U.S. Health Dept. creates bioterrorism plan for health workers


    By Julie Cunningham

    The Utah Department of Health recently submitted a bioterrorism preparedness plan to the Centers for Disease Control and Prevention, which outlined who will be the first to receive the smallpox vaccine.

    The plan called for the inoculation of 2,000 to 5,000 health care and public health workers, including emergency response teams, doctors, nurses, hospital security and janitorial staff, said Jana Kettering, public information officer for the state health department.

    Once these health care workers are vaccinated against smallpox, they will be able to effectively administer to those infected with the disease in case of an outbreak, she said.

    “We hope to never have a case of smallpox, but the reality in this world today is that it is a possibility, so we want to make sure that Utahns are protected in the event by being able to seek medical care from public health care or hospitals,” Kettering said.

    The CDC requested the health departments of each state in the country submit a pre-event vaccination plan to ensure each state is prepared for a bioterrorist attack, she said.

    At this time there is no risk to the general public of contracting smallpox, therefore the vaccination is only available for selected health care workers, Kettering said.

    However, there is enough smallpox vaccine to inoculate all Utah residents, she said.

    “If there was an actual case identified in Utah or a close bordering state, that”s when we would vaccinate the public,” Kettering said. “For instance, we would treat a case in Pocatello, Idaho, very similar to a case we would treat in St. George, Utah. We would look at that as a credible threat, and based on our planning and CDC advice, we would vaccinate those in the vicinity of the individual.”

    The state health department has access to the National Pharmaceutical Stockpile, which contains vaccines, antibiotics and other medicines for all types of diseases, she said. If a credible smallpox case were identified in Utah, within six to 12 hours the state health department would receive large doses of the vaccine from the NPS, which would then be distributed to those who needed it.

    If an individual is exposed to smallpox, he or she can receive the smallpox vaccine within four days after the first exposure and be protected from infection or from causing an outbreak, Kettering said.

    However, there are risks associated with the smallpox vaccine, she said. Out of one million vaccinated, one will die, 15 will become seriously ill and one will be sick enough to miss a few days of work.

    Routine vaccination of the American public against smallpox stopped in 1972 after the disease was eradicated in the United States, therefore eliminating the need for prevention, according to the CDC. The last case reported in the United States was in 1949, and the last reported in the world was in Somalia in 1977.

    After the Sept. 11, 2001, attacks and the anthrax scare, the U.S. government recognized the need to improve its level of preparedness against terrorism and bioterrorist attacks, according to the CDC.

    For smallpox, this included updating a response plan and creating enough smallpox vaccine to immunize the American public in the event of an outbreak, and both plans are in place.

    Utah submitted its pre-event vaccination plan Monday, and the smallpox vaccine is now actively being produced.

    The Provo company Serologicals, along with 12 other collection sites, has been collecting donated plasma since June as part of the U.S. government”s plan to create more smallpox vaccine.

    Utah County is also doing its part to become prepared for a bioterrorist attack, said Justin Jones, public information officer for the Utah County Health Department.

    “We have prepared and crafted a detailed plan that will help us respond to a bioterrorist event,” Jones said. “It is difficult to enter into the mind of a terrorist and know what they are thinking, but we have tried and will be prepared for what they have for us.”

    The plan describes what Utah County and its partners will do in the case of an attack, he said. It will also be tested and revised to make sure Utah County will be as equipped as possible to handle any bioterrorist situation.

    One way the county health department will test its plan is with mock disaster exercises, which will begin in January, Jones said. They will be held once a month, and at least one of those exercises will be held at BYU.

    These mock disasters are similar to the mock earthquake disasters practiced at BYU in the past, he said. Through these mock exercises, the county health department will be able to assess defects in the plan and make the necessary improvements.

    “It”s tragic beyond words what happened on Sept. 11 as well as the anthrax deaths that occurred later on,” Jones said. “But in that, the positive that is coming out is that we are preparing ourselves more so than we ever have before.”

    Residents of Utah County can prepare themselves for a bioterrorist attack by staying informed and updated on any smallpox news, he said. In the case of a smallpox outbreak, the county health department will notify the public of any necessary action.

    “It”s important for Utah County residents to understand that we have a plan, we are responding, and that it”s important to remain calm,” Jones said. “We are prepared.”

    Smallpox is a serious, highly contagious and potential deadly disease, according to the CDC Web site. It is transmitted by direct and prolonged face-to-face contact with an infected person, and can also be spread through direct contact with infected bodily fluids or contaminated objects such as clothing or bedding.

    The first symptoms include fever, malaise, head and body aches and sometimes vomiting, and may take as long as 17 days to appear, according to the CDC.

    Those infected with smallpox first develop a rash of small red spots on the tongue and in the mouth. These spots develop into sores that break open and spread large amounts of the virus into the mouth and throat. At this time, the person becomes most contagious.

    These bumps become larger and develop into pustules, which are sharply raised and usually round and firm to the touch as if there is a small round object under the skin, according to the CDC.

    The pustules begin to form a crust and then scab. After six days, the scabs begin to fall off, leaving marks on the skin that eventually become pitted scars. The person is contagious to others until all of the scabs have fallen off, according to the CDC.

    This entire process from first exposure to the falling off of all scabs lasts an average of 35 days, according to the CDC.

    The deliberate release of smallpox as an epidemic disease is a possibility, according to the CDC. This disease is classified as a Category A agent by the CDC, which means it poses the greatest potential threat for harmful impact on public health and has a moderate to high potential for large-scale dissemination.

    Other Category A agents include anthrax, plague, botulism, tularemia and viral hemorrhagic fevers.

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