Materiały źródłowe

• #1 Smallpox – Taiwan Centers for Disease Control

  https://www.cdc.gov.tw/En/Category/ListContent/bg0g_VU_Ysrgkes_KRUDgQ?uaid=ApIKFskkO8tRtrA2fEVUBQ

  Smallpox is an acute infectious disease caused by the variola virus, which causes varying degrees of health threat to humans. The fatality rate is up to 30%. Deaths often occur within one or two weeks after symptom onset. So far, there is no effective treatment. The disease was first discovered in China and India in the 4th century, and more than 3.5 million people were killed in the world in the 16th century. By 1970, more than 15 million people were infected each year, with at least 2 million deaths worldwide. Therefore, the World Health Organization (WHO) planned to eradicate smallpox, and in 1980 officially announced that the smallpox virus eradicated completely on earth, which will not happen naturally, and recommended that all countries to stop vaccinia vaccination. Three attributes that lead to the success of the variola virus eradication program: construction of strategic disease surveillance system, rigorous isolation of possible cases and vaccination of all contacts. The variola virus has also become the first eradicated virus that causes human disease in nature. […] Since 1955, there has been no confirmed case reported in Taiwan. […] Taiwan National Infectious Disease Statistics System-Smallpox […] Fever screening at international airports and seaports. […] Selfreporting through the tollfree 1922 hotline or local public health authority.

• #1 The Triumph of Science: The Incredible Story of Smallpox Eradication – NFID

  https://www.nfid.org/the-triumph-of-science-the-incredible-story-of-smallpox-eradication/

  Smallpox was declared eradicated on May 8, 1980. […] Smallpox is the first and only infectious disease that has been eradicated in humans, which means it no longer exists naturally anywhere in the world. […] Vaccine research developments, advances in surveillance, and mass vaccination programs across the globe contributed to the success of the program. […] Surveillance and containment strategies were critical to eradication. Intensive surveillance allowed public health workers to identify smallpox cases early, isolate and interview smallpox patients, identify people who had been exposed as well as their close contacts, notify them of their exposure, and monitor their health. […] International collaboration on the strategic use of smallpox vaccine resulted in the global eradication of this feared infectious disease. […] Smallpox vaccination can protect recipients from getting sick or reduce the severity of illness if received prior to, or within a week of, exposure. […] Smallpox eradication is hailed as one of the greatest public health achievements of all time.

• #1 Smallpox: Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/830328-overview

  The last outbreak of smallpox in the United States was in 1947, when 12 cases were reported in New York City. In the United States, routine vaccination of the civilian population ended in 1972, and in 1990 it ended for the US military. […] Since 1978, no cases of smallpox have been reported in the world. The last endemic case of variola major was reported in Bangladesh in 1975; the last endemic case of variola minor was reported in Somalia in 1977. In 1978, a laboratory accident in Birmingham, England, resulted in a single case of the disease. […] Smallpox is authorized to be kept for research purposes only at 2 WHO reference laboratories. One is the CDC, in Atlanta, Ga, and the other is the State Research Centre of Virology and Biotechnology, also known as the VECTOR Institute, in Koltsovo, Russia. Routine smallpox vaccinations were stopped in 1972 and smallpox was declared eradicated in 1980 after a worldwide vaccination program. […] The age distribution of smallpox mirrors that of the general population, although residual immunity from previous vaccination could potentially decrease disease in the older population. Historically, young or old individuals are more susceptible to severe smallpox.

• #1 Speedboat epidemiology: What smallpox teaches us about healthcare today : Short Wave : NPR

  https://www.npr.org/transcripts/1196371558

  Smallpox is a deadly virus. It’s been around for millennia, at least since the third century BC in the Egyptian empire and at one point killed almost 1 in 3 people who had it. In the 20th century alone, there were 300 million deaths, particularly in South America, Asia and Africa. […] And so for basically hundreds of years, people thought it would be impossible to get rid of until smallpox became the first and only human disease to be wiped out globally. […] The World Health Organization first considered eradicating smallpox in the 1950s. Many did not think it could be done, and they thought that they’d have to vaccinate every last person in the world against smallpox to eradicate the disease – really, an impossible task. But early success in West Africa helped pave the way and convince some of those skeptics.

• #1 History of smallpox: Outbreaks and vaccine timeline

  https://www.mayoclinic.org/diseases-conditions/history-disease-outbreaks-vaccine-timeline/smallpox

  Dr. Edward Jenner finds that vaccination with the cowpox virus can protect a person from smallpox infection and creates a smallpox vaccine. He publishes his findings in 1798. […] Massachusetts is the first state to require that children have a smallpox vaccine before going to school to prevent the spread of smallpox in schools. […] The World Health Organization (WHO) declares smallpox eliminated worldwide due to vaccinations. Smallpox vaccination ends. Before the smallpox vaccine, smallpox had been considered one of the deadliest infectious diseases. About 300 million people died of smallpox in the 20th century. […] Defending against smallpox: A focus on vaccines.

• #1 Smallpox – Epidemiology

  https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/smallpox/

  Smallpox outbreaks occurred for thousands of years, but the disease was eliminated from the world after a successful vaccination campaign. […] The last case of smallpox in the United States was in 1949. The last natural case in the world occurred in Somalia in 1977. […] Because of concern that the variola virus might be used as an agent of bioterrorism, even one case of confirmed smallpox would constitute an international public health emergency. […] The variola virus spreads from person to person through direct contact with respiratory droplets from a cough or sneeze, secretions, or skin lesions of an infected person. […] Smallpox is suspected based on the patient’s clinical signs and symptoms. The disease can be definitively diagnosed by laboratory testing of blood or lesions. […] Vaccination within three days after exposure might prevent or significantly lessen the severity of smallpox symptoms in most people. […] Although it is unlikely, it is possible that the variola virus that causes smallpox could be used as a bioterrorist weapon.

