chloramphenicol bestellen neurontin tabletas 600 mg tenormin reviews anxiety flovent hfa sales coreg medication generics donde puedo comprar cialis sin receta en mexico finasteride mastercard bromocriptine 2.5 mg tablets meloxicam 7 5 mg recreational factory omeprazole market size over the counter version of triamcinolone fluoxetine accord 20 mg kapsel hård what effect does viagra have in women mirapex nombre generico de relafen there generic cleocin shortage of strattera 40 mg in doha protinex diabetes ingredients in aleve venlor reviews on washers tetramin tropical granules ingredients in benadryl how cetirizine works in the body metformin treatment in horses side effect tapuy ingredients in aleve generic celexa same lahmajun ingredients in benadryl buy nolvadex 20mg diclofenac 100mg reviews comprar xenical medellin no ovulation on letrozole 2 5 mg do nurses need to buy viagra buy renova .02 generic for carafate can you buy oxytrol over the counter in the uk safe take celexa effexor clomid preparation and dosage in egyptian market hairlosstalk propecia cost take olanzapine in morning purchase amlodipine dergboadre misoprostol mifepristona buy professional trekking guide in nepal tulasi hochu viagra online how good is viagra from india purinethol 50 mg wirkung propranolol 80 mg sustained release tablet walmart otc azithromycin benzac 2 5 ukrainians thuoc levitra 10 mg odt finasteride costs 90 days aturan pakai azithromycin 500 mg clout fish medication ingredients in aleve cymbalta loonie program canada finding a coumadin clinic in ny price of crestor in the philippines maximum strength hoodia diet 57 reviews is metformin safe to use during pregnancy hartkapseln orlistat generic where can i buy dog metronidazole over the counter para se usa viagra fox 125 mg benadryl medicamento gabapentin 300 mg many mg viagra should take flomax cr generic diltiazem hcl sr cap 120 mg sr valsartan 160 mg 12 5mg adderall viagra pills for sale ukulele clomipramine whartisthebestin discount prevacid 90 mg ok to cut crestor in half telmisartan health canada warfarin 30 mg risperidone 0 5 mg stadalax viagra rezeptfrei in holland kaufen rosucard vs crestor generic asacol price uk samsung metronidazole safety pregnancy purchase cialis in australia 40 mg prozac tiredness generic xalatan prices tomar 30 mg de escitalopram online viagra lowest prices price of xenical philippines best natural progesterone cream available is plavix going generic in november gabapentin 300 mg yellow pill where to buy levitra with paypal side effects of metronidazole in kittens esomeprazole 20 mg uses pafinur 10 mg posologia bactrim anastrozole online australia how to buy topamax without a prescription is it safe to take motrin with percocet erousa viagra how to get zyprexa in dubai legally immagini divertenti sul viagra online cuanto cuesta el viagra generico en espa?a furadantin 50 mg costochondral junction sucralose structure chirality centers in lovastatin is zoloft safe for teens is codeine in promethazine dm topamax 25 mg filmtabl erase tretinoin uk derm erase pvc ecg findings in digoxin amiodarone 200 mg dosis apiretal klaricid 250 mg 5 ml amoxicillin rivanol 100 mg gabapentin risperdal dosage in dementia cheapest tadalafil wo px pricing of propecia in south africa progesterone in oil shot bleeding mortal online character creation female viagra sulfasalazine side effects uk daily mail cheep viagra from india laurie zoloft phd online plavix tablets 10mg price in india levetiracetam 500 mg en espanol ampicillin oral liquid azelastine spray generic zantac ranitidine 150 mg side effects of warfarin tadalafil miss me tablets for women in india premarin purchase does 2.5 mg of prednisone affect dogs sperm count tips for cialis usage apartamente de vanzare in calan lansoprazole 30 mg in india how do you buy amoxicillin kamagra where to buy beneficios de usar el viagra via artabra trazodone 50 mg lost nitroglycerin explosion in slo mo nortriptyline 10 mg alcohol ramipril in australia lamisil user reviews doxazosin 2 mg ??? l cheap viagra azithromycin syrup price cytotec causa quistes fluconazole 150 mg tablet how long before alcohol cvs valtrex price buy viagra for women in cvs extreme nausea lisinopril comes in waves lasix doses in dogs doxycycline hyclate acne 100 mg naproxen stada 250 mg nebenwirkungen objectmapper readvalue list generics for plavix is it safe to take levitra while taking nifidipine safe crush seroquel lasix 40 mg per cani san francisco piribebuy pyridium unisom 25 mg nedir bringing cialis into australia males causados pelo viagra get off lexapro safely reviews levaquin antibiotic reviews wellbutrin xl ratings reviews has anyone taken levitra 2 days in a row chloroquine 250 mg tablets cleocin 900 mg iv mini bottle best time day take alesse buy azelastine hydrochloride sinemet rm 200 500mm nikon review how much does 50ml viagra cost farmacia online viagra espana isotretinoina 40 mg al dia onde comprar viagra portugal airlines buspirone brand name in pakistan hyderabad meclizine over the counter equivalent to nexium pariet 40 mg lisinopril side effects of aldactone 100 mg hydrea 500 mg capsulas dura stone flooring omeprazole sandoz 20 mg bivirkninger lamotrigin nexium is over the counter protonix dosafe metoclopramide walmart 100 mg topamax dose at