Smallpox, anthrax: What could happen
By CNN Correspondents
(CNN) -- It was 1947 when the United States last fought a war against the biological enemy smallpox.
A tourist in New York City was found to be infected with the disease, and 6 million city residents lined up to be vaccinated. The result: only 11 cases and two deaths, a public health triumph.
Since then, a 1977 global vaccination program has eradicated smallpox from the planet, except in controlled forms.
But the issue of a smallpox outbreak is once again on the minds of health experts as the September 11 attacks on New York and Washington further highlighted the possibilities of a bio-terrorist attack -- unleashing smallpox, anthrax or pneumonic plague on a large population through crop-duster airplanes or other methods.
"There is a possibility, but we still believe this is an unlikely possibility," says Dr. D.A. Henderson, who headed the 1977 efforts to eradicate smallpox. "The risk that this is going to happen is small, but it's there. It's not zero."
That miniscule chance has led to a new education effort on how the germs might be spread, and what symptoms citizens should look for.
"The speculation is that it would be released into the air as an aerosol, possibly from an airplane or perhaps in a closed room. People would then breathe it in," says Dr. Tara O'Toole of the Johns Hopkins Center for Civilian Biodefense."
The results of such an attack would be undetectable -- at first.
"You couldn't smell it, you couldn't see it, you wouldn't know it was there," says Henderson.
But soon enough, the results would show up. In the case of a smallpox or anthrax attack, the first symptoms would be similar: flu-like fever, aches, and weakness.
In smallpox, a rash would develop about three days later.
"The rash is very painful, usually causes scarring for life, some people go blind and about 30 percent of the people who get smallpox die," says O'Toole.
The rash also opens the doors to victims.
"People are contagious once the rash begins," says Henderson.
"You can spread (smallpox) to people who are in your immediate vicinity, six feet or so away," says O'Toole.
The vaccine can stop smallpox in its tracks if given within three to five days of being exposed. Right now, there are 15 million doses of the vaccine available; another 40 million are on order.
'Dark Winter' exposes weaknesses
They might be needed. Based on past smallpox outbreaks, health experts estimate each smallpox victim could spread the virus to at least 10 others.
In a recent simulated exercise called "Dark Winter," experts studied what would happen if three U.S. cities were dealt a smallpox outbreak. The result: After three months, the virus would have spread to 25 states and 15 countries, killing one million people.
"There were some who said this is an extreme example of what might happen in a worst-case scenario," says Henderson. "I wish I could say that, but I can't."
An anthrax outbreak would start with flu-like symptoms and a temporary recovery. That could be followed over the next six days by serious breathing problems and shock.
Death often follows, particularly if the agent is breathed in. An accidental release of a small amount of anthrax powder from a plant in the former Soviet Union resulted in 65 deaths.
Encouraging news on preparedness
But there are possible cures. The antibiotic ciprofloxacin works best at controlling symptoms and preventing deaths, and an anthrax vaccine -- it takes 18 months to complete the series of shots -- is about 93 percent effective.
Health experts are worried, however, that an outbreak would not be identified by doctors before the damage is done.
"There are still problems," says Henderson, "where the doctors in the emergency rooms or in private practice do not think of calling immediately to the public health authorities in their areas to say, 'I have a couple of cases that look very strange to me. I don't know what they are. I would like your help.'"
There is encouraging news on the level of U.S. preparedness. Experts say the United States is far better able to identify a biological agent that it was just two years ago. That's when the Centers for Disease Control and Prevention launched a network of 50 specialized laboratories across the country for state-of-the-art analysis of samples from infected patients. Results would be available in 24 hours.
Now, a new effort is underway to prepare for the worst-case scenario: A terrorist biological attack that has the success of those on September 11.
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