Press room ... 2001 archive
What should people living with HIV be concerned with
as far as the threat of terrorists using smallpox
as a biological weapon?
November 5, 2001
San Francisco—Recently, rumors have suggested
that terrorists may use smallpox as a biological weapon, much like
the cases of anthrax in the U.S. The reason it's getting a lot of
attention in the U.S. is simply a matter of the federal Department
of Health and Human Services (DHHS) wanting to look prepared. It's
probably very unlikely that smallpox would ever be used as a weapon.
This is because once smallpox starts spreading in any population,
the risk of it spreading around the world is high. It would inevitably
go right back to the terrorists who used it in the first place.
Right now, smallpox is almost totally eradicated except in a few
countries. Spreading smallpox around the world again would earn
the wrath of almost everyone.
The DHHS is currently testing diluted versions of the current smallpox
vaccine to see if that will stretch out the supply. The DHHS is
reluctant to start manufacturing more of that supply as it's a relatively
dirty vaccine, made from smallpox sores from calves and pigs. If
they have to make more, they would rather engineer a new and better
vaccine. The current vaccine will kill some of those who use it
and make others sick.
Statements have been made discouraging the use of smallpox vaccines
in people with immune deficiencies. Technically, that would include
people with AIDS, but it's less sure if it would also include HIV-positive
people with intact immune systems. It's probably safe to say that
doctors would want to make decisions with their patients about this
on an individual basis, based on the patient's history and current
condition.
However, at this time, it's a moot point to speculate about getting
a smallpox vaccination. Nobody is yet getting the vaccine in any
form.
When treating smallpox, it's possible to use one of the anti-CMV
drugs, cidofovir from Gilead. The federal government has discussed
the situation with Gilead, as has Project Inform. There are apparently
large stocks of the drug in storage under Gilead's control because
the drug never sold well for CMV. This was due to its serious kidney
toxicity, its intravenous administration and cases of CMV dropping
dramatically.
The drug has a long shelf life and Gilead apparently made much
more of it than they could ever sell. The government hasn't officially
decided whether it will use cidofovir if there's an outbreak of
smallpox, but it would probably be reserved for serious, life-threatening
cases only. There's little reason to believe they would try to use
it in a preventive way, given its toxicity.
Below you will find some more frequently asked questions and answers,
reprinted from Kaiser Permanente Patient Information.
1. Can I get vaccinated?
There are no available vaccines for the potential agents of bio-terrorism.
The government has a supply of vaccines, which will be released
if needed, but they are not available otherwise. This includes smallpox
and anthrax. In addition, anthrax vaccine has never been shown to
be effective in respiratory anthrax (the form an attack would take)
and has some potentially serious side effects.
2. Should my doctor prescribe preventive antibiotics against anthrax,
plague, or other bio-terrorist threat diseases?
There is no single antibiotic to protect against an attack, and
it is difficult to predict what would be needed and when. Therefore,
preventive antibiotics are not needed for anthrax, plague, or any
other bio-terrorist threat disease, and public health officials
do not recommend prescribing them. Furthermore, inappropriate use
of antibiotics can lead to unnecessary harmful side effects and
to the development of antibiotic-resistant organisms. If there is
an attack, public health authorities have plans to disseminate information
and facilitate supplies of needed medications.
3. How can I tell if a bio-terrorist attack has occurred?
There would be multiple suddenly seriously ill, otherwise healthy
persons. The public health authorities would be notified immediately
and you would hear it via the media. You should seek care for any
normal reason you would seek care, such as severe illness, severe
symptoms or persistent symptoms.
4. How can I be sure my health care needs will be met if a bio-terrorist
attack occurs?
If a bio-terrorist attach were to occur, local and state public
health departments will be responsible for disseminating uniform
treatment guidelines appropriate to the situation and for ensuring
coordinated and rapid distribution of antibiotics to medical facilities,
medical and other response personnel, and to exposed or ill members
of the general public.
The federal government has assembled a National Pharmaceutical
Stockpile (NPS) to supplement local and state resources. The NPS
includes immediate response Push Packages that are caches of pharmaceuticals,
antidotes, and medical supplies designed to address a variety of
biologic and chemical agents. The Push Packages are positioned in
secure regional warehouses ready for immediate deployment to the
airfield closest to the affected area within 12 hours of the federal
decision to release NPS assets. This program is supplemented with
a Vendor Managed Inventory program that ensures the continual supply
of pharmaceuticals, antidotes, and medical supplies to an affected
area when the NPS has been depleted.
Web-based resources for patients
- American Psychological Associate. The APA website contains the
following useful articles:
- David Baldwin's Trauma Information website. This comprehensive
site contains a variety of handouts and links to useful information
from the American Red Cross, the American Psychological Association,
the National Center for Post-Traumatic Stress Disorder, and various
mental health departments and organizations. www.trauma-pages.com/pg5.htm.