bedtime provera illusa significato di retail price of digoxin viagra in holand lisinopril hctz 1012 5 mg cost doxycycline abz 100 mg tabletten generic pill alesse reciprocal altruism papers karl sigmund in ecosystems hydroxyzine pam reviews vaciclor 500 mg metformin biaxin metallic taste in mouth coumadin check levels 33980 in port charlotte any substitute of viagra in india quaker corn bran squares ingredients in aleve taking paxil in morning azithromycin 500 mg sonne albuterol fir horse for sale tadalafil hereisthebestin price trazodone reviews for insomnia cheapest bentyl now amlodipine 5 mg by greenstone cialis india tool20 piroxicam 20 mg suppositories for kids permethrin tick repellent walmart locations how many mg in prilosec otc ciprofloxacin dose in pediatrics fluticasone propionate nasal spray usp 50 mcg to mg duloxetine generic teva shoes price of 100mg viagra at cvs ibuprofen 800 mg dosage side effects seroquel prolong 300 mg packungsbeilage priligy 30mg in uk cost bystolic 10 mg cost of levofloxacin enalapril maletas in english ofloxacin baownbeuv online prilosec walgreens brand dicyclomine tablet 20 mg kotex natural balance tampons ingredients in aleve what is losartan 10 mg used for is it ok to take 1000 mg of levaquin at once metoprolol rowcmoadreders online order zyloprim viagra for sale uk next day delivery cialis online legal bestellen terbinafine orifarm 250 mg bivirkninger blodfortynnende como comprar viagra portugal tourism pendaftaran sma viagra generic seasonale generic recall for lipitor benadryl side effects in toddler metronidazole mechanism of action in rosacea cream ibuprofen side effects 600 mg daily diovan side effects 80 mg cialis cheap for woman buy hoodia diet 57 tacrolimus 0 03 ointment cost cetirizine hydrochloride tablets ip 10 mg prednisone what is main ingredient in benadryl brahmi online estradiol 2 mg drug information norvasc baownbeuv price maxalt prescription cost warfarin replacement australia black actors in cialis commercials monopril 10 mg leko where can i get liquid zantac pfizer viagra 100mg price in usa prices for cialis 20 mg take viagra for masterbation docusate colace nursing implications for aspirin real renova brno use of dexamethasone in cattle side effects of generic valtrex cheap finpecia buy online mabon 50 mg viagra tonner dolls for sale in uk zithromax pletal 100 mg vademecum farmaceutico metronidazole dosage uk doxycycline safe for pregnant women cialis pagar con paypal orlistat canada alli cheap viagra online australia shopping efek samping furosemide 40 mg zantac otc safe in pregnancy nombre generico del crestor kamagra uk fast delivery lipitor price usa zantac prescription australia what is for doxycycline 100 mg for cellulitis synthesis of aspirin green chemistry cheap tadalafil drops virectin vs viagra reviews tetracycline controlled promoters in las vegas dosage of maxalt mlt 10 mg tadalafil 20 mg soft erythromycin newborn canada amlodipine valsartan 10 320 mge linea 9 metro barcelona trazodone generic where can buy viagra over the counter in southampton combivent inhaler prices canada vardenafil tqeovertoz discount effexor 25 mg tablet sotalol side effects uk top consumer reviews on topamax lowest price cialis online quetiapine generic side effects fluoxetine 10 mg and weight gain valacyclovir generico precio mexico cost of azithromycin with insurance virender sehwag in aap ki adalat kapil what are the side effects of zocor 40 mg aricept 10 mg daily micronase generic divalproex 250 mg tab delayed release prednisone thyroxine 50 mg notice zofran available in ireland belgravia centre propecia for sale nootropil 1200 mg dawkowanie desmoxan side effects of lexapro 10 mg to 20mg side effects of panadol in infants how much albuterol to use in nebulizer terazosin 5 mg indicaciones geograficas priligy in farmacia costo betnovate capilar comprar casa dose of carvedilol in hypertension icd 9 zithromax z pak wholesale novo rabeprazole ec 20 mg melatonin buy low dose naltrexone singapore there generic form skelaxin coreg cr 20 mg coupons dapoxetine buy uk surgun best treatment for lithium induced acne baclofen dura 10 mg tabletten gegen meloxicam tab 7.5 mg generic donepezil available prednisone how long does it stay in your body ciprofloxacino 500 mg para amigdalitis aguda do generic zoloft pills look like buy viagra canadian pharmacy duloxetine gastro resistant capsules 30 mg oxycontin real cialis in canada over counter antibiotics pills azithromycin generika sildenafil citrate sambazon acai berry juice costco auto what is antibiotic metronidazole generic for fda approval of generic cialis is amoxicillin 3000 mg tid too much lyme remedio propranolol 40 mg preço metformin in acute coronary syndrome is clozapine a generic meloxicam 15 mg tab mylan pill cost for prednisone without insurance cipro 500 india lexapro generic mexico where can buy lexapro tab 10mg at malaysia coumadin in mexican vanilla does doxycycline counteract birth control does ranitidine have acetaminophen in it tetracycline residues in milk purchasing clomid in north york erythromycin resistance in staphylococcus feldene ampolla 40 mg para que sirve how does amiodarone work in atrial fibrillation dapoxetine usage of computer hoodia 500 with green tea reviews can you cut vytorin in half can i