1976 Ft. Dix swine flu outbreak offers guidance

The mysterious 1976 swine flu outbreak at Fort Dix and the vaccination program that followed are sure to influence the way public health officials respond to the current potential pandemic.

David J. Sencer hopes his searing experience "could help guide decisions."

Sencer, a Harvard-educated public health expert, was fired as director of the U.S. Centers for Disease Control after the 1976 outbreak failed to turn into a pandemic - and the vaccine program turned into disaster. The shot was linked to 500 cases of Guillain-Barre syndrome, including at least 25 related deaths, while the swine flu killed only one of the 230 soldiers it sickened.

Sencer reflected on that 1976 emergency in an article published in the journal Emerging Infectious Diseases in 2006 - amid fears that avian flu would become a pandemic. He remained convinced that his recommendation to hastily ramp up swine flu vaccine production and inoculate the entire country was prudent.

His advice was seconded by CDC vaccine advisers, accepted by then-President Gerald R. Ford, and authorized by congressional legislation that provided funding.

"Because of the unpredictability of influenza, responsible public health leaders must be willing to take risks on behalf of the public," Sencer wrote with a colleague. "This requires personal courage and a reasonable level of understanding by the politicians."

Richard Hodder, 68, one of the Army epidemiologists who investigated the Fort Dix outbreak, thought then that vaccine should be made but stockpiled, and not immediately used. Russia was among countries that stockpiled vaccine after it was made.

Even so, Hodder says now that Sencer was unfairly blamed for the unforeseeable.

"Generals and doctors have the same problem: They have to make a decision today with the information they have," said Hodder, who is retired and lives in Hawthorne, N.Y.

Numerous considerations shaped his recommendation, Sencer wrote.

For one thing, the 1918 pandemic that killed millions was believed to have been a swine flu. For another, an unusual opportunity existed in 1976 because the Fort Dix outbreak occurred in February, giving vaccine-makers just enough time to make swine flu vaccine before launching seasonal flu vaccine production.

In addition, if swine flu broke out in the general population, "the disease would spread faster than any ability to mobilize preventive efforts," Sencer wrote.

"Dr. Sencer felt very strongly that he didn't want to be the person who let a lot of Americans die because he sat on his hands," Hodder said. "And you have to remember, there was nothing else - no Tamiflu or Relenza. Once the disease would start to spread, you'd be in trouble."

Exactly how and why swine flu was contained at the military base remains as mysterious as the strain's origins.

Experts speculate that the seasonal flu may have given the soldiers some weak immunity to swine flu, thwarting its spread. Also, groups of newly arrived soldiers were kept in separate barracks with their own training and recreation facilities for the first six weeks to cut the risk of serious contagions, such as meningitis.

"That was great for us [investigators] because it gave us these isolated cohorts for study," Hodder said. "It also reduced transmission" of swine flu.

While defending the vaccine program, Sencer said it offered important lessons for today's policy-makers.

Under pressure from manufacturers, the government agreed to indemnify them against any claims of adverse reactions from the vaccine.

While this seemed reasonable given "the trend of increased litigiousness in American society," Sencer wrote, "its unintended, unmistakable subliminal message blared, 'There's something wrong with this vaccine.' "

While fear and misinformation ran rampant, the CDC was not holding regular scheduled news conferences, as it does today.

"In retrospect, periodic press briefings would have served better than responding to press queries," wrote Sencer, who went on to become New York City's health commissioner.