Smallpox scares even professionals : LUSENET : Grassroots Information Coordination Center (GICC) : One Thread

Oct 28, 2001 - 12:20 AM

Smallpox scares even professionals

By Cynthia T. Pegram The News & Advance

Like a tattoo without color, the round scar from a smallpox vaccination is a faded message from a bygone time.

Millions of children entering school for the first time before 1972 got the tattoo from a few pricks of a nurse's needle. The site on the upper arm grew round and red and painful. A circular scab formed a hard dark cap atop a shallow volcano of angry-looking skin. A few weeks later, the scab fell away and the aftermath was a protection from smallpox and a scar for a lifetime.

The protection it gave faded, probably within five to 10 years. But it wasn't a concern because smallpox was a vanquished virus and no one encountered it.

Now bioterrorism has awakened fear that one of our worst natural enemies may be set deliberately upon us.

"Anthrax is nothing compared to smallpox," said Dr. Joanna Harris, who as director of the Central Virginia Health District is the area's top public health official. "There is no treatment for it. It is a virus as opposed to bacteria we can treat."

And, unlike anthrax, smallpox is spread from person to person.

"You have one person infected with smallpox, it could spread to 10 to 20 people," said Harris. People are very sick for most of a month with smallpox, and about 30 percent of them die.

Yet, if smallpox turned up in Central Virginia, "we'd gear up and immunize as appropriate," said Harris. "We would mobilize resources, and pull everyone into it and do it."

It would be an effort under the guidance of the federal Centers for Disease Control and Prevention.

On Tuesday, representatives from public health, private physicians, Centra Health, area rescue squads and emergency response teams will gather to update and coordinate local roles in the national defense plans against bioterrorism.

Is Central Virginia adequately prepared?

"Nobody is ready to the state of readiness they'd like to be, " said Dr. Walter B. Beverly, medical director of Emergency Services for Centra Health.

"I think we have to have a realistic view of this threat and respond in a manner to put systems in place to minimize effects," said Beverly. "Yes, there's something to worry about."

But, he added, "We have systems in place, and we're improving them."

Included are links to other hospitals in the area, such as the University of Virginia Medical Centers and Roanoke's Carilion Health System.

Efforts to deal with disaster usually focus on weapons of mass destruction. The threat of smallpox and bioterrorism, "is a lot different from what one usually thinks of as disaster," said Beverly.

From hazardous materials management, to law enforcement, to medicine, to 911 rescue, "we need to take all that to a different level to deal with this to make sure we are coordinated in our efforts," he said.

Connie Purvis oversees Blue Ridge Emergency Medical Services Council (BREMS), the educational and coordinating organization for area rescue squads.

The squads deal with medical emergencies, as well as trauma. Are they prepared for bioterrorism?

"We hope we are. We won't know until it hits," she said.

Right now, she said, BREMS' plan relies on the Health Department, adding, "I think they're doing the best they can to provide information and to give guidance.''

According to the Virginia Department of Health, the last recorded case of small pox was 1944. Estimates are that about half the U.S. population has never been vaccinated against smallpox. And the youngest among those who got the routine inoculation are now pushing 30.

The vaccine was developed in the 1800s and came into widespread use in the 20th century. Recommended for children at about 1 year old, it was required before entering school.

Harris has worked in public health since the 1960s. She remembers the routine smallpox vaccination.

"It was always a little dangerous; people can get complications," said Harris. "That's why the country is not anxious to give vaccines to millions of people. You get thousands of complications."

Routine vaccination produced swollen arms, fever, and a viral shedding from the arm to other parts of the body. The vaccination is done with vaccinia, a virus similar to smallpox. The itchy spot can shed the virus and infect areas that are rubbed or scratched, such as when a child rubs his eyes.

Everyone was relieved to think the vicious disease was gone forever.

"I have never seen a case of small pox." said Harris, "I never want to. We would still have no trouble with it, except for the bioterroists."

Beverly quotes the consensus statement of the American Medical Association: "The deliberate reintroduction of smallpox as an epidemic disease would be an international crime of unprecedented proportions."

Back in the 1970s, it was inconceivable that anyone would reintroduce smallpox.

Unlike anthrax, which is a bacterium, smallpox is a virus. Antibiotics don't work on virus infections.

Microbiologists have described viruses as "straddling the fence between living and non-living.'' Most are far smaller than bacteria. They are inert until they encounter a living cell, which they invade to use its mechanism to reproduce. When the invaded cell becomes too full to hold the viruses, it bursts, releasing the new generation into the body. This method makes it very hard to target by medication, so prevention is the best way to deal with smallpox.

The U.S. has a storehouse of smallpox vaccines, but right now the plan is to give the vaccine only where it is needed - once a case is found.

"We have people calling the health department all the time, people accusing us of hiding it," said Harris. "We do not have it. It is not available."

In a terrorist event, the first cases detected would likely be identified 12 to 14 days after infection. The most contagious time of the very contagious smallpox is in the earliest days of infection, during which it is spread in saliva droplets such as a cough or sneeze.

"We've got to be alert that this could happen," said Harris.

Smallpox starts out like many viral infections, producing aches, a high fever, headache and backaches. Typically, a rash appears on face, arms and legs.

The rash becomes flat red spots, which become pus-filled and crusty in the second week. Scabs develop and fall off in about three or four weeks, leaving round sunken scars. Four varieties of smallpox are known.

The death rate from the most common form in the past was about 30 percent. That means some 70 percent of the people survived. Once having had smallpox, the person has lifelong immunity and most have severe scarring.

Vaccination was thought to protect people from five to 10 years; those with multiple vaccinations may have longer protection.

"There may be a memory in your immune system that would gear up if challenged by smallpox," said Harris. "We don't know. It was eradicated from the world. Most people had one vaccination."

The vaccine remains one of the best weapons against the disease. If given within four days of infection, it can prevent it or lessen its severity. However those stores won't be drawn on unless the disease reappears.

All medically trained people are asked to be vigilant for symptoms that might indicate smallpox.

Even the earliest records from Egypt reference smallpox out breaks.

In past eras, society quarantined individuals, homes, and towns where smallpox appeared. In Lynchburg, during the Civil War, smallpox patients were taken to the Pest House, now located in the Old City Cemetery.

According to the Virginia Department of Health, the last reported case of small pox in Lynchburg was in 1930.

According to the American Medical Association, "The discovery of a single suspected case of smallpox must be treated as an international health emergency and be brought immediately to the attention of national officials through local and state health authorities."

-- Martin Thompson (, October 29, 2001

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