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Report of the CDC
Public Forum on Smallpox

By Dr. Sherri Tenpenny
June 8, 2002
St. Louis, Missouri

The CDC held the third of a series of meetings called the "Public Forum on Smallpox"on June 8, 2002 in St. Louis, Missouri. In front of a small group of approximately 60 people, I had the opportunity to deliver a five minute speech
( )and then had the opportunity to ask several very pointed questions directed toward the CDC representatives. This is my report of the meeting.

Everyone should be aware that the CDC will review the answers collected on its website. The deadline for submission is JUNE 12, but keep sending your comments even after the deadline. All of the questions and comments made at the forums are being taped and will be reviewed by the members of the Advisory Committee on Immunization Practices (ACIP) prior to their final recommendations June 20, 2002. My understanding as after participating in this meeting is that the CDC not only wants to solicit comments, but to see how "willingly"we will accept the vaccine.

The CDC was very forthright in presenting truthful and accurate information about smallpox and about the anticipated problems associated with the vaccine. Surprisingly, it seemed the CDC was advising GREAT CAUTION regarding the use of the vaccine. Even in the event of an outbreak, the greatest emphasis would be placed on isolation, not just on containment (vaccination). This certainly was not what I was expecting to hear. And unless you were an informed listener, you would have missed the most amazing things that the CDC said about a smallpox infection.

The morning opened with Dr. Robert Belshe, M.D, Director of the Division of Infectious Diseases and Immunology from St. Louis University. He has been directly involved with clinical trials involving the Dryvax® vaccine. He presented an overview of the questions the CDC put forth to the community and placed on their website. This was a very important clarification, as the formatting of these questions is very unclear.

The program continued with Dr. Joel Kuritsky, the CDC's director of the Preparedness and Early Smallpox Response Activity for the National Immunization Program. He stated that one of the reasons that the forums were being held was to clear up some misconceptions about smallpox. "For one thing,"he said, "smallpox is not explosively contagious." On two separate occasions, Kuritsky said, "smallpox is NOT like measles; it is NOT a highly contagious disease." This has been one of the cornerstone arguments for mass vaccination propagated by both medical journals and the popular press! I could hardly believe what I was hearing. Was anyone else in the room picking up on this??

    Kuritsky expounded on other smallpox misconceptions:
  1. Smallpox is spread through "droplet contamination." The likelihood of spreading the infection from person-to-person throughout a room is minimal because "coughing and sneezing are not part of the disease."
  2. Transmission through bed clothing contamination is extremely rare.
  3. The virus is NOT spread in food or water.
  4. Contagiousness can be ''nterrupted'by the use of "a properly fitted filtered respirator mask with an NIOSH rating of N95 or better." The key here is personalized fitting: a fitted mask will provide a very high level of protection against biological agents.

An extremely important revelation that Kuritsky delineated was that smallpox will not spread rapidly through the population. The disease is "transmitted slowly and only after prolonged, direct, face-to-face contact."He further clarified close contact to mean "more than 7 days" and face-to-face to mean "contact that is within 6-7 feet."Scientific studies were presented to accentuate this point. Therefore, it is the intensity and duration of contact that spreads smallpox. Dr. Kuritsky said casual contact will not spread smallpox. "The scenario in which a terrorist infects himself and walks through a city spreading the disease just wouldn't happen, even in population-dense areas. In the 1970s, we were able to control the spread of the infection even in highly dense settings such as India and Bangladesh,"he explained.

Kuritsky's information comes in part from a recent paper published by Meltzer. After analyzing data obtained from an outbreak that occurred in 1898, Meltzer's group concluded that "smallpox was not readily spread among the general population by brief, casual encounters, such as walking down the street beside an ill person or briefly being in the same shop or business. Rather, smallpox was primarily spread among persons living in the same house as a smallpox patient.