• #1 Variola virus (smallpox) – UpToDate

  https://www.uptodate.com/contents/variola-virus-smallpox

  Variola virus is the causative agent of smallpox, a highly infectious disease characterized by fever, rash, and a high mortality rate. In 1979, the global eradication of smallpox was announced, marking one of the greatest achievements of modern medicine. Several factors facilitated eradication: […] Human beings were the only known reservoir for the virus. […] No asymptomatic carrier state existed. […] An effective vaccine was available. […] Vaccination of contacts resulted in prevention or modification of disease.

• #1 Smallpox | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/smallpox/

  Before smallpox was eradicated (eliminated), it was a serious infectious disease caused by the variola virus. It spread from person-to-person and caused a fever and a distinctive skin rash. […] Thanks to the success of vaccination, smallpox was eradicated, and no cases of naturally occurring smallpox have happened since 1977. The last natural outbreak of smallpox in the United States occurred in 1949. […] Before it was eradicated, smallpox spread mainly by direct and prolonged face-to-face contact between people. Smallpox patients became contagious once the first sores appeared in their mouth and throat. They spread the virus when they coughed or sneezed and droplets from their nose or mouth spread to other people. They remained contagious until their last smallpox scab fell off. […] Smallpox can be spread by humans only.

• #1 Surveillance and Control Measures during Smallpox Outbreaks

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3320452/

  Targeted surveillance and containment interventions have been successful for outbreak control and should be explored as alternatives to mass vaccination. […] In both outbreaks, extensive contact tracing, quarantine, and staged vaccination campaigns were initiated, and the outbreaks were controlled within 15 months and 3 months, respectively. […] The relatively slow spread of smallpox, as exemplified by the report from Liverpool, allowed for effective implementation of targeted intervention methods. […] Active surveillance, vaccination of contacts, and prompt hospital isolation of patients were important aspects of disease control measures in both outbreaks. […] The success of the surveillance-containment strategy in Liverpool, the basis of which has been discussed more recently elsewhere, was particularly noted by the observers of the time.

• #1 Factsheet – Health Protection Surveillance Centre

  https://www.hpsc.ie/a-z/vaccinepreventable/smallpox/factsheet/

  Smallpox is an acute contagious disease caused by the smallpox (or variola) virus. […] However, following a worldwide vaccination campaign, coordinated by the World Health Organization smallpox was declared eradicated in 1980. […] While the risk of a deliberate release of smallpox virus is very low, there are several factors which contribute to the bioterrorism potential of this virus; high mortality rate, transmission from person-to-person, lack of effective treatment, and declining numbers of vaccinated people (in general, vaccinated people are at least 30 years of age now). […] Smallpox is most often spread by inhaling virus particles through close contact with an infected person (generally family members), but transmission via clothes and bedding is also possible. […] Smallpox is moderately infectious. […] A patient is most infectious during the first two weeks of illness. […] There is no specific treatment for smallpox, management being supportive. […] Yes, and quite easily. There is a very effective vaccine against smallpox which is not administered anymore since smallpox has been eradicated.

• #1 2 Overview of Smallpox and Its Surveillance and Control | Live Variola Virus: Considerations for Continuing Research | The National Academies Press

  https://nap.nationalacademies.org/read/12616/chapter/4

  2 Overview of Smallpox and Its Surveillance and Control S mallpox, the disease caused by the variola virus, is characterized by fever; headache; back pain; vomiting; and, most distinctly, a papular, and later vesicular, rash. […] Epidemiology Smallpox is uniquely a human disease, and variola virus has no other known host or reservoir species. Historically, the virus was transmitted primarily through aerosolization of respiratory secretions, as well as by direct contact with skin lesions or exposure to contaminated bedding or clothing. […] Smallpox epidemics occurred in cycles that varied from annually to every few years. The periodicity depended largely on the number of susceptible individuals in the community, which was heavily influenced by the prevalence of prior infection and by vaccination levels (Fenner et al., 1998).

• #1 Smallpox epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Smallpox_epidemiology_and_demographics

  Smallpox was declared eradicated in 1980 by the WHO. The true incidence of smallpox before its eradication is difficult to estimate due to poor reporting from endemic regions, which may have reported only 1-2% of the cases. […] The number of new cases, reported to the international health authorities, was often inaccurate. The data obtained from non-endemic countries, with good health services, was probably the most accurate. Yet, according to the Intensified Smallpox Eradication Programme, the reported incidence amounted only to 1-2% of the actual number of cases, which made it impossible to obtain an accurate estimate of the incidence. […] In endemic regions there were periods called epidemic years in which the incidence was much higher. […] The age adjusted incidence of the disease may vary depending upon the level of acquired immunity in the population.

• #1 The Epidemiology of Smallpox

  https://scalar.chass.ncsu.edu/bodies-and-structures-2/the-epidemiology-of-smallpox.1

  The smallpox virus is transmitted by airborne droplets or secretions from skin lesions and scabs attached to textiles or house dust. Most outbreaks of smallpox occur in the winter and spring, because the virus can survive outside the human body for a certain length of time under cool and dry weather conditions. But human mobility–of merchants, sailors, pilgrims, and many other kinds of travelers–has always played a critical role in spreading the disease. […] By the middle of the eighteenth century, the smallpox virus had become endemic in Japan. Even in remote rural regions, the virus was either circulating or frequently being reimported from outside. Under these conditions, most children would have been infected by the age of five. […] In the course of the Tokugawa period, travel and migration between urban and rural areas intensified and probably increased exposure to the disease. However, contemporary documentation is not detailed enough to trace the movement of the smallpox virus within and between regions.

• #1 Smallpox epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Smallpox_epidemiology_and_demographics

  Smallpox affected males and females equally. […] The incidence of smallpox did not differ according to the race. […] Developed countries, due to a better and established health system, had lower incidence of smallpox and better reports of new cases to international organizations. […] In developing countries where healthcare facilities are sometimes not trusted by the population, cases were sometimes not reported to public health authorities. Also, vaccination was not sanctioned by some religious beliefs. Taken together, these factors might explain at least in part the higher incidence of smallpox in developing countries.

