CDC Unveils Updated Smallpox Response Plan

The CDC has issued new guidelines to states on how to address potential outbreaks of smallpox, the New York Times reports. Rather than large-scale vaccination, the CDC is recommending isolation for victims and vaccinations for a "containment ring" of individuals exposed to an infected patient (Altman, New York Times, 11/27). The new recommendations update a 1972 plan that did not take bioterrorism "into account, with the possibility that many people might be infected at once" (Meckler, AP/Philadelphia Inquirer, 11/27). The CDC yesterday sent the recommendations, titled "Interim Smallpox Response Plan," to state health officials for review and comment (CDC release, 11/26). The 261-page report includes information about who should receive smallpox vaccination, how to address a large-scale smallpox attack and how to "calm an anxious public" in the event of an attack (Sanders, Los Angeles Times, 11/27). Under the plan, local health officials would "quickly" locate smallpox victims, isolate those exposed to the disease and vaccinate victims and those in contact with victims (Gillis/Connolly, Washington Post, 11/27). However, Dr. D.A. Henderson, a smallpox expert and director of health preparedness at HHS, said that health authorities should not force individuals to receive vaccination (AP/Philadelphia Inquirer, 11/27). The CDC plan also would allow large-scale quarantine as a "last resort." According to the report, the "most extreme case" of smallpox outbreak may force federal and state authorities to establish a "cordon sanitaire" -- a sanitary ring -- around a city or large area and "may require suspension of large public gatherings, closing of public places" and restriction of travel (Washington Post, 11/27). The CDC has asked local health officials to identify large quarantine facilities that could be used to isolate and treat patients (Los Angeles Times, 11/27). The CDC director would launch the smallpox response plan in the event of a smallpox outbreak and would send a supply of vaccine to inoculate patients and agency teams to isolate infected individuals (McKenna, Atlanta Journal-Constitution, 11/27).

Although several experts praised the CDC plan, the report "drew immediate criticism" from some state health officials (Washington Post, 11/27). State health departments said that they "don't have the resources" to "immediately" implement the plan, which "depends heavily" on local and state health officials (Carroll, Wall Street Journal, 11/27). State health officials will likely "press" the CDC to "reconsider" the plan. In addition, although the CDC has vaccinated about 80 to 100 employees who would respond in the event of a smallpox attack, the new smallpox plan "rules out any broader campaign" to inoculate state health employees who would respond to an outbreak. The CDC said that the federal government could "rush" the vaccine to states in the event of an outbreak, but state health officials said that the plan "does not take into account the worst-case scenario: simultaneous smallpox attacks in multiple cities." According to the CDC, the United States has a "limited" supply of smallpox vaccine -- about 15 million doses and cannot vaccinate state health employees on a large scale (Washington Post, 11/27). The federal government plans to purchase an additional 300 million doses by next year (USA Today, 11/27). Henderson said that the government could dilute the existing vaccine supply to expand the number of doses "by a factor of at least five" (New York Times, 11/27). To view an executive summary of the CDC report, go to http://www.cdc.gov/nip/diseases/smallpox/. To view a transcript of a CDC teleconference on the report, go to http://www.cdc.gov/od/oc/media/transcripts/t011126.htm.