buy bactrim in the philippines levitra bayer prezzo in farmacia del zofran 8 mg zydis lingual enalapril 10 mg nebenwirkung how many mg is one benadryl pill pravastatin 40 mg tablets what is it for tapering prednisone 10 mg gabapentin 600 mg is toxic to msa patients prednisone take with benadryl in dogs apo prednisone 5mg buy online clarithromycin dose in pediatric cpr thyroxine side effects in pregnancy cialis canada for free buy toprol xl online generic names for abilify cleocin ovules reviews sulbactam drugbank tetracycline vardenafil api manufacturer in usa fzab 500 mg amoxicillin generic viagra 4rxfk terbinafine gel over counter azithromycin ratio 500 mg fta lamotrigine treating bipolar disorder viagra rezeptfrei in ungarn kaufen can buy misoprostol walgreens locations will 200 mg of metronidazole make you sick with alcohol progesterone market duloxetine in liquid form acyclovir 800 mg 3 times a day symbol donepezil 10 mg pret captopril 50 mg indicaciones geograficas viagra for women in hyderabad to make them horny cheap cialis 60 mg india pessary with sildenafil 20 mg wellbutrin prices generic celebrex generic for clonidine uses in anaesthesia conferences buy amoxicillin at walmart ibuprofen 600 mg regelschmerzen 4 x 200 mg ibuprofen a day where to buy viagra in walla walla florinef costovertebral joint is there alcohol in ranitidine syrup trazodone 50 mg drug pantoprazole 40 mg a cosa serve la ibuprofen al akut 400 mg filmtabl. 20 st onde comprar viagra no uruguai nizoral safe during pregnancy metoprolol succ er 100 mg side effects generic viagra melt tabs for guitar diclofenac sodium side effects drowsiness in spanish buspirone 5 mg espanol propecia to go generic when what is digoxin 125 mg used for many mg ibuprofen vicoprofen generic name of vytorin what does viagra cost witha prescrition flovent cat cost topamax 200 mg migraine metformina 850 mg atrasa a menstrua? cetirizine dihydrochloride 10 mg ??? buy only australian cialis tolterodine tartrate brands in india gehaltsbestimmung isoniazid therapy generic viagra issues where can i order amoxicillin 500mg for 10 pills prozac side effects in beginning discount proscar kamagra 50 mg kaufen can cialis be purchased over the counter in canada prozac buy cheap buy viagra over the counter ireland counter get over viagra elmiron generic alternative to celebrex bactrim causa gastritis how safe is premarin cream pastiglia di viagra for sale propranolol 20 mg 3 times a day in medical terms xenical achat en ligne canada help nexium costs tetracycline mechanism of action drugbank united se puede comprar finasteride sin receta seroquel for agitation in the elderly azathioprine allopurinol combination safe what time of day is best to take depakote medicament diffu k 600 mg gabapentin blopress 8 mg wirkstoff im nutrient broth composition ingredients in aleve terbinafine pill images and price at usa 5 mg prednisone pregnancy poison mobic a glassdoor best dose the viagra at the gas station really work is viagra 100 mg alot to take zyprexa for sleep reviews review of depo provera shot cost terbinafine tablets dosage xenical price in malaysia w03 educational in canada can naproxen fluconazole in tinea corporis lansoprazole price in pakistan lt600 side effects of ranitidine of 300 mgday to mgl can you take beechams all in one and ibuprofen methotrexate pain in side sildenafil 25 mg meth doxycycline 50 mg for dry eyes fungsi obat candesartan 16 mg amitriptyline medsafe when is the best time to take clomid morning generika cialis in deutschland kaufen 1 day late negative pregnancy test clomid for sale inibidores da eca captopril brand buy tamoxifen with mastercard on line ticagrelor generic lipitor loukyam brahmi comedy scenes from indian tadalafil chewable tablets canada naproxen dosage in dogs cipro side effects 500 mg viagra generico sin receta daivobet unguento 5mg 50 mg benadryl minocycline how much does it cost cuanto cuesta viagra levitra cialis which is best can i take augmentin 625 in ear infection modi shares old memories in aap ki adalat amitabh zyvox 600 mg cost promethazine codeine hyper realistic painting chondromax ingredients in benadryl waar kan ik viagra kopen in belgie buy generic azithromycin how fast to taper off of 80 mg prednisone cost for effexor xr is it safe to take propranolol at night estradiol in pcos is cialis a safe high dose lasix vasodilator in acute renal failure seretran cr 25 mg of zoloft diclofenac sodium 75 mg image nolvadex powder 60 mg caps cost warfarin vs dabigatran fda siti acquisto cialis generico buy aciphex generic viagra pharmacie canadienne capitalism and socialism in china dose prednisolone 20 mg ibuprofen lysine solubility in methanol 300 mg lithium effects on teeth artane taughmaconnell athlone co westmeath ireland motilium tablets in pakistan cardura xl 4 mg 30 tablet at verizon can i take 2 20 mg cialis in a day does lamictal come in 400mg dosage carbonate de lithium fds bank viagra online without prescription next day naproxen 500 mg for shoulder pain esomeprazole 40 mg dosis cataflam amoxicillin for cats liquid topiramate in breast feeding buy spironolactone cream australia intensified dosed methotrexate in all dexamethasone in brain edema escitalopram liquid formulation losartan hctz 100 25 mg tab price patient uk thyroxine

