Posted on 10/22/2001 6:04:21 PM PDT by ATOMIC_PUNK
Monday, October 22, 2001
By Rita RubinUSA Today
(USA TODAY)
WASHINGTON -- While the government tries to ramp up production of smallpox vaccine, scientists are hopeful that an antiviral drug that is already on the market might prove to be the first effective treatment for the disease.
Smallpox ranks among the most serious bioterrorism threats. Unlike anthrax, the disease is highly contagious; before it was eradicated in 1977, it killed about one in three infected individuals. Survivors are left severely disfigured with pitted scars.
Health and Human Services Secretary Tommy Thompson has said the government wants to stockpile 300 million doses of smallpox vaccine, enough to immunize every American, if necessary. Routine smallpox immunizations in the USA stopped in 1972, more than 20 years after the last U.S. case was reported. People vaccinated before then may have some residual immunity, but it's likely not enough to prevent them from getting sick if infected.
The incubation period for smallpox averages about 12 days. Infected individuals are not contagious until a day or so before the characteristic rash appears. If a case were to be diagnosed, people who had come in contact with the victim would be quarantined and immunized.
''We know that we have a couple of days' grace,'' says Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. People can be vaccinated up to four days after coming in contact with a contagious individual and still get protection against smallpox, Fauci says.
But all doctors have to offer smallpox patients are therapies to help keep them alive, not fight the virus. That's where cidofovir might come in.
Cidofovir, sold under the brand name Vistide, won Food and Drug Administration approval in June 1996 for the treatment of cytomegalovirus retinitis, a sight-threatening viral infection in AIDS patients. It's the first product marketed by Gilead Sciences, a Foster City, Calif., company.
In March 1998, researchers from the U.S. Army Medical Research Institute of Infectious Diseases reported that cidofovir prevented death and disease associated with a pox disease in primates. Monkeypox symptoms, such as respiratory problems, fever and rash, are similar to those of smallpox in humans.
''The animal data look very striking,'' Fauci says.
Of course, it would be unethical to expose humans to smallpox to test whether cidofovir was effective against that disease. But researchers do expect to have an opportunity to test it in a study that's just getting started, Fauci says. The main focus of the study is to see how effective the 15.4 million doses of smallpox vaccine now stockpiled would be if diluted to one-fifth or even one-tenth strength.
A few of the volunteers in the study may develop a serious reaction to the vaccine, which contains a virus similar to smallpox. Doctors would first treat those volunteers with immunoglobulin that contains antibodies to the virus in the vaccine. If that didn't work, cidofovir would be used as a backup, Fauci says.
Monday, October 22, 2001
SCOTT R. BURNELL, UPI Science News
(United Press International)
WASHINGTON, Oct 19, 2001 (United Press International via COMTEX) -- Tests are underway to check the effectiveness of diluted doses of smallpox vaccine, one way to immediately expand the number of people who could be treated in case of terrorist attacks using the deadly virus, public health officials said Friday.
The National Foundation for Infectious Diseases talked with reporters about national preparedness against bioterror, as well as the misconceptions and psychological impact of the ongoing anthrax episodes.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said there currently is no evidence of smallpox, but U.S. officials are taking steps to be prepared for it.
"We happen to be, at this point in time, almost the victim of our own success," Fauci said. "The public health community succeeded in eradicating smallpox from the world, and with that was the discontinuation of the immunizations against smallpox. Now we have a relatively naive and unprotected population, which we're trying to do something about."
The country currently has 15 million doses of smallpox vaccine, Fauci said, and tests are underway to see how effective the doses remain after dilution.
If the vaccine remains useful at one-fifth strength, then 75 million people can be treated, he said. At one-tenth strength, the stockpile would cover 150 million people. The country also is accelerating efforts to produce more full-strength vaccine, he said.
However many doses are eventually available, they can be distributed more effectively when doctors take advantage of the smallpox incubation period of from one week to 17 days, Fauci said. Smallpox is not immediately contagious, he said, so vaccines administered during the "grace period" before symptoms arise could help stem any outbreak.