• #1 4 Epidemiology | Assessment of Future Scientific Needs for Live Variola Virus | The National Academies Press

  https://nap.nationalacademies.org/read/6445/chapter/8

  The earliest writers on smallpox describe it primarily as a disease of children. This is a mark of well-established endemic prevalence, and argues that smallpox had been present in those areas for centuries. At the beginning of the 20th century a hundred years after the introduction of vaccinations smallpox was endemic in almost every country of the world. A population with at least 200,000 susceptible individuals is required to support endemic smallpox. […] All histories of smallpox record periods punctuated by major epidemics, which can be distinguished by two epidemiologically distinct situations. The first was when smallpox was introduced into a location where it had not occurred previously, or at least not for many years, so that a large portion of the population was susceptible. The second situation was one in which, for a variety of demographic, climatic, and other reasons, optimum conditions for transmission fluctuated so that epidemics occurred every few years against a background of endemicity.

• #1 Smallpox – Our World in Data

  https://ourworldindata.org/smallpox

  It was only with the establishment of the World Health Organization (WHO) that international quality standards for the production of smallpox vaccines were introduced. […] By 1959, the World Health Assembly, the governing body of the World Health Organization (WHO), had passed a resolution to eradicate smallpox globally. […] But it was not until 1966, that funding was provided to the „Intensified Smallpox Eradication Program” to increase efforts for smallpox eradication. […] Smallpox’s eradication was greatly spurred by making use of the fact that smallpox transmission occurs via air droplets. […] Initially, the WHO had pursued a strategy of mass vaccination which attempted to vaccinate as many people as possible, hoping that herd immunity would protect the whole population. […] Soon, however, vaccination efforts were targeted locally around smallpox cases, because smallpox was transmitted by sick patients’ air droplets.

• #1 Speedboat epidemiology: What smallpox teaches us about healthcare today : Short Wave : NPR

  https://www.npr.org/transcripts/1196371558

  Three words – search and containment. That’s the revolutionary public health strategy that finally started to slow the virus around the world. And it’s what would eventually help eliminate smallpox in Bangladesh in 1975. […] It involves active searches for cases, contact tracing, isolation and vaccination. It also relies a lot on forging partnerships with people who really know the area you’re working in, with someone who understands the community’s needs, culture, terrain. […] Squashing a virus like smallpox requires tactics specific to each community and their worries about the vaccine itself. […] This strategy, literally bringing vaccines and health care to people, works beyond mpox, beyond smallpox.

• #1 Smallpox Eradication in India, 1972-1977 | Surveillance-containment searching · Online Exhibits

  https://apps.lib.umich.edu/online-exhibits/exhibits/show/smallpox-eradication-india/indian-engages-pandemic/surveillance-containment-searc

  The strategy of surveillance-containment was simple in design. Teams of healthcare workers would actively seek out (i.e., search) for all potential cases of smallpox as quickly as possible. […] Surveillance-containment was data-driven and data-heavy. The documents that the health workers and epidemiologists had to complete in the field were abundant and various. They had to be submitted promptly and then quickly analyzed. This type of record-keeping was tedious but necessary.

• #1 Smallpox – Our World in Data

  https://ourworldindata.org/smallpox

  This practice is known as ring vaccination. […] Despite the risk of re-introductions, ring vaccination greatly reduced the cost of the eradication campaign. […] The number of administered vaccines declined and smallpox was increasingly brought under control. […] Major pushes in vaccination campaigns, however, successfully drove down the number of infections to zero in India in 1976.

• #1 Mass Vaccination and Surveillance/Containment in the Eradication of Smallpox | SpringerLink

  https://link.springer.com/chapter/10.1007/3-540-36583-4_2

  The Smallpox Eradication Program, initiated by the WHO in 1966, was originally based on mass vaccination. The program emphasized surveillance from the beginning, largely to track the success of the program and further our understanding of the epidemiology of the disease. […] Early observations in West Africa, bolstered by later data from Indonesia and the Asian subcontinent, showed that smallpox did not spread rapidly, and outbreaks could be quickly controlled by isolation of patients and vaccination of their contacts. […] The emphasis therefore shifted to active searches to find cases, coupled with contact tracing, rigorous isolation of patients, and vaccination and surveillance of contacts to contain outbreaks. This shift away from mass vaccination resulted in an acceleration of the programs success.

• #1 Smallpox – Wikipedia

  https://en.wikipedia.org/wiki/Smallpox

  Smallpox was an infectious disease caused by Variola virus (often called Smallpox virus), which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) certified the global eradication of the disease in 1980, making smallpox the only human disease to have been eradicated to date. […] The disease was transmitted from one person to another primarily through prolonged face-to-face contact with an infected person or rarely via contaminated objects. Prevention was achieved mainly through the smallpox vaccine. […] The initial problem the WHO team faced was inadequate reporting of smallpox cases, as many cases did not come to the attention of the authorities. The fact that humans are the only reservoir for smallpox infection (the virus only infected humans and not other animals) and that carriers did not exist played a significant role in the eradication of smallpox. The WHO established a network of consultants who assisted countries in setting up surveillance and containment activities.

• #1 Surveillance of Smallpox | Scilit

  https://www.scilit.com/publications/96b8d8dbc297f6cecc8d367c7e3e198d

  Henderson, D. A. (Smallpox Eradication Programme, World Health Organization, Geneva, Switzerland), Surveillance of Smallpox. International Journal of Epidemiology 1976, 5: 19–28. An intensified global smallpox eradication programme was started by the World Health Organization in 1967. […] This paper describes the basic techniques employed and the experiences involved in implementing the procedures. Surveillance schemes have varied considerably in detail from country to country according to different health structures, and the emphasis is therefore placed on the more generally used approaches. […] Finally, important principles in the implementation of the smallpox surveillance programme are considered in relation to the development of such programmes for other communicable diseases.

• #1

  https://link.springer.com/article/10.1007/BF02030778

  Surveillance is the key for control of smallpox epidemics. Epidemiological characteristics of smallpox make surveillance of this disease very simple, resulting in fast interruption of transmission. […] An epidemiological team should be established and trained in such a manner that they could follow each case and find the source of infection for every case, trace the chain of transmission and detect all other unreported cases. […] The epidemiological unit involved in surveillance activities should preferably be attached at a national level to ensure coordinated policy throughout the country.