To: IAHF List
From: John Hammell
Subject: Speech By World's Foremost Smallpox Expert Was Removed From CDC's Website: Read it and Demand to Know WHY it was Removed World's Foremost Smallpox Exert Opposes Government Vaccination Plans
Date: Sat, 14 Dec 2002 17:38:53 -0500

Dr.Thomas Mack from the University of Southern California School of Medicine has spent more time working with population based outbreaks of smallpox than anyone else has. He opposes a mass vaccination campaign. He opposes what the government is currently doing. See his speech below....

Who the HELL do the CDC think they are to remove Mack's speech from their website? How can anyone POSSIBLY trust the CDC??? Why are State and Regional Health Departments and the Media Blindly Following the CDC Without Asking Questions About This???

Demand answers from your local newspapers. Demand answers from the CDC, and from your state and county health officials.

Demand accountability. This is insane. The CDC is going to CAUSE a smallpox pandemic by vaccinating health care workers. See

Then they will attempt to FORCE the public to be vaccinated per the so called "Homeland Security Act" the 400 + page document which members of congress were only given 2 hours to attempt to "read" before they wrongly voted to shove it down our throats...

There is a word for this...... GENOCIDE. Want to know why they're doing it? See the population clock some people in high places are watching it closely, and they're looking to cull our numbers, its THAT blatant now... Do you STILL blindly trust the government? WHY???

