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Anthrax and Smallpox FAQ 
The following information has been provided by the Centers for Disease Control - National Immunization Program. Other informational resources are provided throughout this document should additional information be required Frequently Asked Questions and Answers 1. Where can I get the smallpox vaccine? Since vaccination is no longer recommended, the vaccine is not currently available. The CDC maintains an emergency supply of vaccine that can be released if necessary since post exposure vaccination is effective. 2. Where can I get the anthrax vaccine? Anthrax vaccine is not available commercially except to members of the military. Members of the military may be at higher risk of exposure because of their occupation. At this time public health officials do not recommend routine vaccination of civilians with anthrax vaccine. 3. Should my doctor prescribe preventive antibiotics against anthrax, plague, or other bioterrorist threat diseases? No unusual illnesses or deaths suggestive of bioterrorism have been reported in California, nor have there been any credible threats of bioterrorism. Therefore, preventive antibiotics are not needed for anthrax, plague, or any other bioterrorist threat diseases, and public health officials do not recommend prescribing them. Inappropriate use of antibiotics can lead to unnecessary harmful side effects and to development of antibiotic-resistant organisms. 4. I am a physician. What kind of antibiotics should I be stockpiling in case of a bioterrorist attack? There are no public health recommendations for stockpiling of antibiotics by individual physicians. If a bioterrorist 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 input of physician groups and hospital facilities is very important to local public health planning efforts for the distribution of pharmaceutical supplies if a bioterrorism event were to occur. We encourage physicians to join their hospital disaster planning committee and/or to contact their local health departments for more information. 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 or 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. Full Message from the CDC's National Immunization Program (NIP) CDC has received multiple calls through various CDC hotlines (including the NIP hotline) and the CDC switchboard concerning bioterrorism especially smallpox and anthrax diseases including queries as to availability and recommendations for these two vaccines. This is definitely something being discussed more in light of the events of the past week. A CDC bioterrorism section has been functioning for more than a year. Below is some information that will assist you in answering questions concerning these two diseases, vaccine availability, and linkages to the smallpox and anthrax vaccines recommendations. 1. The last case of smallpox on earth occurred in Somalia, in 1977. In 1980 the World Health Organization certified that smallpox had been eradicated from the planet. Currently, the only known remaining samples of smallpox virus are held in secure facilities at the Centers for Disease Control and Prevention in Atlanta, GA, and the Institute for Viral Preparations in Koltsovo, Russia. Although destruction of all remaining samples of smallpox virus has been proposed, the United States government has decided to permanently store its samples of smallpox virus. Allegations and rumors of smallpox virus stocks in other locations have not been verified. As a result of the successful eradication program, smallpox vaccine was removed from the commercial market in 1983, and is no longer a licensed product in the United States. The United States Public Health Service maintains an emergency stockpile of approximately 15 million doses. At the present time, smallpox vaccine is supplied only to certain laboratory workers who are at risk of infection with smallpox-like viruses as a result of their occupation. The Centers for Disease Control and Prevention is authorized to release the vaccine only to these workers under an Investigational New Drug (IND) permit from the Food and Drug Administration (FDA). The IND does not allow us to release smallpox vaccine to any other person for any reason. The Federal Government, including the Centers for Disease Control and Prevention, is concerned about the threat of bioterrorism. Plans for a response to such an event are being developed at many levels of the Government. These plans do not include wide spread use of smallpox vaccine at this point. The benefit and risk of reintroduction of smallpox vaccine are continuing to be examined. You may wish to consult the current U.S. Public Health Service's Advisory Committee on Immunization Practicesrecommendations on smallpox vaccination at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm 2. Anthrax Vaccine is not recommended for children under the age of 18. At this point it is not available commercially except to the military because of the risk the military may encounter in their work. You may wish to consult the current U.S. Public Health Service's Advisory Committee on Immunization Practices recommendations on anthrax vaccination at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4915a1.htm 3. Here are websites on bioterrorism and preparedness efforts, http://www.bt.cdc.gov/ and http://www.bt.cdc.gov/Agent/Agentlist.asp. Web-based resources for bioterrorism-related issues: Clinical training material-recognition and treatment of bioterrorist threat diseases 1. New York City Department of Health:
2. US Army Medical Research Institute of Infectious Diseases (USAMRIID) Medical Management of Biological Casualties Handbook: Published
by the USAMRIID, the purpose of this Handbook is to provide concise
supplemental reading material to assist in education of biological
casualty management. The handbook contains information on biological
agents, diagnosis, treatment, and prophylaxis 3.
USAMRICD - U.S. Army Medical Research Institute for Chemical Defense
The U.S. Army Medical Research Institute for Chemical Defense is
devoted to developing medical countermeasures to chemical warfare
agents and to train medical personnel in the medical management
of chemical casualties. This web site provides information about
training, published materials, and links to other web sites about
chemical terrorism, including a link to the Textbook of Military
Medicine Medical Aspects of Chemical and Biological Warfare. 4.
The Medical Society of the State of New York. Public Health Emergencies:
Quick Primer for Clinicians on Detecting Public Health Emergencies.
Vaccine Issues 1.
Vaccinia (smallpox) vaccine: Recommendations of the Advisory Committee
on Immunization Practices (ACIP), 2001 2.
Use of Anthrax Vaccine in the United States: Recommendations of
the Advisory Committee on Immunization Practices (ACIP), December
15, 2000 Healthcare Facility Preparedness 1. APIC/CDC Bioterrorism Readiness Plan: A Template for Healthcare Facilities Prepared
by the Association for Professionals in Infection Control and Epidemiology
(APIC) Bioterrorism Task Force and the CDC Hospital Infections Program
Bioterrorism Working Group, this document is intended to be used
as a reference tool for infection control (IC) professionals and
healthcare epidemiologists in the development of practical and realistic
response plans for healthcare facilities in preparation for a real
or suspected bioterrorist attack. General Information -Biological and Chemical Terrorism 1. Johns Hopkins University Center for Civilian Biodefense Studies The
Johns Hopkins University Center for Civilian Biodefense Studies
is a part of the Johns Hopkins Schools of Medicine and Public Health.
The Center aims to raise consciousness and knowledge base regarding
the medical and public health threats posed by biological weapons,
and to foster the planning and preparation for response to possible
bioterrorist attacks. This web site provides information and web
links to academic, scientific, and governmental sites related to
bioterrorism. 2. Center for Nonproliferation Studies, Monterey Institute for International Studies The
Monterey Institute is the world's largest non-governmental organization
devoted to combating the spread of WMD. Web site materials, authored
primarily by the Institute, are organized by geographical region,
publication type, and subject (chemical and biological weapons,
missiles, nuclear weapons, and treaties and regimes). 3. The Henry L. Stimson Center Chemical and Biological Weapons Nonproliferation Project The
Chemical and Biological Weapons Nonproliferation Project of the
Henry L. Stimson Center examines the panoply of issues associated
with chemical and biological weapons, including treaties for threat
control and reduction, weapons destruction technologies, and export
controls. This web site offers materials developed specifically
for the project, and is organized by geographical region and subject. If
you should need further information, please contact Kay Morgan,
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