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DALLAS, Texas - The ill-fated campaign to vaccinate U.S. health care workers against smallpox probably will be resuscitated next year in hopes of convincing more medical staffers to volunteer for the shots.
Only 38,377 people have been vaccinated so far in the national effort, which initially was expected to attract 500,000 volunteers.
The vaccination effort came in the aftermath of the Sept. 11 attacks when concerns were raised that terrorists may have stolen the smallpox virus from known stockpiles.
A spokesman for the Centers for Disease Control and Prevention said Monday that an assessment was being made of each state's readiness to handle a possible smallpox outbreak should terrorists unleash the long-absent disease - a scenario much feared by federal officials.
"There's no goal number," Von Roebuck, a CDC spokesman, said of a vaccination target. "We need to look at how much planning is in place for a given city or state. It's not just about how many people are vaccinated."
Texas drew the biggest turnout of medical volunteers; 4,241 were inoculated, although the number fell far short of the 40,000 people that had been anticipated. In Dallas County, 294 health professionals were inoculated instead of the original estimate of 4,500.
"We haven't failed," said Dennis Perrotta, the state's chief epidemiologist and top official for bioterrorism response. "We immunized a lot of people in Texas. Is it enough? I don't think so."
The vaccination program got off track earlier this year, in large part because of concerns about possible adverse effects from the vaccine. A number of employee groups, including the Texas Nurses Association, advised their members to avoid the shots out of liability concerns.
Studies have estimated that severe side effects from a smallpox vaccination affect 52 people for every million vaccinated. The illnesses include encephalitis or swelling of the brain, severe skin rashes that can lead to scarring or death and ongoing infection of the vaccination site, which can cause tissue destruction.
One or two deaths per million people vaccinated have been recorded in previous smallpox vaccination efforts.
Dr. Perrotta said the initial vaccination effort probably was hamstrung by the emphasis placed on the most severe - but extremely rare - side effects.
"In an effort to be open about the possible severe consequences of the vaccine, I believe we focused too much attention on that," he said.
Nonetheless, Dr. Perrotta said he weighed those risks before volunteering to be the first civilian in Texas to receive a smallpox shot last February.
"I thought it was important as the person who drew up the plan," he said of why he chose to be inoculated.
As the program unfolded, each potential volunteer underwent an extensive screening process, drawn up by the CDC. The process eliminated people with known health conditions such as hepatitis, diabetes, certain skin ailments and pregnancy. People taking certain medications also were ruled out.
But as the state saw that participants were not materializing as expected, officials decided to concentrate on getting "enough" people vaccinated to handle a possible smallpox outbreak in each region of the state. No actual number was specified, however.
"It was my goal to vaccinate as many (smallpox) response teams as we could without serious side effects," Dr. Perrotta said. "But the more you immunize, the more likely you'll have an adverse event."
As the CDC considers how to re-energize smallpox preparedness, it also will look at how well communities across the country are training hospital workers to recognize and treat smallpox - a disease that has not been seen in the United States since 1949 and was declared eradicated worldwide in 1980.
The CDC's smallpox guidelines will be developed this fall, and a plan submitted in November to the Institute of Medicine, an agency that advises Congress on health-related issues.
"The institute is a group of non-CDC physicians who bring an outside view to this process," Mr. Roebuck says. The review "could very well last into next year."
As part of the effort, states will be asked to recommend strategies for convincing more people to volunteer for the immunizations. In Texas, officials are discussing the possibility of paying volunteers to undergo an inoculation. No dollar amount has been suggested, however.
"Who knows what people will think when you offer them money to be vaccinated," said Dr. David Buhner, an epidemiologist for Dallas County. "It makes you wonder what value you place on someone's life?"
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(c) 2003, The Dallas Morning News. Distributed by Knight Ridder/Tribune News Service.
