Institutes of Health. "Fauci...told scientists and health officials the [smallpox] vaccine is one of the least safe around, although clearly a lifesaver if smallpox makes a comeback."
Neither Fauci nor ANY of the physicians you quote were involved with or participated in the elimination of smallpox in 1977 by WHO. Fauci's comments are laughable when one compares the risk/benefit profile of smallpox to Rotashield.
But do understand--you won't make the decision for those who don't want the vaccine.
I am making the decision for MYSELF, MY FAMILY, and any patients/families who want similar treatment. It is unacceptable for government to preclude me from doing my best to defend my patient's interests. In this case, the ACIP is dead wrong and I don't intend on permitting the on-going hypocrisy at ACIP to continue status quo.
I can think of no better example of government hypocrisy and failure that the recent ACIP recommendation. ACIP admits the threat is real and chooses to immunize themselves and their "teams". ACIP fails us because it does not provide for the common defense. Ronald Reagan said in 1980, "Government isn't the solution to the problem. Government is the problem!"
With all due respect, unless you are an epidemiologist or similar infectious disease specialist, your professional credentials go only so far.
I don't need to post resume. I have already posted plausible and reasonable public policy discussion. If you have some reason to attack that policy, state it! If not, end your attempt at "resume attack" and start revealing your real identity. May I inquire what your credentials are?
Quite obviously, there are others in the medical profession who don't regard smallpox vaccination as an essential medical service.
quite obviously, you choose to not safeguard yourself or your family. That is your choice. However, your choice should not limit my ability to defend my own family and community.
So far as you know, and safe to say that Biopreparat doesn't send a full accounting of its activities to American physicians.
READ KEN ALIBEK and LISTEN TO GENERAL EITZEN. I have.
Other than anecdotal evidence to the contrary, neither do you.
I'd say that General Eitzen isn't lying when he publicly states the threat. Has the CDC requested a briefing from the General? Did ACIP even consider a threat assessment by USAMRIID? If so, the ACIP statement does not even acknowledge the leading role that USAMRIID should be playing. Instead, the liberals are attacking USAMRIID as the "source!" of anthrax. How ridiculous!
Right. And you'll also want a pair of E-passes for the rides at USAMRIID?
1. You don't have E-passes at USAMRIID.
2. You have no data to support your arguments
If you do have data, you've not posted one lick of it.
Nice to get a qualified opposing viewpoint. Perhaps you would be so kind as to comment on the quotes in #16. Also, and although it would be nice if it were strictly a rhetorical question, where is the line? There are some problems with the Vaccine-of-the-Week approach to all potential threats. And why, if smallpox was reduced to two carefully controlled stocks, does it now pose such a threat?
The same quotes to which you replied. Thank you.
The MSNBC story basically is rewritten from the ACIP recommendation for a lay audience.
Ironically, in another MSNBC story posted today, scientists appear to dispute ACIP's recommendation. http://www.msnbc.com/news/771788.asp
Scientists urge anti-terrorist action Lack of planning yields ‘enormous vulnerabilities,’ study says---- ASSOCIATED PRESS "WASHINGTON, June 24 — Warning that the country suffers “enormous vulnerabilities” to terrorist threats, top scientists called Monday for immediate action to tighten control of nuclear materials, ensure production of medicine to repel biological attacks, improve transportation security and protect energy distribution systems."
ACIP appears to favor planning for less and hoping that the WMD is never used. It is unreasonable to permit such vulnerability for our citizens.
I do agree that it all depends on threat assessment, and if I thought it was zero, I would not favor voluntary vaccination.
But I don't think it is zero, and neither do the authorities who are funding a crash program to develop a new vaccine and to produce 300 million doses.
I think the POV that the threat is low to nonexistent is not data based-I think it is based on wishful thinking, and the wish to maintain the fiction that smallpox was "eradicated" in 1977.
Of course it was not eradicated, and there is a good reason that the two cold war antagonists were permitted by treaty to keep it alive-because of its enormous military potential. According to the same treaty, we are supposed to destroy our stocks this very year.
Do you think this is a good idea?
Do you think the experiment of creating the largest virgin population for smallpox in world history (a/k/a our children) was a good plan with retained stocks of variola in the USSR?
Do you think that taking the threat off the table by vaccinating the US population would be stabilizing, or destabilizing?
