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What Should People Living with HIV Be Concerned with As Far As the Threat of Terrorists Using Smallpox As a Biological Weapon?

Recently, rumors have suggested that terrorists may use smallpox as a biological weapon, much like the cases of anthrax in the US. The reason it's getting a lot of attention in the US 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.

Bio-Terrorism: Information and Resources for Patients

Reprinted from Kaiser Permanente Patient Information

Frequently Asked Questions and Answers

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 attack 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

1. American Psychological Association. The APA Web site contains the following useful articles:

   • "Coping with Terrorism"
     www.helping.apa.org/daily/terrorism.html

   • "Managing Traumatic Stress: Tips for Recovering from Disaster and Other Traumatic Events"
     www.helping.apa.org/daily/traumaticstress.html

   • "Reactions and Guidelines for Children Following Trauma/Disaster"
     www.helping.apa.org/daily/ptguidelines.html

2. David Baldwin's Trauma Information Web site. 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.