Pharmacy Division Ramathibodi Hospital


News 10/11/2544

Should smallpox be used as a biological weapon in the USA, public health officials must have the authority to quarantine and forcibly vaccinate the entire population -- with the help of the military if needed.

ETHNICITY INADEQUATE TO REPRESENT PHARMACOGENETIC VARIATIONS Genetic markers can better identify various drug metabolism profiles than race or demographics.

Enforceable, Mandatory Vaccination Seen Necessary in Event of Smallpox Attack

WASHINGTON (Reuters Health) Nov 05 - Should smallpox be used as a biological weapon in the USA, public health officials must have the authority to quarantine and forcibly vaccinate the entire population — with the help of the military if needed — an expert said on Monday.

"You can't have a patchy response. There has to be compulsion" to vaccinate in the event of an attack, said Dr. Stephen D. Prior, the research director at the National Security Health Policy Center. "Each state has different laws and that's one of the problems," he said.

Massachusetts and other states have laws allowing authorities to force mass vaccination to stem outbreaks of highly contagious disease, but the federal government has no enforceable way of guaranteeing widespread vaccination.

The government is in the process of procuring 300 million smallpox vaccine doses, enough for every person living in the US. Officials from the Centers for Disease Control and Prevention (CDC) say that they have no plans to institute mass vaccination because there is currently no identifiable threat of a smallpox attack.

Authorities currently plan to deal with any possible smallpox outbreaks by vaccinating in a widening circle around a newly discovered case. Such a practice is useful with a relatively fixed population, Dr. Prior said, but it is essentially useless in a highly mobile society.

Dr. Anita Barry, the communicable disease control director for the Boston Public Health Commission in Massachusetts, told a Senate subcommittee last Friday that states needed the authority to confine infected persons to their homes for quarantine.

Federal law gives the US Surgeon General the authority to vaccinate and quarantine individuals to protect the public health. "But he has no means of enforcing it," Dr. Prior said.

A spokesman for the chairman of the Senate Health, Education, Labor, and Pensions Committee, Edward Kennedy (D-MA), said that mass vaccination is not part of the bioterrorism bill lawmakers are expected to consider soon. "We've heard the issue but we've done nothing with it," said spokesman James Manley.

Military planners are currently mulling whether or not they should have a role in enforcing mandatory mass vaccinations or quarantines in the event of a highly contagious biological attack, said Edgar H. Brenner, co-director of the Inter-University Center for Legal Studies in Washington.

Brenner told reporters that he had discussed the potential plans with high-ranking military officials. "They had no answer yet," he said. But Pentagon spokesman James Turner could not confirm the conversations Brenner mentioned or that officials are discussing such plans.

Dr. Prior acknowledged that the potential for federally enforced mandatory vaccinations could arouse anti-government sentiments in some sectors of the American public. Any mass-vaccination policy would also have to take into account the vaccine's side effects. Historically, the smallpox vaccine caused serious reactions in about one in every 4000 persons and caused death in about four per million.

"The debate has to take place, and the public has to be involved," he said.

Ethnicity Inadequate to Represent Pharmacogenetic Variations

WESTPORT, CT (Reuters Health) Nov 06 - Genetic markers can better identify various drug metabolism profiles than race or demographics, according to an analysis published in the November issue of Nature Genetics.

"It is well known that the efficacy of certain drugs varies from individual to individual, depending in part on variation in the genes that encode drug metabolizing enzymes," Dr. Howard L. McLeod says in a Nature Genetics commentary. "This was the first study to clearly establish that looking at genetics is more informative than looking at geography or ethnic markers" in terms of identifying individuals or groups most likely to carry particular genetic polymorphisms, he told Reuters Health.

Dr. David B. Goldstein of University College London and colleagues compared the abilities of race, geographic region and X-linked microsatellite genotyping to identify groups of individuals having certain drug metabolizing phenotypes. They included more than 350 subjects in the study.

Clustering patients by race or geographic region did not reveal any significant patterns in the expression of genetic polymorphisms associated with different drug metabolizing phenotypes. However, when the researchers clustered the patients using a series of genetic markers not associated with any specific genes, they were able to identify four distinct groups with different drug metabolizing profiles.

These groups were not made up of any specific racial, ethnic or geographic populations, Dr. McLeod, of Washington University School of Medicine in St. Louis, Missouri, told Reuters Health. For example, one of the groups contained approximately 90% of the Caucasians in the sample, as well as approximately 60% of the Ethiopians.

The bottom line, Dr. McLeod said, is that information gained from "genetics is a better marker of what's going on in the body than geography or ethnicity."

"This is a step forward, but it's really leading us to individual patient genotyping," Dr. McLeod commented. While the new data could be used to select ideal patients for clinical trials of new drugs, he said, only when individual genotyping is possible will the findings have an impact on actual patient outcomes.

Nat Genet 2001;29:247-248. []

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