~Medical volunteers will take first doses
SIKESTON -- Vaccinations for a few dozen military personnel began mid-December, and by the end of this month states are expected to begin inoculating health care response teams and others who would respond to a smallpox attack.
Members of the Missouri Delta Medical Center staff could receive voluntary smallpox inoculations late next month.
"At this point I look for us to begin our smallpox plan probably late February or first of March to vaccinate our staff," said MDMC Safety and Infection Control Manager Joy Cauthorn.
The Department of Health and Senior Services is currently training their nursing staff and employees on the appropriate technique to administer the smallpox vaccine since it hasn't been given since 1972.
The shot that carries rare but serious side effects. One or two out of every 1 million vaccinated will be killed by the vaccine, and 15 will face life-threatening complications.
MDMC is working collaboratively with the Missouri Department of Health and Senior Services as well as the Missouri Hospital Association.
"They're going to provide us with as much information as possible to develop our initial plans for implementation of Missouri's pre-event smallpox plan," said Cauthorn.
Missouri Delta's plan has to be turned into the Missouri Hospital Association and the Department of Health and Senior Services by Jan. 16.
Approximately nine to 12 people (or 30 percent of MDMC's staff) will be voluntarily vaccinated so that they can provide care around the clock, 24 hours a day, Cauthorn estimated.
"We have not made the voluntary vaccination announcement to our people yet because we just received the documents a week ago from the Missouri Department of Health and Senior Services," Cauthorn explained. "We haven't put out memos or asked people yet, but it is part of our plan."
While hospitals are developing smallpox plans, the Missouri National Guard currently isn't.
"We have not had any higher orders about smallpox inoculations," said Lt. Tammy Spicer, of public affairs for the Missouri National Guard in Jefferson City. "Eventually Missouri will get orders once a plan is in place."
The government will make the vaccine available to the general public beginning in late spring or early summer.
Civilian vaccinations will begin with about 450,000 people most likely to encounter a highly contagious smallpox patient. That includes people who work in hospital emergency rooms and those on special smallpox response teams.
Next up will be emergency responders, such as police officers, firefighters and other health care workers. The government is recommending the vaccine for an estimated 10 million in this group, and health officials predicted that about half would say yes.
Adults who want the vaccine can sign up for clinical trials now under way. HHS also will create a special program for people who want to sign up -- expected in late spring or early summer, health officials said.
Or, people could wait until 2004, after the vaccine is licensed, although it will still not be recommended.
Once among the most feared diseases on Earth, smallpox killed hundreds of millions of people in past centuries, but it hasn't been seen in this country since 1949. Its eradication was one of public health's greatest victories.
But because no one has been vaccinated in decades, the population is highly vulnerable. While all stocks of the virus beyond two official labs were supposed to be destroyed, experts fear that hostile nations or terrorist groups may have smallpox and could use it in an attack.
The most serious complications include encephalitis, which can cause paralysis or permanent neurological damage, and progressive vaccinia, where the vaccination site does not heal and the virus spreads, eating away at flesh, bone and gut.
The vaccine poses significant risks for certain people, including cancer patients, organ transplant recipients, people with HIV, pregnant women and people with a history of eczema. People who live with others who have these conditions should not be vaccinated, because the live virus used in the vaccine can sometimes escape the inoculation site and infect others.
Health workers delivering the shots will have to ask questions that will screen these people out. Federal officials are recommending that states make pregnancy and HIV tests available to people considering the vaccination.
With its plan implemented, basically MDMC will provide care to identify, diagnose and treat smallpox.
"We do not administer the smallpox vaccination here. That will be done by five designated health departments in Missouri. And the designated local health department that will provide Missouri Delta staff with immunization is the Butler County Health Department in Poplar Bluff," Cauthorn said.
The other four health departments are in St. Louis, Springfield, Columbia and Kansas City. Officials at the Scott County Health Department said they haven't heard any plans about smallpox immunizations at their department.
Specimens are only collected at MDMC, Cauthorn noted. Smallpox has to be collected at the site and sent to a higher level lab for confirmation and diagnosis, she added.
"We've always had a disaster plan," Cauthorn said. "Last year we developed a bioterrorism plan that flowed into the disaster plan. They all flow into each other. And the plan we have set up now will flow into the bioterrorism plan."
The Associated Press contributed to this story.