I'm not. Reason...AIDS. Smallpox vaccination could kill a lot of AIDS patients, including undiagnosed HIV positive patients. The AAP is riddled with morons, but I would agree that a widespread vaccination program at this time would be counterproductive. Remember the swine flu vaccination fiasco. Such an immunization program without any documented cases of smallpox would result in some highly publicized deaths and adverse reactions...which can happen with any vaccine.Could be counterproductive if the real thing showed up next.
However, I do think the vaccine should be made available to those patients who want to get it on their own. There is plenty of the vaccine around. In addition, the efficiency and side effect profile of the vaccine could be studied on the people who requested the vaccination.
Smallpox outbreaks can be controlled by isolation and vaccination. Methodology has been established...smallpox outbreaks can be controlled effectively with vaccination. That is how it was eliminated. The man who was responsible for the eradication of smallpox probably had a lot to do with this decision. Would people die from a smallpox outbreak. Yes, but people would also die from the vaccination.
Also, no telling what would happen if people were vaccinated against smallpox, only to find out that tons of anthrax were dispersed. It may be that the initial cases of anthrax were merely a test, and the real thing is yet to come.
Dr. Koopman is incorrect. CDC's own website has this interesting tid-bit (we'll see how long it stays on their website.)
"The potential of aerosolized smallpox to spread over a considerable distance and to infect at low doses was vividly demonstrated in an outbreak in Germany in 1970 (11). That year, a German electrician returning from Pakistan became ill with high fever and diarrhea. On January 11, he was admitted to a local hospital and was isolated in a separate room on the ground floor because it was feared he might have typhoid fever. He had contact with only two nurses over the next 3 days. On January 14 a rash developed, and on January 16 the diagnosis of smallpox was confirmed. He was immediately transported to one of Germany's special isolation hospitals, and more than 100,000 persons were promptly vaccinated. The hospital had been closed to visitors because of an influenza outbreak for several days before the patient was admitted. After the diagnosis of smallpox, other hospital patients and staff were quarantined for 4 weeks and were vaccinated; very ill patients received vaccinia-immune globulin first. However, the smallpox patient had had a cough, a symptom seldom seen with smallpox; coughing can produce a large-volume, small-particle aerosol like what might occur after its use as a terrorist weapon. Subsequently, 19 cases occurred in the hospital, including four in other rooms on the patient's floor, eight on the floor above, and nine on the third floor. Two were contact cases. One of the cases was in a visitor who had spent fewer than 15 minutes in the hospital and had only briefly opened a corridor door, easily 30 feet from the patient's room, to ask directions. Three of the patients were nurses, one of whom died. This outbreak occurred in a well-vaccinated population."
Thinking twice about getting immunized? I would.
Given that rotavirus is a threat to a limited segment of the population (a younger group that regards diaper contents as edible), and that Rotashield was pulled off the market, you have a point.
All this logic adds up to profit to Wyeth Ayerst...the one and only company manufacturing the vaccine. Distribution cost to the physician is $59.00 per dose. So, the cost to give the vaccine is really about $80.00 per dose. That's more than polio, diptheria, tetanus, pertussis, H. flu, and Hepatitis B COMBINED!
Special thanks to the policy wonks on ACIP (appointed by AAP and AAFP's hierarchy) for exposing every physician in the country to medical malpractice liability during this time of supposed Prevnar shortages.
But, given the serious nature of this threat, I'm disappointed that ACIP appears to be uninformed about the CDC's own documents. In this quotation, you will see that Dr. Henderson had the foresight to predict almost exactly the actions and decisions following the anthrax attack in late 2001. He also appropriately predicts the concerns related to a smallpox bio attack in our nation. We need to review this guy's work and translate his advice to public policy.
From http://www.cdc.gov/ncidod/EID/vol4no3/hendrsn.htm
Bioterrorism as a Public Health Threat D.A. Henderson The Johns Hopkins University, Baltimore, Maryland, USA -------------------------------------
An outbreak in Yugoslavia in February 1972 also illustrates the havoc created even by a small number of cases. Yugoslavia's last case of smallpox had occurred in 1927. Nevertheless, Yugoslavia, like most countries, had continued populationwide vaccination to protect against imported cases. In 1972, a pilgrim returning from Mecca became ill with an undiagnosed febrile disease. Friends and relatives visited from a number of different areas; 2 weeks later, 11 of them became ill with high fever and rash. The patients were not aware of each other's illness, and their physicians (few of whom had ever seen a case of smallpox) failed to make a correct diagnosis.