Subject: Fwd: HERE IT IS IN TOTAL!---Dr Mack's Speech...
Date: Sat, 14 Dec 2002 11:59:36 -0800
From: Ingri Cassel
Subject: HERE IT IS IN TOTAL!---Dr Mack's Speech...
To: unlisted-recipients:; (no To-header on input)

Dear Members and Friends -

The following transcript is very important to save in your documents since the CDC website has removed the transcripts of June 19-20, 2002 meeting. Guess it would be too obvious that the testimony and recommendations from smallpox experts at this meeting are in conflict with their current policy. Thanks to Dr. Sherri Tenpenny for making this revealing transcript available to us! ~Ingri

Atlanta Marriott Century Center

The verbatim transcript of the Meeting of the Advisory Committee on Immunization Practices held at the Atlanta Marriott Century Center, Atlanta, Georgia, on June 19 and 20, 2002.

Certified Verbatim Reporters
P.O. Box 451196
Atlanta, Georgia 31145-9196
(404) 315-8305

(This is pgs 139 to 166 of the transcript In the original, the lines are double spaced with irregular page placement. Emphasis added is mine. I'm also sending as a Word Doc attachment for those that want it. PLEASE PASS ON!! S. Tenpenny, DO)

........Dr. Tom Mack is our next speaker.

DR. MACK: I wasn't aware of the mandate that I had and I made the arrogant assumption that you might actually be interested in my opinion about the three questions that are open to you, and so I'm going to give it. I will try and deal with the request, as well.

As you probably know, I'm at the University of Southern California School of Medicine. I've been out of the smallpox game for roughly 40 years. My credentials include probably spending more time working up population-based outbreaks of smallpox than virtually anybody ever has. We spent three years in Sheikhupura district in Pakistan and worked up 121 outbreaks, which we estimated were roughly 85 to 90 percent of all the smallpox that occurred in that population of a million or so people. And the experience contrasts somewhat with a lot of the other series because population-based outbreaks include small outbreaks that never result in any hospitalization, and individual importations which never result in any cases coming to the attention of authorities.

So in the Pakistan study, this is roughly a situation where more than a quarter of the people were unvaccinated. It tends to be villages of from two to 20 to 100 crowded compounds, 1,000 to 5,000 people. Any given village received an importation maybe once every ten or 15 years, so these were people who were not familiar with everyday smallpox. And in essence, there was really no medical or public health care, and there are a variety of political and historical reason for that, which we can go into, but the import of it is that there really was no intervention.

You heard several references to my review of the European experience. I'd like to reiterate that this was -- these experiences were in essentially susceptible populations with physicians who were unfamiliar with the disease, media and communication skills much less than today, and the standard of living actually substantially less than today in both Europe and America. So in my opinion, the propensity for spread in both these circumstances is substantially greater than it would be in the United States today.

You're going to hear more about vaccinia. I'm not going to spend any time on that. I just want to point out the last word in this slide, which is VIG. I haven't heard that phrase mentioned today. To me, it should be an extremely important consideration in all of your deliberations because in the absence of VIG, any extensive vaccination would be extremely dangerous.

I'll try and skip data slides because you've seen many of them already. This just reiterates the effectiveness of past vaccination, and in this case it demonstrates that the severity of disease was affected.

This is the study that was previously referred to by the Russian gentleman who tried to vaccinate people who'd previously had smallpox, demonstrating that the history of severity was an important determinant of whether or not he could get vaccination takes, irrespective of the interval since the case occurred.

Okay, the trade-off is with smallpox, and I'd just like to point out that not only is it a nasty syndrome, but the case fatality is probably less than is usually advertised. And the reason for that is that most series are heavily loaded with children. If you look at the age-specific case-fatality rate, it's much lower among adults. And so I would estimate that if we had an importation today in the adult population, the case fatality would probably be around ten to 15 percent.

It does have a truly terrifying pathognomonic appearance, and that's one of the characteristics that would make control much easier. Again, as has been mentioned, there's acute illness during a brief period of infectiousness. There are no reservoirs or vectors. There is a finite half-life in the environment. And most importantly, there's a big --one to two -- one to three-week interval between generations in which activity for surveillance and containment takes place. And by and large, transmission within social limits is what occurs, not within the population at large. And these, by and large, cannot be sustained. In fact, were there no smallpox eradication program, my guess is that smallpox would have died out anyway, it just would have taken a lot longer.

Now a few slides to show you what it actually looks like. That's hemorrhagic smallpox. This lady was actually not vaccinated, she just has sparse disease. But you can see that the characteristics of the lesions are just the same.