• #1 Smallpox Surveillance — Worldwide

  https://www.cdc.gov/mmwr/preview/mmwrhtml/00049694.htm

  A total of 3,234 cases of smallpox have been reported from Eastern Africa to the World Health Organization (WHO) in the period January 1-December 6, 1977. […] To date, the last known case of smallpox occurred in Somalia on October 26 in the Merca District. […] During October and November surveillance in Somalia has been severely hampered by heavy rains that have made it difficult or impossible to travel by vehicle. […] As of April 14, 1978, no cases of smallpox have been reported to the World Health Organization (WHO) from anywhere in the world since the last case had onset of rash on October 26, 1977, in Merka town, Somalia. […] However, a total of 2 years of effective surveillance must elapse before this last endemic area can be confirmed to be smallpox-free. […] With the apparent interruption of transmission of the disease on a global basis, smallpox activities are being directed toward promptly certifying and providing authoritative endorsement of this historic event.

• #1 Smallpox Surveillance — Worldwide

  https://www.cdc.gov/mmwr/preview/mmwrhtml/00049694.htm

  Recognizing that this certification is based on verifying that 2 years has elapsed with no case of smallpox being detected by a surveillance system which would have detected any case had it occurred, the recommendations called for the establishment of a Global Commission. […] If no more cases of smallpox are detected, the countries of Somalia, Ethiopia, Djibouti, Kenya, Yemen, and Democratic Yemen will be eligible for certification in October 1979. […] The legacy of the smallpox program, beyond eradication, has been enduring and includes the Expanded Program on Immunization (with its remarkable reductions of measles and other vaccine-preventable illnesses), the impending eradication of Guinea worm disease and poliomyelitis, and improved global disease surveillance and public health logistics systems.

• #1 Smallpox – Our World in Data

  https://ourworldindata.org/smallpox

  Smallpox is the only human disease that has been successfully eradicated. […] The eradication of smallpox is therefore a major success story for global health. […] The smallpox vaccine was the first vaccine to be developed. […] The last variola major infection was recorded in Bangladesh in October 1975, while the last variola minor infection occurred two years later in Merka, Somalia, on October 26th, 1977. […] During the following two years, WHO teams searched the African continent for further smallpox cases among people with rash-like symptoms, which can be a symptom of several diseases. They found no further cases of smallpox. […] In May 1980, the World Health Assembly, the governing body of the World Health Organization, officially certified the global elimination of smallpox, the first-ever eradication of a disease in human history.

• #1 Smallpox: Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/237229-overview

  After the disease was eliminated from the world, routine smallpox vaccination was stopped. […] The long-term consequence of eradication is that much of the world’s population is now unvaccinated and at risk for smallpox infection. […] Smallpox is a high-priority (category A) agent for bioterrorism, defined as follows by the CDC: Easily disseminated or transmitted from person to person; High mortality rate and potential for significant public health effect; Probable instigator of panic and social disruption; Special actions required for public health preparedness.

• #1 Smallpox – Disease Surveillance Epidemiology Program – MeCDC; DHHS Maine

  https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vaccine/smallpox.shtml

  Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus, and marked by fever and a distinctive progressive skin rash. Prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. […] The majority of patients with smallpox recover, but death may occur in up to 30% of cases. In 1980, the disease was declared eradicated following worldwide vaccination programs. Smallpox can be prevented through use of the smallpox vaccine. […] Smallpox is classified as a Category A agent by the Centers for Disease Control and Prevention. Category A agents are believed to pose the greatest potential threat for adverse public health impact and, broad-based public health preparedness efforts are necessary.

• #1 Smallpox Virus | BCM

  https://www.bcm.edu/departments/molecular-virology-and-microbiology/emerging-infections-and-biodefense/specific-agents/smallpox-virus

  Smallpox, one of the biggest killers in history, is caused by a virus called variola. […] People generally become infected with the smallpox virus by breathing in virus droplets following exposure to infected individuals or by direct contact with infected fluids or contaminated objects. […] A worldwide immunization program was instituted decades ago and has led to the elimination of smallpox as a human health threat. […] The smallpox virus is classified as a highest risk Category A bioterrorism agent for several reasons. […] The general population lacks immunity to smallpox. Routine smallpox vaccination ended in the United States in 1972. […] Discontinuation of the smallpox vaccination program in the early 1970s has reduced immunity to the variola virus in the general population. […] In the event of a biological attack with smallpox, the results of Dr. Mbawuikes work should provide guidance in decisions to revaccinate the public, particularly the elderly and other immunodeficient persons. […] MVM investigators have also participated in smallpox vaccine trials.

• #1 Smallpox | Mass.gov

  https://www.mass.gov/info-details/smallpox

  Smallpox was eliminated as a naturally occurring threat to humans in the late 1970s. The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in 1977 in Africa. Currently, there are only 2 known stockpiles of Variola (smallpox virus) in Atlanta and in Russia. […] Monitoring for a disease that does not currently exist anywhere in the world presents unique challenges. Currently, diagnosing a case would be based on classic symptoms a person would experience when ill with smallpox. […] People with suspected or confirmed smallpox need to be isolated because they are capable of spreading the virus. In addition, people who come into close contact with someone who has smallpox should be vaccinated and closely watched for symptoms of smallpox. […] Smallpox was declared globally eradicated in 1980; however, there are concerns that the smallpox virus could be used for bioterrorism. The risk for smallpox occurring as a result of a deliberate release by terrorists is not known, but is considered very low.

• #1 Smallpox | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/smallpox/

  After smallpox was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer needed. Routine smallpox vaccination among the American public was stopped in 1972. However, because of concern that variola virus might be used as an agent of bioterrorism, the U.S. government has stockpiled enough smallpox vaccine to vaccinate everyone who would need it if a smallpox outbreak were to occur. […] Historically, the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated. In addition, the vaccine was proven to prevent or substantially lessen infection when given within a few days after a person was exposed to the smallpox virus.

