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BMJ 2002;324:1540 ( 29 June )

News

US draws up plans for smallpox outbreak after terrorist attack

Fred Charatan, Florida

A US advisory group has recommended that people likely to be directly involved in handling any outbreak of smallpox after a terrorist attack should be vaccinated as a precautionary measurealthough mass vaccination has been deemed unnecessary.

The 14 member advisory committee on immunisation practices at the Centers for Disease Control and Prevention (CDC) has voted unanimously against vaccinating all Americans against smallpox. It said, "Under current circumstances, with no confirmed smallpox, and the risk of an attack assessed as low, vaccination of the general population is not recommended, as the potential benefits of vaccination do not outweigh the risks of vaccine complications."

The recommendations up-date those made by the committee in June 2001 and follow the formation of a joint working group with the national vaccine advisory committee, with forums in major cities across the United States (18 May, p 1176).

It recommends pre-release vaccination of selected groups to improve response readiness to smallpox: "Smallpox vaccination is recommended for persons pre-designated by the appropriate bioterrorism and public health authorities to conduct investigation and follow-up of initial smallpox cases that would necessitate direct patient contact."

It advised the establishment of smallpox response teams in each state and territory, which might include a designated medical team leader, public health adviser, medical epidemiologists, disease investigators, diagnostic laboratory scientist, nurse vaccinators, and security and law enforcement staff.

The committee has also recommended smallpox vaccination "for selected personnel in facilities pre-designated to serve as referral centres to provide care for the initial cases of smallpox." These facilities would be predesignated by the appropriate bioterrorism and public health authorities, and staff in these facilities would be selected by the hospital.

© BMJ 2002
 

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