Tens of thousands of health-care workers will be among the first to receive smallpox vaccinations under the federal government's plan to protect the public against possible terrorist use of the virus.
States prepared to wrap up the first phase of the vaccination process by the end of January. Vaccination plans were submitted to the Centers for Disease Control and Prevention earlier this week.
The CDC said it has received 62 plans submitted by the 50 states, District of Columbia, U.S. territories and the nation's largest cities, calling for the vaccinations of 450,000 individuals in the first phase. An estimated 130 million Americans have never been vaccinated for smallpox.
"The probability of an intentional release of smallpox virus remains low but, since the consequences of such an attack would be so great, we must be prepared," said Dr. John Lumpkin, director of the Illinois Department of Public Health. "This effort will focus on offering personal protection from smallpox disease to those who would be called upon to investigate and to provide treatment in the event of a smallpox release or outbreak.
"By protecting these individuals, we improve our ability to safeguard the public, and we increase the capacity and capabilities of the public health system and hospitals to respond to and control a smallpox outbreak."
Lumpkin said the state has requested vaccine for as many as 16,000 public health and hospital personnel. Local health departments will handle the vaccination process. Other emergency personnel, including police and firefighters would be vaccinated in a second phase of the program, which has not yet been finalized.
California officials have submitted plans to vaccinate 70,000, while Texas has proposed vaccinating 40,000 in the first phase.
New York officials said they would not release details of their plan, which covers 57 counties outside New York City. The officials would say only 16,000 doses had been requested for 15 public health teams.
Colorado said it expects to vaccinate 1,200 health care workers.
"This is being done strictly as a precautionary measure," said Dr. Ned Calonge, Colorado's acting chief medical officer.
Minnesota plans to send a doctor and four nurses to Atlanta next week to learn how to give smallpox shots as part of its plan to vaccinate 10,000 doctors, nurses and other personnel in the first phase of the national response.
Massachusetts officials said vaccinations against smallpox could begin for emergency personnel, hospital and public health workers as soon as next week.
The first to be vaccinated will be a core group of some 100 people. Between 10,000 and 12,000 personnel will then be vaccinated over some four months starting Jan. 19, the Massachusetts Department of Public Health announced. Dr. Alfred DeMaria, chief of infectious diseases, said all those to be vaccinated will be volunteers.
About 6,300 health care workers in special smallpox teams will be the first to be vaccinated in Connecticut. A second stage would take place after that, with vaccinations of some 125,000 health care workers, emergency department staff and police and fire personnel.
Elsewhere, Michigan plans to begin its program with 5,000 to 7,000 members of public health response teams; Louisiana, 20,000; Missouri, 6,000 to 8,000; Kansas, 3,000 to 4,000; Indiana, 5,000 to 7,000; Hawaii, 3,400; Idaho, 800; Oregon, 700 to 900; Georgia, 500; Vermont, 2,000; South Carolina, 7,600; Kentucky, 10,000; Alabama, 12,000; Virginia, 25,000, and Utah, 3,000 to 5,000.
Smallpox is a highly contagious, disfiguring virus that can be spread through the air or infected bed linen or garments. It can infect 30 percent of those exposed, a third of whom will die. There currently are no effective anti-viral treatments for the disease, which is blamed for killing a large proportion of the Native American population after Europeans came to the New World.
The vaccination has not been routinely administered in the United States since 1972 although millions of Americans have some residual immunity as a result of receiving the vaccination earlier in the century.
The last case of smallpox in the world occurred in 1977 in Somalia. The last case in the United States was in 1949.
Research indicates one or two people die and 52 develop life-threatening reactions for every 1 million people vaccinated. Some 30 million Americans have medical conditions, like HIV, cancer and organ transplants that would comprise their immune systems, arguing against their being vaccinated. Pregnant women also would have a higher risk of adverse reactions.
CDC spokesman Curtis Allen said about 2.7 million doses of the vaccine have been licensed for distribution by the Food and Drug Administration, with another 12 million doses awaiting certification. One manufacturer has donated 85 million doses and the government has ordered another 209 million.
The vaccine is administered in 15 quick pricks. It produces a red itchy bump that turns into a large, puss-filled blister, which eventually dries up and scabs over.
Despite the belief people over 30 would have some residual immunity, the same dose of vaccine is given to everyone.