The very existence of the plan rattled many Americans, but it also raised confusing logistical and medical questions. How would the massive public-health effort actually play out? And if the worst did occur, should you or your family members seek vaccinations, which can cause serious, if rare, side effects?
The 48-page report (available at www.cdc.gov) lays out the vaccination program in some detail–everything from parking requirements to trauma counseling. If an outbreak did occur, the president, the CDC and the Department of Health and Human Services would decide whether to trigger the plan. If they went ahead, each state would call on hundreds of health workers to staff 20 pre-designated clinics per state, 16 hours a day. State-recorded messages with clinic directions and hot-line numbers would be broadcast on radio and television. Once people arrived at the clinics, they’d be evaluated for risk of complications and shown an instructional video. A vaccine shortage is unlikely–the government expects to have 280 million doses ready by Christmas and the CDC says it can ship anywhere in five days.
But the preliminary report omits other important details–issues like crowd control at the clinics aren’t mentioned. And each state must now figure out how to implement the massive public-health effort. Even if they can solve logistical issues, the vaccine itself may cause problems. Although the vaccine uses a related virus in place of the smallpox pathogen, mass inoculation could cause dozens of deaths. When smallpox vaccination was routine in the 1960s, one out of every million people died from complications. Some groups are more likely than others to have a bad reaction. Children under the age of 1 may experience brain swelling, which can be fatal. (This can occur in about 42 out of a million infants vaccinated.) Children of all ages are also more likely to touch the scab from the shot, spreading pustules to any other part of their body they touch afterward–including the eyes, which could cause blindness. And pregnant women shouldn’t be vaccinated unless they think they’ve been exposed directly to smallpox, in which case they should get the shot immediately. The vaccine almost never ends a pregnancy, but the disease often does.
It’s also unclear how people with weak immune systems–including HIV, chemotherapy and organ-transplant patients, as well as people with skin conditions like eczema–would respond to the vaccine. For now, the CDC is advising all these groups to get vaccinated only if they’re sure they’ve been exposed. But that dictum could change depending on the severity of an outbreak. Bottom line: don’t panic, but take smallpox as seriously as the CDC does.