• #1

  https://dph.illinois.gov/topics-services/emergency-preparedness-response/public-health-care-system-preparedness/small-pox.html

  Smallpox is a serious, contagious and some times deadly disease caused by the Orthopox virus. It no longer exists in nature. The last case was reported in 1978. The virus only exists in two laboratories, one in Russia and one in the United States. […] Smallpox can be spread from person to person. Direct and extended face-to-face contact is needed to spread smallpox from person to person. Smallpox is not known to be spread by insects or animals. […] Smallpox can be aerosolized and released into the air quite easily. […] People who are sick from smallpox need to be isolated. […] Yes, there is a vaccine for smallpox. Currently, the United States has enough stock of smallpox vaccine for everyone in the country who might need it in the event of an emergency. […] If you think that you or someone you know may have come into contact with smallpox, contact the local county health department right away.

• #1 Development of Smallpox Antibody Testing and Surveillance Following Smallpox Vaccination in the Republic of Korea

  https://www.mdpi.com/2076-393X/12/10/1105

  Development of Smallpox Antibody Testing and Surveillance Following Smallpox Vaccination in the Republic of Korea […] Despite its global eradication in 1977, smallpox remains a concern owing to its potential as a biological agent, thereby prompting the ongoing development and utilization of its vaccine. […] The potential threat of bioterrorism using the smallpox virus is a genuine concern. […] Rapid diagnosis is crucial in containing the spread of the disease during a smallpox outbreak. […] Serological testing for immune antibodies is effective for epidemiological assessments and retrospective population surveys, as virus-specific immunoglobulin G antibodies remain in the body for an extended period. […] The persistent threat of smallpox as a potential bioterrorism agent or biological weapon has caused South Korea to take proactive measures, including the accumulation of smallpox vaccine stockpiles and the development of vaccination plans for first responders and medical personnel.

• #1 National Academies report says US not ready for intentional, accidental smallpox outbreak | CIDRAP

  https://www.cidrap.umn.edu/smallpox/national-academies-report-says-us-not-ready-intentional-accidental-smallpox-outbreak

  The United States’ national stockpile contains three kinds of smallpox vaccines, two types of smallpox antivirals, and a drug to treat orthopox-related complications. […] „Because the nation has never faced a smallpox outbreak in the 21st century, planners will also need to consider how the diverse MCMs available today, and in the future, will work together in a response; logistical and clinical considerations are paramount,” the report authors wrote. […] The report calls for creation of a smallpox research and development (RD) roadmap and pathways toward licensure and commercialization; development of point-of-care tests and approved antibody assays, single-dose smallpox vaccines that are adaptable and scalable, and an array of new and combination antivirals and non-vaccine biologic drugs; and periodic risk-benefit analyses for smallpox RD based on emerging technologies.

• #1

  https://www.who.int/health-topics/smallpox

  Smallpox is an acute contagious disease caused by the variola virus, a member of the orthopoxvirus family. […] The World Health Organization launched an intensified plan to eradicate smallpox in 1967. Widespread immunization and surveillance were conducted around the world for several years. […] The WHO Smallpox Secretariat based in WHO Headquarters coordinates all smallpox eradication-related and post-eradication activities. These include overseeing permitted research with live variola virus for the development of countermeasures such as vaccine and antivirals. […] The Secretariat manages the biosafety and biosecurity inspections of the authorized variola virus repositories as mandated by the World Health Assembly, and ensures annual reporting to WHO Governing Bodies. […] Preparedness in case of any kind of smallpox event requires national and international attention.

• #1 Smallpox | Australian Government Department of Health and Aged Care

  https://www.health.gov.au/diseases/smallpox

  Find out how we define and monitor cases of smallpox, and where you can learn more about this disease. […] Smallpox is a nationally notifiable disease. […] We monitor cases through the National Notifiable Diseases Surveillance System (NNDSS).

• #1

  https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Smallpox.aspx

  Last naturally acquired human case in the world occurred in Somalia in 1977; global eradication was certified two years later. […] Notify MOH immediately on suspicion. Call MOH Communicable Diseases Surveillance team at: 98171463. […] Airborne and contact precautions. Isolate patients in negative pressure isolation room. […] Patients should be considered infectious until all scabs separate and should be isolated during this period. […] Droplet and airborne precaution for a minimum of 17 days following exposure for all persons in direct contact with the index case.

• #1 Smallpox – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470418/

  Smallpox is the first human infectious disease to be successfully eradicated worldwide. It remains of clinical concern because of the potential for release and weaponization. […] Smallpox is a human disease without animal reservoirs, which became an important factor in its successful eradication. […] Smallpox transmission occurs through airborne respiratory droplet secretions or direct contact with lesions or contaminated fomites. […] The last naturally-occurring case of smallpox was found in Somalia in 1977. […] The Centers for Disease Control and Prevention (CDC) has developed an evaluation tool for clinicians caring for patients presenting with a rash illness that resembles smallpox based upon major and minor criteria. […] After the events of Sept. 11, 20001 in the United States, the concern arose for the deliberate release of the virus as an act of bioterrorism, and research for medical countermeasures including vaccines and anti-viral medications was renewed.

• #1 Session: Smallpox Surveillance: Local, State and Federal Issues

  https://apha.confex.com/apha/131am/techprogram/session_11246.htm

  Although the WHO declared smallpox globally eradicated in 1980, there is concern that smallpox may be used for bioterrorism. Surveillance is a key component of smallpox preparedness and response at the national, state and local levels of the public health system. […] Since January 2002, the CDC has assisted state/local health departments in conducting enhanced surveillance for rash illnesses suspected of smallpox. […] This special session will discuss surveillance of smallpox and of adverse reactions to smallpox vaccine (vaccinia), update current recommendations for preparedness and response, and highlight future surveillance. […] Describe the historical and contemporary aspects of smallpox surveillance in the United States. […] Discuss smallpox preparedness and response in the United States and the role of surveillance.

• #1 Controlling Spread of Smallpox | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/smallpox/controlling

  All suspect and known cases will be isolated at an appropriate site, which may include a healthcare facility or at home. […] If a suspect or known case of smallpox infection is reported in your county or if you suspect an outbreak, immediately consult with the epidemiologist on-call for CADE at (800) 362-2736. CADE can help determine a course of action to prevent further cases and can perform surveillance for cases that may cross several county lines and therefore be difficult to identify at a local level. […] The best way to prevent smallpox is to vaccinate all those potentially exposed and susceptible.

