July 2002 • Volume 8 • Number 7 |
 The Missouri AFP fully supports AAFP's policy on smallpox vaccination, says FP Mark Mengel, M.D., of Clayton, Mo. |
The good news is that the threat level is probably minimal. The bad news is that there's a threat at all. That was the word coming out of one of four community forums the CDC recently hosted on smallpox and its bioterrorism potential. The June 8 forum here saw ample discussion about the disease, its possible use as a biological weapon, and the appropriate public health response to a probable or confirmed outbreak.
"We want to reiterate that the threat level at this time is not known, but it is thought to be small," said Joel Kuritsky, M.D., director of preparedness and response activity for the CDC's National Immunization Program. "We've talked about a lot of threat scenarios, however, including a self-infected terrorist walking amongst us. One of the big things you consider with bioterrorism is aerosolization of the agent and spread in a high population-density locale, like a subway."
The CDC sponsored the community forums to solicit feedback from health professionals, emergency responders, public health officials and others on the following questions:
Mark Mengel, M.D., chair of the family medicine department at Saint Louis University School of Medicine, highlighted the family physician's role in recognizing, reporting and responding to bioterrorism. Mengel spoke as the representative from the Missouri AFP, giving testimony in line with AAFP's policy on smallpox immunization, issued last month.
"The Missouri Academy will work with state bioterrorism and public health authorities in the identification of potential response team physician members in their role as sentinel physicians, especially in underserved and rural areas," Mengel said.
The Missouri AFP, he said, fully supports the AAFP stance, which embraces the strategy outlined in the 2001 CDC Interim Smallpox Response Plan and Guidelines (available at http://www.cdc.gov/nip/smallpox/). The AAFP policy further advocates "immunization of a limited number of persons predesignated by the appropriate bioterrorism and public health authorities" as "the next step in preparedness."
Go to http://www.aafp.org/immunization/smallpox.html for the full text of the Academy's policy statement.
Views aired at the forum varied widely, with some advocating little or no change from the 2001 CDC recommendations, others pressing for a more liberalized immunization policy, and still others taking a firm stance against universal vaccination. St. Louis resident Elizabeth Boone was definitive in her statement against mass immunization.
"I will not take the vaccine," said Boone. "You'd have to shoot me to get me to take it." What it boils down to, she added, is sharing complete information and allowing people to make their own decisions.
Universal smallpox vaccination is probably not a prudent course at this time, said Richard Clover, M.D., of Louisville, Ky., in a later interview. Clover, a member of the AAFP Commission on Clinical Policies and Research, is one of two AAFP liaisons to the CDC's Advisory Committee on Immunization Practices and has worked with that group to help formulate an appropriate national response plan to the specter of smallpox.
"Given what we know about possible complications associated with administering the vaccine," Clover said, "even with careful screening of candidates, the risks of mass vaccination appear to outweigh the potential benefits for a significant segment of the population. "Especially in the absence of a defined threat," he added.
Additional forums occurred June 6 in San Francisco and New York and June 11 in San Antonio.
The ACIP-National Vaccine Advisory Committee Smallpox Working Group, which advises the CDC, has reviewed feedback from these forums and from other meetings in which the AAFP has participated. At press time, no updates to the CDC guidelines had been announced. Go to http://www.cdc.gov/nip/smallpox/ for the latest information on those guidelines.
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Copyright © 2002 by American Academy of Family Physicians.