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March 19, 2003 Health workers around the state roll up their sleeves as Oregon prepares for unlikely, but possible, smallpox threat This guest opinion is by Grant Higginson, M.D., state public health officer in the Oregon Department of Human Services. For a photograph of Dr. Higginson or an electronic version of this guest opinion, call Bonnie Widerburg at (503) 731-4180 or e-mail bonnie.l.widerburg@state.or.us Length: 529 words By Grant Higginson, M.D., M.P.H. This month Oregon began vaccinating up to 800 health workers across the state against smallpox in preparation for the unlikely, but possible, release of the virus by a terrorist. Smallpox is a devastating disease that, over thousands of years, has probably caused more deaths worldwide than any other infection. About a third of those who become ill with the virus die. The disease is no stranger to public health. In Oregon, smallpox and other deadly diseases were major factors in the creation of the state Board of Health in 1903. One of the first state health officer’s priorities was to develop a smallpox prevention and vaccination program. Thanks to public health programs of vaccination and disease investigation, the disease was declared eradicated from the entire earth in 1980. Routine smallpox vaccination programs here and in other countries were discontinued. Smallpox is once again a public health concern because there is a small chance that terrorists could obtain the virus. Although the probability that they would intentionally use it as a weapon is low, we need to be prepared. In December, Oregon’s two smallpox preparedness plans were approved by the federal Centers for Disease Control and Prevention. One plan calls for disease control and response. The second plan, underway now, is to vaccinate health workers. In the next month, health workers from all over Oregon will travel to one of three locations to receive smallpox vaccination. Once vaccinated, they are able to serve on a smallpox response team. This means they can immediately and safely be deployed to investigate a suspected case, provide care to the smallpox patient and vaccinate others. Oregon is among the last of the states to begin vaccination. We have taken a conservative and cautious approach, weighing the need to prepare for smallpox against the risk of side effects that the vaccine carries. These side effects, though not common, can be severe. Smallpox vaccination involves extensive pre-screening, informed consent procedures and clinical follow-up. The vaccination itself is time consuming, involving more than a simple shot. For these reasons, we’ve planned carefully with our partners and will conduct a practice clinic later this month. We are not vaccinating professional groups other than health workers, nor is smallpox vaccination a good idea for the general public right now. The last smallpox case was in 1978 and the vaccine is not completely safe. If Oregon ever had an outbreak, we would control it using "ring vaccination," which worked before, finding cases and vaccinating their contacts. If given within four days of exposure, the vaccination will prevent the disease or lessen the symptoms. The health workers now being vaccinated do so voluntarily. I respect and thank them for their commitment to protecting public health. I sincerely hope the day never comes when we need to rely on them for a response to smallpox in Oregon. But the fact that they have taken this step means we are better prepared. For public health, it is ironic to find ourselves preparing for an old enemy that we already vanquished. As we prepare for this unthinkable threat, it’s important to remember, we conquered smallpox once. We can beat it again if need be. Grant Higginson, M.D., M.P.H., is state public health officer in the Oregon Department of Human Services and oversees the state’s bioterrorism preparedness program. For more information: www.dhs.state.or.us/publichealth/acd/smallpox/index.cfm |
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