• #1 2 Overview of Smallpox and Its Surveillance and Control | Live Variola Virus: Considerations for Continuing Research | The National Academies Press

  https://nap.nationalacademies.org/read/12616/chapter/4

  Surveillance And control The 2001 anthrax attacks in the United States reminded the world that a biological agent could be used as a weapon of terror and made the research agenda for high-consequence pathogens such as variola a national priority (Lane et al., 2001). Even though naturally occurring smallpox has been eradicated (Henderson, 1987), the risk of smallpox resulting from a deliberate or accidental release of the agent remains (Mahalingam et al., 2004). […] WHO considers a single verified case of smallpox to be a public health emergency of international concern, and under the 2005 revisions of the International Health Regulations, reporting of such a case to WHO is obligatory. […] One key to implementing effective disease control strategies for a pathogen such as variola is prompt and accurate detection, either directly by identifying the biological agent or indirectly by methods that demonstrate the hosts response to the suspected pathogen (Fraser et al., 2004).

• #1 2 Overview of Smallpox and Its Surveillance and Control | Live Variola Virus: Considerations for Continuing Research | The National Academies Press

  https://nap.nationalacademies.org/read/12616/chapter/4

  In response to the detection of variola, three options exist for controlling any resulting outbreak of disease: isolation and quarantine, vaccination, and administration of antiviral drugs. […] CDC has specific procedures in place for containment of the disease should it be diagnosed, including use of isolation and quarantine, identification and vaccination of close contacts, and vaccination of those not directly exposed. […] Despite the research that has been accomplished since 1999, capability gaps for smallpox control remain. These include the development and licensure of rapid field diagnostics that are specific for variola or for antibodies induced by variola infection, further assessment and licensure of antivirals for the treatment of smallpox, and a licensed smallpox vaccine with a more favorable safety profile.

• #1 National Academies report says US not ready for intentional, accidental smallpox outbreak | CIDRAP

  https://www.cidrap.umn.edu/smallpox/national-academies-report-says-us-not-ready-intentional-accidental-smallpox-outbreak

  With the bungled responses to the COVID-19 pandemic and a recent mpox outbreak still fresh in mind, a new report from the National Academies of Sciences, Engineering, and Medicine highlights the United States’ need to fortify its preparedness for a smallpox outbreak. […] While the World Health Assembly declared the eradication of the highly contagious and deadly smallpox virus in 1980, experts remain concerned that the United States wouldn’t be able to marshal enough tests, vaccines, and treatments to contain an intentional or accidental release or natural resurgence particularly amid evolving threats and technologies. […] The report, done at the behest of the US Administration for Strategic Preparedness and Response, also acknowledges the threat: „Advancements in genome science and genetic engineering raise the possibility of deliberate re-creation and misuse of variola virus, considered appealing to terrorists for its potential to create a more lethal and transmissible strain.”

• #1 Smallpox – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/pox-viruses/smallpox

  No cases of smallpox have occurred in the world since 1977 because of worldwide vaccination. […] Concerns about bioterrorism using smallpox virus from retained research stores or even from synthetically created virus raise the possibility of a recurrence. […] Diagnosis of smallpox is confirmed by documenting the presence of variola DNA by PCR of vesicular or pustular samples. […] Suspected smallpox must be reported immediately to local public health agencies or the CDC at 770-488-7100. […] Treatment of smallpox is generally supportive, with antibiotics for secondary bacterial infections. […] Vaccination with ACAM2000 is dangerous and not recommended for some people, especially those with the following risk factors: weakened immune system, skin disorders, eye inflammation, heart condition, age under 1 year, pregnancy.

• #1 Development of Smallpox Antibody Testing and Surveillance Following Smallpox Vaccination in the Republic of Korea

  https://www.mdpi.com/2076-393X/12/10/1105

  These findings have crucial implications for public health, particularly regarding bioterrorism threats involving variola or related Orthopoxvirus species, highlighting the need for continued vigilance and the potential reevaluation of vaccination strategies. […] The increased presence of neutralizing antibodies in individuals of Groups A and B, who were likely vaccinated due to the smallpox vaccination campaigns actively conducted in South Korea until 1978, during which smallpox vaccination was mandatory for most of the population, with no detectable neutralization in those from Group C, who were least likely to have been vaccinated because smallpox was officially declared eradicated in 1980 and routine smallpox vaccinations were no longer administered, indicated a generational immunity gap, likely owing to the discontinuation of smallpox vaccination post-1978.

• #1 Development of Smallpox Antibody Testing and Surveillance Following Smallpox Vaccination in the Republic of Korea

  https://www.mdpi.com/2076-393X/12/10/1105

  These observations highlight notable public health concerns, particularly regarding potential smallpox resurgence, as it indicates heightened vulnerability of the younger, unvaccinated population in the event of an outbreak. […] This study has some limitations. First, its focus on a specific population in South Korea may restrict the generalizability of its findings to other regions with different demographics or vaccination histories. […] In conclusion, in this study, we developed and optimized an ELISA method that can effectively detect Orthopoxvirus antibody responses across various population groups.

• #1 Smallpox Biosecurity in a New Era of Technology | Think Global Health

  https://www.thinkglobalhealth.org/article/smallpox-biosecurity-new-era-technology

  When the World Health Assembly declared smallpox eradicated in 1980, many technologies used to study, alter, or create pathogens were new, considered science fiction, or had yet to be imagined. […] To counter risk responsibly, the global community should adopt a proactive approach and collaborate to better detect, respond to, and prevent a potential outbreak or biological attack. […] Even though the World Health Organization has overseen essential research with live variola virus in the United States and Russia, the world continues to debate whether these research samples should be destroyed. […] If the threat of smallpox can arise from more places than secure laboratories, disease surveillance systems will need to become more geographically dispersed and data sharing will need to be strengthened to ensure rapid and accurate identification of suspicious cases. […] Robust public health systems, functioning as the foundation of biosecurity, are essential to harnessing the full potential of emerging biotechnologies and ensuring a future free from the threat of smallpox and, potentially, other infectious diseases that have long plagued humankind.

