ENFORCEABLE, MANDATORY VACCINATION SEEN NECESSARY IN EVENT OF SMALLPOX
ATTACK
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.
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