AREA HEALTH WORKERS TO GET SMALLPOX SHOTS.

Byline: Troy Anderson and Grace Lee Staff Writers

Los Angeles County plans to vaccinate up to 20,000 public health workers and hospital emergency employees against smallpox as the first step in preparing for potential bioterrorist attacks, officials announced Monday.

They acknowledged that the county is ill-prepared overall at this point, with decontamination facilities for chemical or radiological terrorist attacks at only a few of the county's 81 hospitals that have emergency rooms. Already overcrowded, area hospitals are not prepared to handle mass casualties, they said.

The concern was emphasized by Jim Lott, executive vice president of the Hospital Association of Southern California, which represents 200 hospitals.

``There are not enough isolation beds, or rooms, to deal with a highly contagious disease in any mass quantities in Los Angeles County,'' Lott said. ``Contagious vectors like smallpox don't confine themselves to specific areas of a hospital if introduced into the environment.''

Lott said occupancy levels at hospitals in the county are already exceeding 80 percent, and there is not enough room to handle huge numbers of patients in the event of an outbreak. He was critical of county health officials for not including all hospital employees in the initial phase of smallpox vaccinations.

Dr. Jonathan Fielding, county director of public health, said the department is preparing to administer the smallpox vaccine to only a limited number of health care workers, between 13,000 and 20,000, as part of a three-phase plan.

The department is expected to submit a smallpox-preparations plan next Monday as required by the Centers for Disease Control and Prevention.

The first phase calls for vaccinating public health workers, doctors, nurses, medical epidemiologists, language translators, lab workers, mental and environmental health employees, security guards and law enforcement investigators.

``During this first phase we will receive only enough doses to vaccinate those health care workers who would be needed to begin vaccinating Los Angeles County residents, should that become necessary, or those who may be the first to investigate or care for a case of smallpox,'' Fielding said.

After the plan is submitted, President George W. Bush will have 48 hours to review it and then, if it is approved, county personnel would have 30 days to vaccinate the first group of health workers. In the second phase of the plan, vaccinations would be administered to a broader group of health workers and to firefighters, paramedics and law enforcement officials who would be the first to respond in an outbreak.

In the final phase, Fielding said the entire U.S. population could be vaccinated. The Centers for Disease Control and Prevention have 15 million doses that could be used along with older doses, which could be diluted, to vaccinate the entire population.

``It is now suggested the vaccination be made available to the general public as part of phase three, and it's likely, but not definite, the government would wait until the new vaccine has been developed and licensed, and that's expected in late 2003 or early 2004,'' Fielding said.

Federal CDC personnel recommend that state and local health departments, in collaboration with hospitals and medical facilities, establish public health and medical response teams that would deal with a smallpox outbreak. They also recommend establishing local clinics for mass smallpox vaccinations.

The vaccination of health workers is voluntary, and those people will undergo medical screening. Fielding said about 30 percent of the population could have an adverse reaction to the vaccine and should not take it, including people undergoing cancer treatment, pregnant women and people with immune-system problems, such as HIV, and some skin conditions.

Fielding said one to three people in a million could die from the vaccine, likely to result in 300 to 900 deaths nationally.

A terrorism exercise conducted two months before the Sept. 11, 2001, attacks indicated that smallpox releases in three shopping malls in three states could kill 1 million Americans and infect an additional 2 million within two months. The simulation showed 6,000 new infections daily and a spread of the disease to 26 states within 22 days.

``It doesn't take any sophisticated devices to bring smallpox into the United States,'' a Defense Department official said in September. ``You take an infected group of people, and you bring them into the United States, and you have them simply circulate through the population for some period of time. And if they are infectious when they come, they will, indeed, spread the disease.''

Smallpox is fatal in 25 percent to 35 percent of cases. The incubation period is seven to 17 days, and the symptoms begin with a fever above 101 degrees, headaches, body aches and vomiting. A rash would develop on the face, hands and feet within a few days - the point at which the virus is the most contagious. Smallpox is spread from one person to another by infected saliva droplets in face-to-face contact within six feet.

Fielding said he is not aware of any imminent threat.

``It has been speculated, and there have been reports that Iraq has smallpox virus and other countries may as well, in addition to the United States and Russia, where it is known to be kept under quite careful guard,'' Fielding said.

``I would assume the concern about the Middle East and the possibility of going into Iraq played into the decision-making process, but I know of nothing new with respect to the threat that would make it more imminent.''

Virginia Hastings, director of county emergency medical services, said officials of cities and counties are much more prepared now than they were immediately after Sept. 11, 2001, when terrorists flew hijacked jets into the World Trade Center towers and the Pentagon.

She said antibiotics and other drugs to combat biological attacks have been placed in caches spread throughout the county, government employees have undergone training, and health workers have been taught to identify the symptoms of bioterrorist warfare.

But she said only a few of the hospitals in the county have outside decontamination facilities to cleanse people in the event of a chemical or radiological attack.

``The decontamination facility should be outside,'' Hastings said. ``You don't want it to be inside. It could shut down your emergency room and hospital. That's what a good portion of our grant funding is going for.''

County government got a federal grant of about $30 million this year to buy protective suits for health workers and to build decontamination facilities, but Hastings said many hospitals will need money from a grant next year to complete construction.

Ellis Stanley, general manager of the Emergency Preparedness Department in Los Angeles, said city and county officials have been working together to prepare for a bioterrorist attack.

``We feel we have a very strong working relationship with our partners and are very well prepared to deal with it,'' Stanley said.

In Ventura County, the Public Health Department will coordinate smallpox vaccination plans for all the cities in the county. Health officials, in response to a request by the state Department of Health Services, will submit a plan today outlining how they will vaccinate a core group of response workers.

These response teams - about 1,000 to 2,000 health care workers, ambulance personnel and public health personnel - would be in charge of diagnosis, isolation, surveillance and treatment of smallpox cases. Some members of the Sheriff's Department and firefighters will also be part of the initial response, as outlined in the first phase of the plan.