• #1 From smallpox to mpox: the surprise cost of eradicating a virusverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverified

  https://www.gavi.org/vaccineswork/smallpox-mpox-surprise-cost-eradicating-virus

  The demise of smallpox and rise of mpox are inextricably linked, highlighting the importance of surveillance after eradication. […] Today, mpox is a major problem for global health. Although scientists still believe that stopping smallpox vaccination was the right thing to do, because the first and second-generation vaccines have an unacceptable side-effect profile in the absence of smallpox, they argue that the rise of mpox could provide valuable lessons both on the importance of surveillance and on ensuring valuable skills and infrastructure aren’t lost once a disease no longer poses an imminent threat. […] The rise of mpox could provide valuable lessons both on the importance of surveillance and on ensuring valuable skills and infrastructure aren’t lost once a disease no longer poses an imminent threat.

• #1 From smallpox to mpox: the surprise cost of eradicating a virusverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverifiedverified

  https://www.gavi.org/vaccineswork/smallpox-mpox-surprise-cost-eradicating-virus

  The greater issue has been the lack of investment in surveillance and surveillance systems to be able to identify cases and get in front of outbreaks, rather than chasing behind them. […] A major lesson from the cessation of smallpox vaccination and the rise of mpox is the need for continued surveillance, even once the immediate threat appears to have passed. Ongoing surveillance also means there is a skeleton crew of individuals with the experience and expertise to identify, test for and deploy resources against the pathogen of interest, if it does begin to reemerge, rather than having to retrain everyone from scratch. […] That’s why surveillance is so critical.

• #1 4 Epidemiology | Assessment of Future Scientific Needs for Live Variola Virus | The National Academies Press

  https://nap.nationalacademies.org/read/6445/chapter/8

  If the release exposed persons who were highly mobile, the relatively lengthy incubation period of the infection could enable the infection to spread widely before being identified. […] Individuals infected with variola virus become sick before they are fully infectious to others. […] Although the human-to-human transmission rate of the disease can be high, an individual infected patient did not have numerous close contacts unless he or she was in a large household, a hospital, or some other institution. […] Herd immunity (a large number of immune individuals in the exposed population) limits the spread of diseases transmitted by subclinically infected persons or patients who are fully mobile. […] Given that the disease would probably be transmitted to the second generation of patients before being diagnosed, however, suitable antiviral therapies would be of great value. […] A smallpox outbreak would be a medical emergency. […] The lessons of the past can help us prepare for future smallpox outbreaks.

• #2 Smallpox – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/pox-viruses/smallpox

  No cases of smallpox have occurred in the world since 1977 because of worldwide vaccination. […] Concerns about bioterrorism using smallpox virus from retained research stores or even from synthetically created virus raise the possibility of a recurrence. […] Diagnosis of smallpox is confirmed by documenting the presence of variola DNA by PCR of vesicular or pustular samples. […] Suspected smallpox must be reported immediately to local public health agencies or the CDC at 770-488-7100. […] Treatment of smallpox is generally supportive, with antibiotics for secondary bacterial infections. […] Vaccination with ACAM2000 is dangerous and not recommended for some people, especially those with the following risk factors: weakened immune system, skin disorders, eye inflammation, heart condition, age under 1 year, pregnancy.

• #2 Smallpox: Background, Etiology, Epidemiology

  https://emedicine.medscape.com/article/237229-overview

  Smallpox is an acute, contagious disease caused by the variola virus, a member of the genus Orthopoxvirus, in the Poxviridae family. […] The history of smallpox is remarkable not only because of the spectacular devastation it wreaked upon civilization since the dawn of humankind, but also for the astounding achievement of modern medicine, which eradicated this plague through the concerted efforts of global vaccination. […] The last outbreak of smallpox in the United States was in 1947, when 12 cases were reported in New York City. […] Since 1978, no cases of smallpox have been reported in the world. […] In 1980, the World Health Organization (WHO) officially declared that smallpox had been eradicated. […] Currently, the only remaining known variola virus isolates are frozen in closely guarded repositories at the US Centers for Disease Control and Prevention (CDC) in the United States and at the VECTOR Institute in Russia.

• #2 Smallpox – Epidemiology

  https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/smallpox/

  Smallpox outbreaks occurred for thousands of years, but the disease was eliminated from the world after a successful vaccination campaign. […] The last case of smallpox in the United States was in 1949. The last natural case in the world occurred in Somalia in 1977. […] Because of concern that the variola virus might be used as an agent of bioterrorism, even one case of confirmed smallpox would constitute an international public health emergency. […] The variola virus spreads from person to person through direct contact with respiratory droplets from a cough or sneeze, secretions, or skin lesions of an infected person. […] Smallpox is suspected based on the patient’s clinical signs and symptoms. The disease can be definitively diagnosed by laboratory testing of blood or lesions. […] Vaccination within three days after exposure might prevent or significantly lessen the severity of smallpox symptoms in most people. […] Although it is unlikely, it is possible that the variola virus that causes smallpox could be used as a bioterrorist weapon.

• #2 Speedboat epidemiology: What smallpox teaches us about healthcare today : Short Wave : NPR

  https://www.npr.org/transcripts/1196371558

  Smallpox is a deadly virus. It’s been around for millennia, at least since the third century BC in the Egyptian empire and at one point killed almost 1 in 3 people who had it. In the 20th century alone, there were 300 million deaths, particularly in South America, Asia and Africa. […] And so for basically hundreds of years, people thought it would be impossible to get rid of until smallpox became the first and only human disease to be wiped out globally. […] The World Health Organization first considered eradicating smallpox in the 1950s. Many did not think it could be done, and they thought that they’d have to vaccinate every last person in the world against smallpox to eradicate the disease – really, an impossible task. But early success in West Africa helped pave the way and convince some of those skeptics.

