Although troops are massing thousands of miles away to fight a
potential war with Iraq, the war against bioterrorism is coming
home to Santa Clara County.
Although troops are massing thousands of miles away to fight a potential war with Iraq, the war against bioterrorism is coming home to Santa Clara County.
The county’s Public Health Department has begun working internally and with Saint Louise Regional Hospital and other county hospitals to implement the first phases of a nationwide smallpox vaccination plan recently directed by the federal government and Bush administration.
Across the nation, health officials are building a network that can respond immediately to smallpox cases and eventually tackle the huge task of vaccinating millions of Americans. In California, Santa Clara County officials said they’re taking a leadership role in the effort.
“I think we’ve been a leader statewide,” said Dr. Martin Fenstersheib, the county’s health officer. “I think Santa Clara County is well beyond most other counties in its preparedness.”
As part of its overall effort to prepare for possible bioterrorism, the county has created a new Office of Disaster Medical Services to focus on planning and logistical response, Fenstersheib said. The county is also preparing for other “Category A” bio-agents such as bubonic plague and anthrax, but the smallpox plan is the first on-the-ground plan to come out of that general framework.
The first phase of the plan involves gathering volunteers to vaccinate and serve on response teams within the Public Health Department and each of the county’s 14 hospitals. The teams would be the first to respond to a potential smallpox case.
At hospitals, the teams would involve staff that would isolate and care for people with smallpox cases, Fenstersheib said. Those teams would include a wide range of professionals ranging from doctors and nurses to housekeepers and cafeteria workers.
“It’s anybody that might come into contact with somebody who’s affected,” he said.
In the Public Health department, response teams would identify cases, then perform tracking and surveillance to attempt to prevent spread of the disease. Those that have come into contact with an infected person would be vaccinated.
The second phase of the overall vaccination plan, which involves vaccinating the rest of the health care community as well as first-responsders such as firefighters and paramedics, is anticipated to begin immediately at the end of phase one.
That would lay the basis for infrastructure needed for a third phase – the sweeping nationwide effort to offer the vaccine to the general public.
“By the end of phase two, nationally we’ll have quite a number of people who would be able to respond if there was a case,” Fenstersheib said. “And we could also vaccinate a lot of the larger population fairly quickly.”
Under current plans, John and Sally Q. Public probably won’t be offered vaccinations until early 2004. But a case anywhere in the world would be considered an international health emergency and would most likely cause authorities to begin offering it immediately to everyone in the country, Fenstersheib said.
“We’d need to go through a different mode,” he said. “It spreads quickly and if you don’t get a handle on it it will quickly ge out of control.”
Even if a resident is exposed today to smallpox, they would still have a one- to three-day window to get vaccinated in order to protect themselves, Fenstersheib said.
“If you haven’t been vaccinated and you come into contact, it’s not the end of the road,” he said. “You have a window period of time.”
Hospitals are due to respond by mid-January with initial response-team rosters, when the first doses of vaccine are expected to be on-hand. The recruitment effort for response teams is strictly voluntary.
So far, Fenstersheib is fairly optimistic the county will get enough volunteer interest in its first phase. Nationwide, the first phase is expected to include vaccinations of roughly 500,000 people, not counting military personnel. Santa Clara County has requested 5,000 doses for the first-phase vaccinations here.
“It’s a limited number of people,” he said.
Worst-case reactions are extremely rare with the vaccine, Fenstersheib said. Officials expect one to two deaths die per million for those who have never been vaccinated, and less mortality for those that have been previously vaccinated.
“It was used for decades and decades,” he said.
While the federal governement will pay for the actual doses of vaccine and the needles to deliver them, so far the county is on the hook for the staff time and human resources costs needed to implement the plan. Staffers have already been pulled away from conventional duties to nail down local logistics of the response plan.
Fenstersheib did not have a solid cost amount for the county’s first-phase plans, but did not anticipate it would reach the hundreds of thousands of dollars.
The actual logistics of the smallpox plan itself have been assembled over the course of about a month’s time, but were aided by the overall planning that’s been tackled over the course of the last year. Officials were also able to incorporate lessons learned from last fall’s post-9-11 anthrax scare.
“We basically had to make that up as we went along,” he said. “We learned a lot and used that info to put together a plan, so we have a better sense now of areas we had to strengthen and people we had to bring on board.
“We want to do this without doing any harm and do it right, and we will.”
Officials stress the likelihood of a smallpox attack is remote, and there are no signs such an attack is imminent. The disease was eradicated by the World Health Organization in 1980, and worldwide there are no current cases of smallpox, Fenstersheib said.
Still, every community has been instructed to develop a plan.
“Right now smallpox is the one (agent) our government feels we need to address, given the world situation and the risks of that virus being in the hands of potential terrorists,” said Fenstersheib.