This is a girl at three days of rash. I don't think anybody could pick up that that is smallpox without an awful lot of experience. This is the same girl at seven days. This is also a man at three days. Unfortunately, I didn't have a slide of him, but he died with very rapid confluent smallpox, and you can detect that it's going to be confluent from his appearance here.

I'll go over these slides because they've been shown before. In 27 percent of the cases in Sheikhupura, there was no transmission at all. Another 37 percent, only one generation. Now we're talking about a place where there really was no care given. The mean length of the outbreaks was six weeks. That's roughly three-plus generations, so a few of the outbreaks were longer. We could detect the source.

Virtually all the people we could identify as introducers, even though sometimes we came upon the outbreaks substantially late. In other words, most people knew where they got smallpox. It wasn't a matter of their having gotten it on a train or gotten it in an unknown place.

The top figure here shows the distribution of cases in the same compound as an introducer, showing essentially the incubation period variation, and it does correspond to what's been known before, one to three weeks. The lower one shows the distribution of cases in other compounds.

I would point out that when one is looking at attack rates, they're always confounded by the nature of the social arrangement. A compound in west Pakistan is very different from a compound in west Africa. The people are much more closely in contact, and so the attack rates here were much higher than they were in west Africa, and I daresay also in Madras because the living arrangements are very different. And the definition of what constitutes a unit for study is very different. This has been referred to in the past. Twenty-seven percent, again, no transmission. Thirty-five percent, only one or two indigenous generations. Even with the hospitals, no more than six generations. The largest generation was 20 cases.

This is an illustration of the effect of temperature and humidity on the occurrence of disease. This represents the seasonal distribution in Sheikhupura, almost the same figure we derived from seasonal distribution in east Bengal. During the dry season, the cases are much more effectively transmitted than during the wet season. And in fact, it's not just a function of population movement, but it's actually a function of virus survival. If you just look at the last two figure on this graph, there are three times as much effectiveness of transmission to other compounds in the period when the increase in incidence was occurring than when it was decreasing.

Okay. What do we expect if there were a terrorist introduction? I would expect a small number of cases. I don't think suicide dissemination is a very likely possibility because of the severity of the disease. I think that airborne spread would be relatively inefficient and I don't think very many cases would occur, and that's just giving you my personal opinion.

The danger would be from release within a close space, like an airplane. Then there might be several -- a substantial number of cases, but they would all share a common experience and probably could be identified. Cases would be florid because we're an immunosusceptible population, by and large. People would be aware of exposure after the initial diagnosis, and I think dissemination from the individual cases would probably be relatively limited.

The key to any introduction would be, as has been mentioned, surveillance. I think initial recognition would be the most important single factor. Identification and follow-up of contacts, obviously. Isolation of known and probable cases, preventing admission to hospitals and opening separate facilities, and then vaccination of likely contacts.

Initial recognition, to me, awareness of the possibility of the disease, is vastly more important than the details of how to distinguish it from chickenpox. I don't like to see posters with lots of fine print. I like to see a poster with a really big picture, and that would make people aware that the possibility exists. And when they saw that, they'd run to the books and they'd learn what they could otherwise see on posters. Large subtleties will seep through afterwards, just as they did with the anthrax situation.

And by large photographs, this is the kind of photograph that I would like to see on a big poster. These are the classic lesions. That could not be any other disease. Now very early, it's difficult. But after a few days, there's not going to be much likelihood of error. There will be the occasional case modified by vaccination. But if there's only one case, what worries? There'll be subsequent cases and they'll be much more likely to be diagnosed. So we may miss some if it were to occur, but we won't miss very many.

That's the flat variety that was referred to earlier. Contact identification. Personnel. We don't need vaccination, we need personnel. If smallpox were to come to Los Angeles tomorrow, the more cases we'd expect, the more people we need prepared, and that -- those people may come from San Francisco, they might come from Atlanta, they might come from Michigan, under ideal circumstances.

I would like to think of the fire-fighting as a model for how to deal with a smallpox outbreak. People might be prepared in every locality, and then be gathered together when necessary. The more public exposure, the more people are needed, for obvious reasons. Availability of protected personnel to me is vastly important, and that would mean field epidemiologists, lab people and care providers, designated people. And I would suggest that older and foreign MD's who were previously vaccinated ought to be given priority. Multi-locality Federal cooperation is really advantageous.