There also is great promise in the area of antiviral drugs, Fauci said. The fight against HIV has created several medications highly effective against pox-like viruses in animals, he said, and researchers are studying those results for applicability in humans.
As for anthrax, Fauci said pharmaceutical companies are working on tests to spot exposure and infection more rapidly. Those tests would probably also have a higher incidence of false positives, he cautioned.
Fauci said government officials have made only small mistakes while speaking publicly about the outbreak, and praised their overall leadership.
Other speakers, including noted psychologist Dr. Joyce Brothers, said people should avoid taking unnecessary precautions out of superstition or misinformation. Brothers said the House of Representatives showed reasonable caution in closing its offices to allow health inspections. She also praised the media for reporting information fairly and quickly while avoiding rumors.
The forerunners of psychological problems stemming from the anthrax outbreak are starting to appear, Brothers said. People are self-medicating, she said, with liquor stores reporting higher sales and doctors reporting more requests for tranquilizers.
The best way to avoid mass hysteria, Brothers said, relies on the three kinds of human reactions to extreme emergencies: altruistic behavior, freezing in place and mindlessly fleeing. Each occur in about a third of the population. Focusing the altruistic third's helpful actions on those reacting without thinking will stop the situation from boiling over, she said.
The plan is, when the first case is diagnosed, to isolate (quarantine) the building and then to vaccinate everyone inside.
CDC can supposedly deploy vaccine in 24 hours.
Here's hoping it pans out favorably.
Before the breakup of the USSR these recombinants were being developed and produced and now they are "out there."
I would worry about the US response to a bacteria/virus genetically altered by the Soviets unleashed by the Iraqis and sold to OBL.
The reality is when it comes to B/W's all roads lead to Russia. Our new ally.
Strange bedfellows, eh?
http://www.google.com/search?q=cache:-IZx9-JTCeM:cmg.health.ufl.edu/mgm/bios/moyerr.htm+genetics+of+variola+virus&hl=en
This is a JAMA article on studies using Cidofovir and MCV
http://www.google.com/search?q=cache:FFtc8e3DYyA:www.ama-assn.org/special/hiv/library/readroom/jama97/ob7006.htm+acyclovir+and+molluscum+contagiosum&hl=en
We seem to keep paying attention to the ants in the kitchen while there's elephants in the living room. But then again I could be wrong.
This is a "self-congratulatory" attempt to state that our national health officials and federal government "screwed up" terribly back in the 70's by following the WHO directive to stop vaccinnating new born infants...the reason we are now faced with the dreadful situation of an almost totally vulnerable population.
Cidofovir just happens to be a fairly broad spectrum anti-viral. It also reportedly works on another unrelated common virus, warts. I've seen case reports of it clearing widespread warts and MCV when used topically when compounded and also when used IV. I've heard that the drug company wasn't interested in developing a commercial topical form. I know the IV form has significant side effect problems, perhaps the same may occur when used topically. If so I hope someone developing less toxic derivatives of Cidofovir.
In the new study that offers Cidofovir as the 2nd line response to vaccination reactions the first line response mentioned is something called Vaccinia immune globulin. The JAMA bioterrorism article on smallpox a few years back mentioned that stockpiles of that were quite small, just a few thousand doses I think. VIG sadly doesn't work against smallpox itself, just against vaccination reactions. If we intend large scale vaccinations again we'll probably need more VIG. I presume the only way to get more is to vaccinate people at low risk for reactions and then have them donate plasma. I don't know how many donors are needed, but I hope somebody is planning ahead.
No, stopping then was the right decision. Side effects and deaths from mass vaccination had become a greater risk than naturally occurring smallpox. For small natural or accidental outbreaks vaccinating those exposed in the first few days effectively controls smallpox with far less risk.
The 1st "screw up" came in the 80s when we didn't "trust, but verify" before reducing the WHO stockpile of vaccine from 200M units to 0.5M units. No one in the west knew then the Soviets had weaponized smallpox. The 2nd "screw up" was our delay in ordering more vaccine, once we learned, until '99.
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