One of the 11 patients was a 30-year-old teacher who quickly became critically ill with the hemorrhagic form, a form not readily diagnosed even by experts. The teacher was first given penicillin at a local clinic, but as he became increasingly ill, he was transferred to a dermatology ward in a city hospital, then to a similar ward in the capital city, and finally to a critical care unit because he was bleeding profusely and in shock. He died before a definitive diagnosis was made. He was buried 2 days before the first case of smallpox was recognized.
The first cases were correctly diagnosed 4 weeks after the first patient became ill, but by then, 150 persons were already infected; of these, 38 (including two physicians, two nurses, and four other hospital staff) were infected by the young teacher. The cases occurred in widely separated areas of the country. By the time of diagnosis, the 150 secondary cases had already begun to expose yet another generation, and, inevitably, questions arose as to how many other yet undetected cases there might be.
Health authorities launched a nationwide vaccination campaign. Mass vaccination clinics were held, and checkpoints along roads were established to examine vaccination certificates. Twenty million persons were vaccinated. Hotels and residential apartments were taken over, cordoned off by the military, and all known contacts of cases were forced into these centers under military guard. Some 10,000 persons spent 2 weeks or more in isolation. Meanwhile, neighboring countries closed their borders. Nine weeks after the first patient became ill, the outbreak stopped. In all, 175 patients contracted smallpox, and 35 died.
What might happen if smallpox were released today in a U.S. city? First, routine vaccination stopped in the United States in 1972. Some travelers, many military recruits, and a handful of laboratory workers were vaccinated over the following 8 years. Overall, however, it is doubtful that more than 10% to 15% of the population today has residual smallpox immunity. If some modest volume of virus were to be released (perhaps by exploding a light bulb containing virus in a Washington subway), the event would almost certainly go unnoticed until the first cases with rash began to appear 9 or 10 days later. With patients seen by different physicians (who almost certainly had never before seen a smallpox case) in different clinics, several days would probably elapse before the diagnosis of smallpox was confirmed and an alarm was sounded.
Even if only 100 persons were infected and required hospitalization, a group of patients many times larger would become ill with fever and rash and receive an uncertain diagnosis. Some would be reported from other cities and other states. Where would all of these patients be admitted? In the Washington, D.C., metropolitan area, no more than 100 hospital beds provide adequate isolation. Who would care for the patients? Few hospital staff have any smallpox immunity. Moreover, one or two patients with severe hemorrhagic cases (which typically have very short incubation periods), who would have been hospitalized before smallpox was suspected, would have been cared for by a large, unprotected intensive care team.
What of contacts? In past outbreaks, contacts of confirmed or suspected cases numbered in the thousands, if not tens of thousands. What measures should or could be taken to deal with such numbers? Would patients be isolated as in Yugoslavia, and if so, where? Logistics could be simplified if rapid, easily used laboratory tests could confirm or rule out smallpox among suspected cases. At present, however, such tests are known only to scientists in two government laboratories.
An immediate clamor for mass vaccination (as in the outbreaks in Germany and Yugoslavia) can be predicted. U.S. stocks of smallpox vaccine are nominally listed at 15 million doses, but with packaging, the useful number of doses is perhaps half that number. How widely and quickly should this vaccine be used? Were vaccine to be limited strictly to close contacts of confirmed cases, comparatively few doses would be needed. However, the realities of dealing with even a small epidemic would almost certainly preclude such a cautious, measured vaccination effort. Vaccine reserves would rapidly disappear, and there is, at present, no manufacturing capacity to produce additional vaccine. If an emergency effort were made to produce new stocks of smallpox vaccine, many months to a year or more would be required.
What of anthrax, which has been so enthusiastically embraced by both Iraq and the Aum Shinrikyo? The organism is easy to produce in large quantity. In its dried form, it is extremely stable. The effect of aerosolized anthrax on humans once had to be inferred from animal experiments and the occasional human infection among workers in factories processing sheep and goat hides (12). It was clear that inhalation of anthrax is highly lethal. Just how lethal became evident in the 1979 Sverdlovsk epidemic (13).
In all, 77 cases were identified with certainty; 66 patients died. The actual total number of cases was probably considerably more than 100. The persons affected lived or worked somewhere within a narrow zone extending some 4 km south and east of a military bioweapons facility. An accidental airborne release of anthrax spores occurred during a single day and may well have lasted no more than minutes. Further investigations revealed anthrax deaths among sheep and cows in six different villages up to 50 km southeast of the military compound along the same axis as the human cases.