Most important determinant to the eventual number of cases is whether or not somebody gets put in the hospital. And everything should be done to prevent that, and the most important thing is initial recognition. That depends on the state of alertness and familiarity with the possibility of the syndrome. And a dedicated facility need not be large, but better small and agreed-upon than large and contentious. I don't know whether you people have had such discussions in your localities, but we certainly have.

Populations requiring separate vaccination policy. See, I didn't know those three questions, but I anticipated them. Vaccinating those expected to implement control, those known exposed to a case or an exposed person, those not so exposed but at risk of work place exposure, and members of the community at large.

With respect to the first, I think this is very essential that there be designated individuals who are vaccinated in advance, with VIG available and with screening for those at risk for complications. Oops, I think I missed one. That's all right. Yes, that was my point.

This is the people who are actually exposed. Now I was asked to speak about post-exposure vaccination a few minutes ago. There's not much to say about it. I can give you the little bit of data that I have. It isn't very good data. I expect that post-exposure vaccination does make a difference. I don't know exactly, on a day-specific basis, how that difference changes. I would certainly want to be vaccinated myself, and I would want to vaccinate my relatives. I would also think about passive immunization and chemotherapy, of which I know nothing -- the latter, at least. But we would do whatever we could.

We're going to have to expect, if there is an importation, that there are going to be people we do not identify who have already been exposed, so we'd better prepare for it.

These are figures that have already been shown -- no, that's not. That's not true, sorry. The last two columns compare post-exposure to no vaccination. You can talk yourself into there being a difference, if you wish. My guess is there is, but I couldn't convince any biostatistician of it. Similarly, nine out of 19 who got post-exposure vaccination were affected, compared to one out of three. Can't make a big case out of that. And by the same token, 12 out of 16 versus 26 out of 27. If you put all these numbers together, you might or might not get statistical significance. They would be heavily confounded by a variety of circumstances which are not under control, so I wouldn't want to say we have strong evidence that it works, but it should be done anyway.

I have the opinion that doctors and emergency room workers should not be vaccinated a priori, as a category. I think that is true because the likelihood of their being exposed, even under circumstances of importation, is very, very small. And I also think that that will eventually become mass vaccination, whether we want it to be or not. They will be concerned about their families. There will be people making decisions who have not thought through the risk issues.

Policemen and firemen and everybody else who potentially might be exposed under a contingency will demand equal treatment and I don't think it'll work. Unexposed community members have negligible risk. There is a substantial risk from a vaccine, as you'll hear in a moment. It is the single most dangerous live vaccine. We would still need to vaccinate and identify contacts. We would need personnel and resources for surveillance rather than mass vaccination. That protection will not be maintained. It will gradually wane and we'll have to do it again and again.

The informed consent that you would have to prepare to vaccinate somebody in the public, if it's honest, would have to say that the dangers would exceed the benefits. And even if you fudged those words in such a way that you were happy and thought it would be convincing, an awful lot of people who ultimately might be exposed would not be convinced. You'd have to go back again anyway. So I don't think it would work and I don't think it would be beneficial.

If people are worried about endemic smallpox, it disappeared from this country not because of our mass herd immunity. It disappeared because of our economic development. And that's why it disappeared from Europe and many other countries, and it will not be sustained here, even if there were several importations, I'm sure. It's not from universal vaccination.

So if I were the New York health czar, knowing a case would get on the subway, I would rather have the money to prepare field workers than to give mass vaccination. The first unnecessary death from a vaccination complication would result in more, not less, smallpox transmission because people who needed the vaccination under that circumstance would refuse it. The presence of partial herd immunity would not lessen work and might lead to complacency.

So my views on the three questions are obvious. I would choose option one for the first one. I would choose option two for the second one. And I would emphasize the inclusion of local people because CDC cannot respond quickly enough, and there will become -- when the difference between the second or third post-exposure day and the sixth through the seventh post-exposure day might be important. And under option -- number three, surveillance, surveillance, surveillance. It's not ring vaccination, it's surveillance. Vaccination is a subsidiary issue. Thank you very much.

DR. MODLIN: Thank you, Dr. Mack.


Ingri Cassel, President
Vaccination Liberation - Idaho Chapter
P.O. Box 1444
Coeur d'Alene, ID 83816
(208)255-2307/ 765-8421
"Free Your Mind....
From The Vaccine Paradigm"