Meltzer's paper goes on to state that, "most outbreaks have an average transmission rate of less than 1 person infected per infectious person." This means that less than one person contracted smallpox from a primarily infected person! The oft-repeated story that "millions could die from the rapid spread of smallpox after an exposure"appears to be nothing more than theoretical hype. (I strongly encourage everyone to read this paper. - SEE FOOTNOTE FOR REFERENCE)

It is critically important to understand that people are only contagious after the smallpox pustules have erupted on the skin. There is no "carrier state"for this disease, as seen with chickenpox, in which the person is contagious for several days before the vesicular rash occurs. The incubation period after an acute exposure to smallpox can range from 2-17 days. The onset of a fever is a warning sign, indicating that the person may have contracted the infection. This is referred to as the "prodromal stage."At that point, the person feels very ill and will most likely go to bed. "The person is sick and will not be walking around," said Kuritsky.

The value of surveillance post-exposure lies in the fact that a person's temperature can be monitored daily and he can be quarantined AT THE ONSET OF FEVER, preferably in his own home. However it is critically important to understand that, even at this stage, the person is not contagious!! It is only after the appearance of the smallpox rash, generally 2 to 4 days after the onset of the fever, that the person becomes infectious. Keep in mind that there are other causes for fever: the person may just have the flu!!

The smallpox rash has a distinctive appearance and feel. The distribution is primarily on the face, palms and soles, with very little seen on the trunk. In addition, unlike chickenpox, all of the pustules have a consistent appearance throughout the body. When palpated, the rash feels "shoddy,"or like buckshot under the surface of the skin.

    However, there are other rashes that can potentially be "confused"with smallpox. Dr. Kuritsky gave a list of infectious diseases that present with rashes that can potentially be misinterpreted as smallpox:
  1. Chickenpox
  2. Disseminated herpes simplex
  3. Disseminated herpes zoster (shingles)
  4. Hand-foot-mouth disease
  5. Secondary syphilis
  6. Molluscum contagiousum (a viral infection)
  7. Erythema multiforme

In addition to viruses, reactions to medications can occasionally precipitate a rash that could be mistaken for smallpox. The CDC has established a "rash algorithm"to assist healthcare professionals in differentiating smallpox from other skin conditions. This can be viewed by going to . In addition, the CDC has set up a 24 hour "Rash Hotline" at 770-488-7100. With all these helpful aides to assist practitioners in making the correct diagnosis, it is doubtful that one of these rashes could be confused with smallpox, precipitating the mass havoc as seen on the recent "ER" episode.

Prior to 1967, the World Health Organization stated that a global vaccination rate of greater than 80% was needed to eradicate smallpox. However, even when this rate was attained, outbreaks still occurred in Asia and India. Therefore, a new strategy was introduced in 1973. Smallpox cases were actively searched for and isolated. Vaccination of only the person's immediate close contacts created a barrier "ring"to decrease the spread of the infection. Within two years after the implementation of surveillance and containment approach, the number of smallpox outbreaks had dramatically declined. This is the basis for the current CDC recommendations of "surveillance and containment"in the event of an attack.

It is crucial to realize that even in the event of a confirmed case of smallpox, there is no need to panic. The CDC's position paper on smallpox, "Vaccinia (Smallpox) Vaccine Recommendations"published June, 2001 states that vaccination of close personal contacts within 4 days of the onset of the rash will be protective. However, Dr. Kuritsky stated that "vaccination 12-13 days out will still be protective." Based on this information, it appears that any rush to vaccinate first responders and medical personnel is not based on current understanding of the disease and appears to be inappropriate.

Dr. Harold Margolis, CDC senior advisor for smallpox preparedness, was the next to speak. The majority of his presentation focused on the potential side effects and complications of the vaccinia vaccine. As a former pediatrician who was still in practice when the smallpox vaccine was still given routinely, he had seen many of these reactions first hand. Dozens of impressive pictures were shown demonstrating the types of reactions that could occur. In fact, many more dreadful pictures were shown of smallpox vaccine reactions than of smallpox itself!

It is an unfortunate fact that a large percentage of the population is in much poorer health today than when smallpox vaccine was "routinely"given prior to 1971 and this exponentially increases the risk of vaccination complications. Now more than 25% of our population is immunosuppressed by diseases or drugs. This includes more than 28 million people with eczema and millions more with a past history of eczema; 184,000 organ recipients, 850,000 individuals with diagnosed and undiagnosed HIV infection or AIDS, and 8.5 million people with cancer. Dr. Margolis presented a slide that contained these facts. What he failed to discuss, however, were risks involving the untold millions who are taking immunosuppressive drugs such as the corticosteroids Prednisone® and Medrol®. These medications are given to both adults and children, and are prescribed for dozens of conditions including but not limited to: asthma; emphysema; allergies; Crohn's disease; multiple sclerosis; herniated spinal discs; acute muscular pain syndromes; and all types rheumatoid and autoimmune diseases. All of these patients would be at risk for serious complications - including death - not only from the vaccine, but also from coming in contact with a vaccinated individual.

