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U.S. Experts Update Plan to Combat Smallpox

Health: Unlike with anthrax, federal disease sleuths give local officials details on how to react to a bioterrorism assault.


After being criticized for its handling of the anthrax attacks, the Centers for Disease Control and Prevention said Monday that it has updated its smallpox response plan to help prepare the nation for another possible bioterrorist attack.

The smallpox virus is one of the few biological agents with "the ability to cause illness or panic to the extent that existing medical and public health systems would be overwhelmed," the CDC said in its report.

The 261-page plan, sent to state health officials Friday, includes new information about who should get smallpox vaccinations, how agencies might cope with a large outbreak caused by terrorists and what could be done to calm an anxious public.

"What we are trying to do with this plan is to help state health departments and local health departments identify things that they need assistance with," said Dr. Lisa Rotz, the CDC's bioterrorism preparedness expert.

The report comes amid complaints by some state and local authorities that the federal government has not cooperated in sharing information about homeland security issues, including possible bioterrorist attacks.

CDC officials stressed that there is no evidence that Americans are at an increased risk for smallpox. There have been no known smallpox cases in the United States since 1940, and the disease was eradicated worldwide in 1980.

The CDC did not have a response plan for dealing with anthrax, and the agency was criticized for failing to act quickly enough to protect postal workers. Of the five people who so far have died of anthrax, two were postal workers. Starting in September, anthrax-laced letters have been mailed to media outlets and politicians.

Though CDC officials have been repeatedly surprised by the spread of anthrax in the recent attack, they feel they know much more about smallpox and are confident that they could contain an outbreak. Much of the revised response plan is based on the strategies that helped defeat the disease 20 years ago.

The plan instructs local health officials how to respond if a smallpox case is detected, including tracing and vaccinating the patient's family and recent contacts, setting up vaccination clinics and dealing with the media.

Because a terrorist attack involving smallpox would likely be more widespread than a naturally occurring outbreak, the CDC is advising local officials to identify large quarantine facilities, such as hospitals, vacant hotels or unused college dormitories, that could be used to isolate and treat patients.

Smallpox typically spreads via infected saliva droplets from face-to-face contact within a distance of about 6 feet. It begins with fever, backache, headache or malaise. Within about four days, a skin rash develops on the face, arms and legs. Patients are most infectious during the first week of the rash, after the illness has most likely been diagnosed.

The overall mortality rate of smallpox was about 30% before the disease was eradicated.

Dr. D.A. Henderson, director of public health preparedness for the U.S. Department of Health and Human Services, said Monday that previous smallpox outbreaks tended to take place from November to April, when the weather is cooler and transmission occurs more easily.

Henderson also discussed an ongoing CDC trial to determine the effectiveness of diluting current stocks of smallpox vaccines in an effort to stretch supplies.

Officials hope to divide current doses by about five, increasing the existing supplies to about 77 million doses.

Though the CDC has vaccinated some of its own workers against smallpox, the revised plan does not recommend that state health officials receive vaccinations until an outbreak is confirmed.

In a related development, health officials investigating the anthrax-related death of a Connecticut woman said Monday that environmental samples from her home, her garden and other locations she is known to have visited continue to test negative for the presence of anthrax spores.

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