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    Tuesday, September 24, 2002

    Smallpox Vaccine Plan: The CDC’s guidelines for public health clinics on how to handle a smallpox epidemic are on line now. (Warning: pdf file) The plan is really geared only to the logistics of providing the vaccine to a large number of people in the event of an attack. They also deal with the issue of quarantine and provide instructions on what to do with a suspected case. (Warning: both are pdf files). They strike me as woefully inadequate. There’s no mention at all of the necessity of educating physicians on bioterror preparedness. The quarantine is to take place at a designated quarantine facility, something which few places have up and running. It isn’t clear whether the healthcare providers will be vaccinated before an attack or at the first sign of a case.

    A defense is only as strong as its weakest link, and in this case the weakest link is the people who are going to be the first responders - practicing physicians and their staffs. Waiting until smallpox is upon us to begin vaccinating invites chaos and panic. A couple of years ago, there was an outbreak of meningitis in our area. Now, this is a disease that is far less contagious than smallpox, but the response to it was horrible:

    And if people are panicked about meningitis, imagine what would happen in the event of a smallpox outbreak. In Alliance, thousands of people lined up at Alliance Community Hospital hoping to get antibiotics, even though CDC guidelines, at that point, suggested against antibiotic use.

    The reason panic set in was that the first responder responded incorrectly by holding a news conference and recommending that everyone in the town take antibiotics. This sort of thing could be prevented if the CDC and state health departments would take the initiative and educate practicing physicians on how to handle a case. If someone walked into my office today with smallpox, I wouldn’t know what to do with them. I suppose I’d have to lock everyone in the office until the health department officials could respond and help me out. And I’ve been trying to keep up on the topic. Imagine what it would be like for someone who hasn’t been.

    UPDATE: A good and worthwhile discussion of the role of antiviral drugs in a smallpox outbreak can be found here. (via Instapundit). An antiviral may be helpful to curb the spread and the complications of the disease, but it shouldn't be relied on as a line of first defense. We have no experience with them for smallpox, and the antivirals we do use for other conditions are never curative. They only reduce the duration and severity of symptoms. The effectiveness of vaccination, on the other hand, is proven. And it confers immunity from future infection.

    posted by Sydney on 9/24/2002 07:17:00 AM 0 comments


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