Dr. Margolis provided the following information regarding the current and projected supply of the vaccine stock:

Name of vaccineManufacturer Made from Number of doses
Dryvax (1982) Wyeth Calf lymph 15-75 million
Accum 1000 (new)AcambisMRC-5 cells
(human fetal tissue)
54 million
Accum 2000 (new)AcambisVero cells
(monkey tissue)
155 million
"frozen vaccine"(1980s)Aventis(Unsure)70-90 million

He reaffirmed that vaccinia is NOT cowpox; it is a completely separate virus. In addition, he remarked in passing that the vaccinia vaccine is considered an IND, or investigational new drug. This designation should not be taken lightly. The old versions of the vaccine - the Aventis vaccine and Dryvax®--will be re-released. These vaccines were never subjected to controlled clinical trials. The new Acambis vaccines will not have to be subjected to rigorous safety standards in human trials. The new FDA rulings on the development of drugs and vaccines related to bioterrorism will lower safety production standards to fast- track production. And as always, vaccine manufacturers as well as physicians will be protected from liability for any vaccine-induced injuries or deaths that will undoubtedly occur. These facts must be taken into consideration before deciding to receive the vaccine.

There was a "wrap up" of the morning, and then the floor was opened to questions from the audience. I asked the following questions:
Q: If a person was vaccinated with the smallpox vaccine, can they be tested to see if they still have protective antibody levels?
A: There is no commercially available test available to the general public.

Editorial Comment: Some studies suggest that antibody levels from previous vaccination may last as long as 50 years. Since this is a test that can be performed at research laboratories, the CDC should make this type of testing available before the vaccinia vaccine is used.

Q: (asked by another person): Is it essential for a scar to form to know that a person has developed immunity?
A. (Belshe) There is a high relationship between the development of an antibody response and the development of the scar. "The scar is a simple indication that the vaccine is working.”

Q: The CDC has published a 260 page document called "Interim Smallpox Response Plan & Guidelines." Is this plan intended to be a "prototype" in the event that other types of biological weapons are released on the general public?
A: (Kurtisky): Parts of it could be used for that purpose.

Q: In the event of a confirmed outbreak, would those people considered to be "close contacts"and in the "immediate ring"be required to be vaccinated, even if they had a medical contraindication?
A: We would have to do the best that we could to not vaccinate them, but they are also the ones at greatest risk for the most serious complications from smallpox.

Editorial Comment: There was no direct answer to this, even when several others in the audience asked this question in various formats, including "what is the CDC's definition of voluntary?"The question was diverted and vaguely addressed.

Q: We read in every medical and general publication that the case fatality rate of smallpox is 30%. What was the actual cause of death from smallpox?
A: (by Dr. Margolis): Most people died from electrolyte imbalances and possibly renal (kidney) disease. In addition, the skin sometimes exfoliated (sloughed off) and it acted like a burn. In addition, most cases that died were in Bangladesh and Central Africa.

Q: So, what you are saying by your answer is that those conditions are treatable and that most cases that died took place in countries where they did not have advanced medical care and since the last case of known smallpox in the U.S. was in Texas in 1949, we have the medical capability to treat complications of smallpox today.
A: Some "imported cases" people died in Europe too.

Editorial Comment: Both doctors demonstrated an interesting "body language" response when I asked this question. They both shifted abruptly back into their chairs, looked at each other. I read Margolis lips, as he asked Kuritsky, "do you want to answer this?" Kuritsky shook his head "no." I have never seen either of these complications listed in association with smallpox, let alone the cause of death of smallpox! In addition, this means that people die from potentially treatable COMPLICATIONS of this infection, not from the infection itself! This is a critical distinction. The reason that most people say that they would accept the smallpox vaccine is because of its reported 30% death rate.

