The Mohave County Department of Health and Social Services will soon have a plan on how to vaccinate the entire county population against smallpox in a 3-5 day period, if an executive order to do so is issued by President George W.
Bush is expected to order vaccinations for 500,000 emergency workers that likely would be exposed to smallpox following a bioterrorism attack, along with an equal number of military personnel.
The county smallpox vaccination plan must be finished and submitted to the state health department by Jan.
1, according to Patty Mead, director of the county health department.
"What it looks like right now is that an initial team of five health department staff members will get vaccinated within two weeks and become the county's epidemiological team," Mead said.
"If anyone should exhibit symptoms of smallpox, that team would go in and determine if it really is smallpox."
Epidemiologist Leslie Joyce, a doctor and three nurses are the county health department members that will receive the first vaccinations in Phoenix, Mead said.
Smallpox is a disease caused by variola virus that comes in at least two strains, variola major and the milder variola minor.
Incubation of the virus takes 12-14 days after exposure.
Someone who is infected will experience a high fever, vomiting, fatigue, headache, backache and possibly severe abdominal pain and delirium.
Two to three days later, a raised, spotted rash appears on the mouth, throat, face and forearms, quickly spreading to the torso and legs.
One or two days later the rash bumps fill with fluid and later pus.
Scabs form over the rashes and later fall off.
The patient can infect others until those scabs fall off.
"You must vaccinate before you develop symptoms," Joyce said in explaining why 3-5 days after possible exposure to the virus is the critical period.
"If you vaccinate after getting the symptoms, you may get some immunity but it's not the same.
"Whether vaccination will help also depends on the level of symptoms.
A person with a sore throat and fever may not even notice them and be contagious.
But you're more contagious once you develop the sores."
Variola minor causes mortality in one percent of unvaccinated victims.
Variola major results in mortality to three percent of people vaccinated and 30 percent not vaccinated.
Smallpox was eradicated worldwide in 1977 after a 10-year campaign led by the World Health Organization.
But it is a weapon that may be used today by bioterrorists.
"What we've been told is that if one (confirmed) case of smallpox appears anywhere in the world our government will consider it an act of war and we'll get orders to vaccinate everyone," Mead said.
"That's why we must have a plan to carry out vaccinations in three to five days."
County health department employees make up the first tier of people who would be vaccinated, as they would come into direct contact with infected individuals, Mead said.
Tier two is health care professionals and emergency responders, while tier three is the general population, she said.
No one can be forced to undergo vaccination, Mead said.
She added that she does not yet know if vaccine will be made available for the public without an executive order.
There are risks to consider for those thinking about vaccination.
"The vaccine can cause serious complications for those with immuno-compromised conditions like HIV and hepatitis C or certain skin conditions like dermatitis and eczema," Mead said.
Studies from the 1960s indicate that 15 of every million people vaccinated for the first time will experience life-threatening complications.
Vaccination causes the recipient to develop an open sore that will scab over after three weeks.
A health care professional must examine the scab site at that time to determine the degree of immunity for the patient, Mead said.
The site of the sore needs to be kept covered and strict hand washing rigidly observed.
Scratching or rubbing the sore will spread the active virus cells and surely lead to contracting smallpox, Mead said.
"A vaccination should give 7-10 years of protection from smallpox," she said.
"People who have gotten the vaccination in the past may have some belated degree of immunity, so if exposed they may not get smallpox as seriously as those who never had the vaccination."