Tuesday, September 24, 2002

State of Hawaii

Hawaii devises
smallpox strategy

The state could vaccinate 1 million
people in 10 days should a
bioterror threat materialize

By Genevieve A. Suzuki

The state Health Department has a plan to vaccinate 1 million people in 10 days against smallpox, one of the most serious threats in a bioterrorism attack, said Health Director Bruce Anderson.

The department received guidelines yesterday from federal officials on how to implement a mass vaccination program as part of a program to battle smallpox.

"This would allow us to vaccinate virtually everyone here in Hawaii within a 10-day period for smallpox," Anderson said.

Officials are evaluating what number of smallpox cases in Hawaii, probably started by a terrorist attack, would trigger the mass vaccination: 20 clinics would administer vaccines for 16 hours a day.

"It's probably going to take months for us to get the resources and staff trained and the resources in place to effect the plan," Anderson said. "With 230 or more volunteers per site and over 20 sites in the state, we're looking at a staff of approximately over 4,000, which is a lot of people to be able to bring to bear on the problem quickly."

Anderson said the federal government will provide the vaccines. The state will use some of the money from its $8.4 million federal grant toward bioterrorism preparedness to pay for staff and training costs, he said.

Bart Aronoff, the manager of the state bioterrorism program, said the guidelines from the U.S. Centers for Disease Control and Prevention and the Health and Human Services Department do not necessarily require 20 new clinics and that larger existing locations may take the place of several clinics. "We would look at recreation centers, schools, noted public facilities, auditoriums, some places where you could physically set up and be as minimally disruptive to everything else that's going on, so we're still working on where those sites would be," Aronoff said.

Smallpox is highly contagious and is spread through the air, much like the flu.

Smallpox also causes flulike symptoms, said Aronoff. People with the disease experience high fever and aching pains, followed by a rash on the face and extremities. Up to 30 percent of smallpox cases can result in death.

The United States declared smallpox eradicated in 1980, and the last case of smallpox was in 1978, according to the guidelines.

If the state were to implement the mass vaccination plan, there are several groups of people who should not receive the vaccine, according to the federal guidelines: pregnant women, children less than 1 year old and people with skin conditions such as eczema or immune system problems such as HIV.

"Live vaccines present a risk, and if your immune system can't appropriately respond to it, it can be fatal," Anderson said.

The two treatments for people who experience adverse reactions to the vaccine need to be intravenously administered and require the patient to stay in a hospital.

People who choose to not be vaccinated and come into contact with people who have smallpox may be placed in isolation for 18 days, under the guidelines.

"I don't believe that one case -- say, in Maine -- is going to precipitate a nationwide mass vaccination program," Anderson said. "It would depend a lot on the circumstances. If there were multiple cases identified at the same time in different states, that would perhaps indicate a mass vaccination program is appropriate.

"We're going to need to look further to see what criteria might be necessary for implementing such a program. I'm sure we're not going to have a black-and-white program."

The state still plans to vaccinate first responders such as health care personnel, hospital employees and medical examiners, Anderson said. The guidelines list other people who should be among the first to be inoculated.

"The fact is, panic is probably going to be the most significant impact of any terrorist event where smallpox would be released," Anderson said. "And one of the things that we're going to be focusing a lot of attention around is reducing the panic that would be resulting from the threat of release."

Hawaii is probably well down on the list of target choices for bioterrorism, said Anderson.

The guidelines are posted at


More on smallpox

Deadly disease

Thought to have been eliminated worldwide by 1980, recent biological attacks have raised fears about use of smallpox as a biological weapon.


Despite widespread acceptance of the 1972 Bioweapons Convention Treaty, which called for worldwide destruction of bioweapon stocks and a halt on related research, the Soviet Union continued to produce smallpox in large quantities.

At least two labs in the former Soviet Union are believed to maintain smallpox, and Russian biologists may have left Russia to work for rogue governments.


Smallpox spreads most effectively during cool, dry winter months, but can be transmitted in all climates. It is most contagious during development of rash on patient.

Between 5 and 10 percent of cases develop into a more rapidly progressive malignant form of the disease that is almost always fatal within five to seven days.


After "eradication" was declared in 1980, vaccine production was halted. The U.S. government has 15.4 million vaccinations available today.

Vaccination either before exposure or within two to three days of exposure affords almost complete protection. After four or five days of exposure, vaccination may protect against death. Widespread innoculations in the United States were halted in 1972 and may not be effective against current strains of smallpox. Vaccines are not recommended for pregnant women, children under 1 year old, people who suffer from skin conditions such as eczema and people with immune system problems such as HIV.


A contagious virus that is unique to humans, smallpox is spread by inhalation of air droplets or aerosols. Twelve to 14 days after infection, high fever and aching pains develop, followed by a rash on the face and extremities. Rash turns to scabs, which separate and leave pitted scars. Without proper vaccination, death usually occurs in the second week.

Source: Centers for Disease Control and Prevention

Centers for Disease, Control and Prevention
State of Hawaii

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