In addition, this reported 30% death rate is a statistic based on old data. It is doubtful that the death rate would be any where near that high today. However, the severe complication and death rate from the vaccine might well be at least that high due to the vast number of immunosuppressed people in our country as I mentioned earlier.

In light of all this information, it was disheartening and alarming to hear the prepared answers read by the organizations in attendance. Each person that commented was required to state their name and the organization that they represented when they read their prepared 5 minute statement. The overwhelming response by the organizations, with the exception of my comments, can be summarized as follows:

  1. Do not start vaccinating the general public at this time.
  2. Begin vaccination of first responders now, but on a limited basis only.
  3. In the case of an outbreak, all bets are off but vaccination should be used with responders and quite possibly with large sectors of the general public.

Was anyone listening? It appears that the "public" is willing to ignore the facts that the CDC presented and go further than was really warranted.

What is the "real agenda" of the CDC? Why were these meetings held, given the fact that the CDC has never been interested in what the public has to say about their policies? Over the next few weeks and months, the rest of the story will undoubtedly unfold.

I want to personally thank all of you who called and who emailed me with letters of support and concern after reading my press releases on and or hearing me on the radio with Joyce Riley or with Bill Boshears. Your kind words and thoughts were very much appreciated and I will continue to do my very best to keep you updated and informed as the possibility of mandatory smallpox vaccination draws near.

While the possibility of mandatory vaccination is the "bad news" the good news is that most of the letters I received asked, "What can I do to help?" In fact this is not just good news, it is great news, as time is short and we need America to wake up and do it fast! To protect ourselves from those who would "protect"us by denying us our most basic rights, we will need to be aware and willing to act. Everyone one of us - and everyone one of our friends and family members MUST become aware of the critical juncture at which we now stand and get involved.

In spite of the fact that, by the CDC's own admission, mass vaccination is not necessarily the answer, the Patriot Act and The Model State Emergency Health Powers Act have laid the groundwork for it. (To view the full text of these documents, go to .) Thinking "this could never happen here!"will not protect you. The only chance that we have to protect our disappearing rights is to GET INVOLVED.

Here are my recommendations:

A. Go to the CDC website and answer the questions. Time is of the essence, as they are only accepting comments until JUNE 12, 2002. To answer the questions, a clarification is necessary. The questions are wordy and can be confusing. In simple terms, this is what the CDC is asking: Question #1: The CDC's current policy for smallpox vaccination is to only vaccinate laboratory workers. Should this be changed? Should the vaccine be available to the general public?

1. No change in policy; Not recommended for the general public
2. CDC does not recommend the vaccine but it would be available on request to the general public
3. CDC is neutral on recommendation, but vaccine would be available on request
4. The vaccine would be available to the general public

Question #2: Should specific groups of first responders (ex: EMT/paramedics; police; fireman; ER doctors and nurses; etc.) be vaccinated now?
1. No. Vaccine should be only for laboratory personnel
2. Yes, but limited only to smallpox response teams created by the CDC or the States.
3. Yes. Widespread vaccination of all medical and non-medical first responders and their support staff.

Question #3: In the even of a confirmed outbreak, how should the vaccine be used?
Surveillance and containment: Use ring vaccination only on limited basis of direct personal contacts
1. Surveillance and containment PLUS selected medical and 1st responders
2. Surveillance and containment PLUS the general public in the affected communities
3. Surveillance and containment PLUS mass vaccination of the general public.

Now that you can understand the questions that they are asking, you can give a response that most represents your understanding of the situation and how you feel best meets your needs and those of your family. This is how I responded:
Question #1 ....Answer #1
Question #2 ....Answer #1
Question #3 ....Answer #1 PLUS the following comments:
a. The CDC data shows that this is NOT a highly contagious virus
b. The CDC data shows that the virus has a slow transmission rate
c. Even those at highest risk will only contract smallpox if they have had intense contact for more than 7 days
d. The general public must be advised to NOT go to the hospital as the transmission rate to others is highest within the confines of a building.
e. It is the job of the CDC and the Public Health Officials to ensure that the general public fully understands this information and DOES NOT PANIC. Smallpox is not only slow to spread, it is slow to cause severe illness.