Of the 58 patients with known dates of disease onset, only 9 had symptoms within a week after exposure; some became ill as late as 6 weeks after exposure. Whether the onset of illness occurred sooner or later, death almost always followed within 1 to 4 days after onset. However, there appeared to be a somewhat higher proportion of survivors after the fourth week. This almost certainly resulted from the widespread application of penicillin prophylaxis and anthrax vaccine, both of which were distributed in mid-April throughout a population of 59,000.
Meselson and his colleagues, who documented this outbreak, calculate that the weight of spores released as an aerosol could have been as little as a few milligrams or as much as "nearly a gram." Iraq acknowledged producing at least 8,000 L of solution with an anthrax spore and cell count of 109/ml (1). The ramifications of even a modest-sized release of anthrax spores in a city are profound. Emergency rooms would begin seeing a few patients with high fever and some difficulty breathing perhaps 3 to 4 days after exposure. By the time the patients were seen, it is almost certain that it would be too late for antibiotic therapy. All patients would die within 24 to 48 hours. No emergency room physicians or infectious disease specialists have ever seen a case of inhalation anthrax; medical laboratories have had virtually no experience in its diagnosis. Thus, at least 3 to 5 days would elapse before a definitive diagnosis would be made.
Once anthrax was diagnosed, one would be faced with the prospect of what to do over the succeeding 6 to 8 weeks. Should vaccine be administered to those who might have been exposed? At present, little vaccine is available, and no plan exists to produce any for civilian use. Should antibiotics be administered prophylactically? If so, which antibiotics, and what should be the criteria for exposure? What quantity would be required to treat an exposed population of perhaps 500,000 over a 6-week period? Should one be concerned about additional infections resulting from anthrax spores subsequently resuspended and inhaled by others? Should everyone who has been anywhere near the city report to a local physician for treatment at the first occurrence of fever or cough, however mild? Undoubtedly, many would have such symptoms, especially in the winter; how can such symptoms be distinguished from the premonitory symptoms of anthrax that may proceed to death within 24 to 48 hours?
We are ill-prepared to deal with a terrorist attack that employs biological weapons. In countering civilian terrorism, the focus (a modest extension of existing protocols to deal with a hazard materials incident) has been almost wholly on chemical and explosive weapons. A chemical release or a major explosion is far more manageable than the biological challenges posed by smallpox or anthrax. After an explosion or a chemical attack, the worst effects are quickly over, the dimensions of the catastrophe can be defined, the toll of injuries and deaths can be ascertained, and efforts can be directed to stabilization and recovery. Not so following the use of smallpox or anthrax. Day after relentless day, additional cases could be expected, and in new areas.
The specter of biological weapons use is an ugly one, every bit as grim and foreboding as that of a nuclear winter. As was done in response to the nuclear threat, the medical community should educate the public and policy makers about the threat. We need to build on the 1972 Biological and Toxin Weapons Convention to strengthen measures prohibiting the development and production of biological weapons and to ensure compliance with existing agreements. In a broader sense, we need a strong moral consensus condemning biological weapons.
But this is not enough. In the longer term, we need to be as prepared to detect, diagnose, characterize epidemiologically, and respond appropriately to biological weapons use as to the threat of new and reemerging infections. In fact, the needs are convergent. We need at international, state, and local levels a greater capacity for surveillance; a far better network of laboratories and better diagnostic instruments; and a more adequate cadre of trained epidemiologists, clinicians, and researchers.
On the immediate horizon, we cannot delay the development and implementation of strategic plans for coping with civilian bioterrorism. The needed stocking of vaccines and drugs as well as the training and mobilization of health workers, both public and private, at state, city, and local levels will require time. Knowing well what little has been done, I can only say that a mammoth task lies before us.
D.A. Henderson is a distinguished service professor at the Johns Hopkins University, with appointments in the Departments of Health and Epidemiology, School of Hygiene and Public Health. Dr. Henderson directed the World Health Organization's global smallpox eradication campaign (1966-1977) and helped initiate WHO's global program of immunization in 1974. He also served in the federal government as deputy assistant secretary and senior science advisor in the Department of Health and Human Services.
References
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Message to Cooper: If the pox comes to America, we will hold you personally responsible for the deaths among the public. How hateful that you endorse immunizations for the "important people", but not the moms, dads, and kids. You reminded me that Orwell had it right. "All pigs are equal, but some are more equal than others."
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