WASHINGTON – Maryland health officials plan to vaccinate 5,500 health care workers and have started recruiting volunteers for the teams that would be the first line of defense against any bioterror attack using the disease.
The teams could also be called on to vaccinate other health care workers, public safety crews and the general public, if those are called for under a national plan still being considered by the Bush administration.
“This is a plan to put together teams of individuals, pre-vaccinated and pre-trained for quick response for any potential case of smallpox in the state,” said Dr. Georges Benjamin, former secretary of the state Department of Health and Mental Hygiene.
Vaccinations cannot begin until the Bush administration announces the national plan and releases the vaccine. A Department of Health and Human Services official said Wednesday that a decision is expected soon from the White House on the policy.
The state plan was submitted Tuesday to the Centers for Disease Control and Prevention for approval, said Dr. Diane Matuszak, acting deputy secretary for the state health department. She said every state submitted a plan, and warned that they are “very much living documents” that can be altered at any time.
Maryland’s plan calls for 80 health department teams — two from the state, the rest from local health departments — that will total about 500 workers. Another 5,000 team members will be drawn from hospitals that have emergency medical services. Those teams will have 50 to 250 members each, depending on hospital location and size, said Karen Black, spokeswoman for the Department of Health and Mental Hygiene.
When the state was developing its plan in October, Benjamin said he was not worried about recruiting volunteers.
“Public health workers are pretty gung-ho folks,” said Benjamin, who is now executive director of the American Public Health Association. “I don’t think it will be a problem getting people to volunteer. I don’t think it will be difficult to find heroic workers that want to support their neighbors.”
The first-response teams are phase one of a three-part vaccination plan. Phase two would expand vaccination to health care and public safety workers and phase three would involve vaccinating the general public. Matuszak said phases two and three are currently just recommendations made by an advisory committee to the CDC.
While many health officials favor vaccinating response teams, some remain skeptical that mass vaccination is wise, because of potential risks of the vaccine.
“It makes sense to start with (health care workers) and wait and see,” said Gigi Kwik, a fellow at the Center for Civilian Biodefense Strategy at Johns Hopkins University. “They are the most at risk.”
Benjamin said he is not support vaccinating the whole population “because the risk of vaccine outweighs the risk of the disease.”
“For a disease that is not here, no human being in the planet has it, giving people a vaccination en masse is a more of a risk than waiting,” he said.
Routine vaccination for smallpox ended in 1972 and the disease was eradicated worldwide in 1977. It is a highly contagious disease with initial flu-like symptoms, followed by a progressive full-body rash. Approximately one- third of those infected with the virus die.
Despite some risks associated with the smallpox vaccine, it is the only defense against the disease.
According to the CDC, most people experience mild reactions to the vaccine, including sore arm, fever and body aches. One in three people felt bad enough to miss school or work after vaccination. About 1,000 in 1 million have serious, but not life-threatening reactions, that include an allergic reaction at the site or the spread of the vaccinia virus to other parts of the body or other people.
Between 14 and 52 people per 1 million have potentially life-threatening reactions and one or two of those people will die from the vaccine, the CDC estimates.
But 65 percent of Americans are willing to be vaccinated, according to a poll released Wednesday by the Robert Wood Johnson Foundation. It said the poll reflects a growing concern about the potential use of smallpox in a terrorist attack.
Even with the potential risks, Maryland officials are preparing for vaccinations.
“I think everybody recognizes that there have been reports smallpox could be weaponized,” Matuszak said. “The president called upon the nation to be prepared, we are all being prudent and prepared the best we can.”
The CDC also asked states this month to proposse a plan for responding to a smallpox outbreak. That plan, which is separate from the vaccination plans currently under consideration, could include vaccine safety monitoring, outbreak investigation strategies and patient care, Matuszak said.
“If you can handle the initial phases and then the post-event phase, I guess the assumption is that you can immunize those in between,” she said.