B. Focus on education. The real war has become an information war; it is being fought now! Inform your state and federal (congressional) leaders of your position. Let them know the level to which you will resist, if that is what you are planning to do. Inform and educate political leaders, City Counsel members, school board members, local charities and your police and fire departments. Have a family and neighborhood meeting. Know in advance what your response is going to be. Most importantly, share this information with everyone that you know.

C. Increase your stores of food and bottled water in case a quarantine situation arises. Purchase a filtered mask for each person in your family that is NIOSH approved with an N95+ rating. Most importantly, have the mask appropriately fitted for each person and keep it in an accessible place.

D. Grow and/or purchase organic produce for your family. Seek alternative types of healthcare to improve your immune system and maintain or restore your health. Create your own stock of vitamins, herbs, homeopathics. Avoid prescription medications as much as possible.

E. Keep your immune system healthy! Avoid white (refined) sugar, white flour and white rice. Now is the time to determine your "bowel tolerance"for Vitamin C. The best way to do this is with powdered Vitamin C. Start with 10,000mg and increase by 5,000 mg/day until you reach a level that causes diarrhea. That level is your bowel tolerance. If you have an acute infection, START AT THIS LEVEL and continue to increase to your next level of bowel tolerance. It is a well-known and established medical fact that Vitamin C is a potent anti-viral vitamin. Keep large stocks of this on hand in the event of any type of bioterrorism attack.

F. Become familiar with the use of Essential Oils, homeopathy, and other herbal remedies that have been shown to be effective against viral infections.

Nightfall does not come at once, neither does oppression. In both instances, there is a twilight where everything remains seemingly unchanged. And it is in such twilight that we all must be aware of change in the air... however slight... lest we become unwitting victims of the darkness."
--Justice William O. Douglas


i Frey, Sharon E. et al. Dose Related Effects of Smallpox Vaccine. NEJM Vol. 346; No. 17. 1275-1280. April 25, 2002.
ii Am. Journal Epidemiology. 1971; 91:316-326.
iii Meltzer, Martin I. Modeling Potential Responses to Smallpox as a Bioterrorist Weapon Appendix I: A Mathematical Review of the Transmission of Smallpox. Emerging Infectious Diseases. Vol.7, No.6. November-December, 2001.
ivMeltzer. Ibid. November-December, 2001.
v Rao AR. Smallpox. Bombay: The Kothari Book Depot, 1972.
vi WHO Bulletin 1975 52:209-222.
vii ACIP recommendations on Smallpox: [made 22Jun01]
viii Diepgen TL. Is the prevalence of atopic dermatitis increasing? In: Williams HC, ed. Atopic Dermatitis: The Epidemiology, Causes and Prevention of Atopic Eczema. New York: Cambridge Univ Pr; 2000:96-112.
ix United Network for Organ Sharing (UNOS). All Recipients: Age at Time of Transplant. x Joint United Nations Programme on HIV/AIDS. Epidemiological Fact Sheets on HIV and Sexually Transmitted Infections: United States. /index.html
xi National Cancer Institute. CanQues.
xii J. Infectious Diseases. 1972: 125:161-169.

Frey, Sharon E. et al. Dose Related Effects of Smallpox Vaccine. NEJM Vol. 346; No. 17. 1275-1280. April 25, 2002.
Am. Journal Epidemiology. 1971; 91:316-326.
Meltzer, Martin I. Modeling Potential Responses to Smallpox as a Bioterrorist Weapon Appendix I: A Mathematical Review of the Transmission of Smallpox. Emerging Infectious Diseases. Vol.7, No.6. November-December, 2001.
Meltzer. Ibid. November-December, 2001.
Rao AR. Smallpox. Bombay: The Kothari Book Depot, 1972.
WHO Bulletin 1975 52:209-222.
ACIP recommendations on Smallpox:
Diepgen TL. Is the prevalence of atopic dermatitis increasing? In: Williams HC, ed. Atopic Dermatitis: The Epidemiology, Causes and Prevention of Atopic Eczema. New York: Cambridge Univ Pr; 2000:96- 112.
United Network for Organ Sharing (UNOS). All Recipients: Age at Time of Transplant.
Joint United Nations Programme on HIV/AIDS. Epidemiological Fact Sheets on HIV and Sexually Transmitted Infections: United States. /index.html
National Cancer Institute. CanQues.
J. Infectious Diseases. 1972: 125:161-169.