Bartlett JG et al. Routine smallpox vaccination in the United States was discontinued in 1972 and even persons vaccinated before that may no longer be protected. The deliberate release of the virus would create an international health emergency with potential to cripple affected cities or regions. There is growing concern that samples of the smallpox virus, variola, maintained in the Soviet Union may fallen into the hands of other countries and groups. This consensus statement outlines expert opinion on the epidemiology, clinical presentation, diagnosis, prevention, and public health management of a potential epidemic from terrorist use variola as a biological weapon.
Smallpox spreads primarily by oropharyngeal aerosols from infected patients.
Patients are not contagious until the rash appears. Hemorrhagic and malignant variants of smallpox are difficult to diagnosis and carry an even higher case-fatality rate than the typical form. Current supplies of vaccine are limited, and may cause severe reactions in patients who have HIV or are otherwise immunosuppressed. Current priorities in dealing with this potential threat include development of a safer and more effective vaccine, immunotherapy, and improved diagnostic tests. As was the consensus group's previous review of anthrax , this article is important reading and essential for anyone with a special interest in the topic.