• #2 The World Health Organization and global smallpox eradication | Journal of Epidemiology & Community Health

  https://jech.bmj.com/content/62/10/909

  The global eradication of smallpox was certified by an independent committee of experts in December 1979, and the announcement was ratified by the World Health Organization (WHO) in 1980. […] The WHO’s World Health Assembly (WHA) started considering the prospect of eradicating smallpox worldwide in early 1950 discussions on the topic were held within the WHA that year, and in 1953, 1954 and 1958. […] The relatively small number of WHO officials who started discussing the prospects of global eradication of smallpox in the early 1960s very much hoped that it would be a top-down campaign, wherein the WHO HQ in Geneva and, particularly, some departments within it would be able to set a general campaign agenda. […] The South Asian subcontinent, which was the focus of the global eradication programme in the late 1960s and the 1970s owing to the high incidence of variola in the region, was a good case in point.

• #2 Smallpox – Our World in Data

  https://ourworldindata.org/smallpox

  It was only with the establishment of the World Health Organization (WHO) that international quality standards for the production of smallpox vaccines were introduced. […] By 1959, the World Health Assembly, the governing body of the World Health Organization (WHO), had passed a resolution to eradicate smallpox globally. […] But it was not until 1966, that funding was provided to the „Intensified Smallpox Eradication Program” to increase efforts for smallpox eradication. […] Smallpox’s eradication was greatly spurred by making use of the fact that smallpox transmission occurs via air droplets. […] Initially, the WHO had pursued a strategy of mass vaccination which attempted to vaccinate as many people as possible, hoping that herd immunity would protect the whole population. […] Soon, however, vaccination efforts were targeted locally around smallpox cases, because smallpox was transmitted by sick patients’ air droplets.

• #2 Smallpox – Disease Surveillance Epidemiology Program – MeCDC; DHHS Maine

  https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vaccine/smallpox.shtml

  Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus, and marked by fever and a distinctive progressive skin rash. Prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. […] The majority of patients with smallpox recover, but death may occur in up to 30% of cases. In 1980, the disease was declared eradicated following worldwide vaccination programs. Smallpox can be prevented through use of the smallpox vaccine. […] Smallpox is classified as a Category A agent by the Centers for Disease Control and Prevention. Category A agents are believed to pose the greatest potential threat for adverse public health impact and, broad-based public health preparedness efforts are necessary.

• #2 Smallpox – Wikipedia

  https://en.wikipedia.org/wiki/Smallpox

  Smallpox was an infectious disease caused by Variola virus (often called Smallpox virus), which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) certified the global eradication of the disease in 1980, making smallpox the only human disease to have been eradicated to date. […] The disease was transmitted from one person to another primarily through prolonged face-to-face contact with an infected person or rarely via contaminated objects. Prevention was achieved mainly through the smallpox vaccine. […] The initial problem the WHO team faced was inadequate reporting of smallpox cases, as many cases did not come to the attention of the authorities. The fact that humans are the only reservoir for smallpox infection (the virus only infected humans and not other animals) and that carriers did not exist played a significant role in the eradication of smallpox. The WHO established a network of consultants who assisted countries in setting up surveillance and containment activities.

• #2 Smallpox | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/smallpox/

  Before smallpox was eradicated (eliminated), it was a serious infectious disease caused by the variola virus. It spread from person-to-person and caused a fever and a distinctive skin rash. […] Thanks to the success of vaccination, smallpox was eradicated, and no cases of naturally occurring smallpox have happened since 1977. The last natural outbreak of smallpox in the United States occurred in 1949. […] Before it was eradicated, smallpox spread mainly by direct and prolonged face-to-face contact between people. Smallpox patients became contagious once the first sores appeared in their mouth and throat. They spread the virus when they coughed or sneezed and droplets from their nose or mouth spread to other people. They remained contagious until their last smallpox scab fell off. […] Smallpox can be spread by humans only.

• #2 Mass Vaccination and Surveillance/Containment in the Eradication of Smallpox | SpringerLink

  https://link.springer.com/chapter/10.1007/3-540-36583-4_2

  The Smallpox Eradication Program, initiated by the WHO in 1966, was originally based on mass vaccination. The program emphasized surveillance from the beginning, largely to track the success of the program and further our understanding of the epidemiology of the disease. […] Early observations in West Africa, bolstered by later data from Indonesia and the Asian subcontinent, showed that smallpox did not spread rapidly, and outbreaks could be quickly controlled by isolation of patients and vaccination of their contacts. […] The emphasis therefore shifted to active searches to find cases, coupled with contact tracing, rigorous isolation of patients, and vaccination and surveillance of contacts to contain outbreaks. This shift away from mass vaccination resulted in an acceleration of the programs success.

• #2 Speedboat epidemiology: What smallpox teaches us about healthcare today : Short Wave : NPR

  https://www.npr.org/transcripts/1196371558

  Three words – search and containment. That’s the revolutionary public health strategy that finally started to slow the virus around the world. And it’s what would eventually help eliminate smallpox in Bangladesh in 1975. […] It involves active searches for cases, contact tracing, isolation and vaccination. It also relies a lot on forging partnerships with people who really know the area you’re working in, with someone who understands the community’s needs, culture, terrain. […] Squashing a virus like smallpox requires tactics specific to each community and their worries about the vaccine itself. […] This strategy, literally bringing vaccines and health care to people, works beyond mpox, beyond smallpox.

• #2 Smallpox Facts – MN Dept. of Health

  https://www.health.state.mn.us/diseases/smallpox/smallpox.html

  Characterized by fever and a distinctive type of rash, smallpox was once one of the leading health threats facing the human species. Caused by a virus, smallpox used to kill up to a third of the people who developed the illness. […] However, by 1980, smallpox was effectively eliminated as a public health concern, thanks to a major campaign conducted by the World Health Organization. The last known case – anywhere in the world – was reported in the late 1970s. Since no animals other than humans are known to carry or transmit smallpox, the risk of getting the illness had effectively been reduced to zero. […] Unfortunately, smallpox may not be completely behind us. A few samples of the smallpox virus were kept for laboratory use after the illness was eradicated – and there is now reason to believe that the virus may have been adapted for use as a weapon. The possibility of a smallpox outbreak, caused by a deliberate release of the virus, is now regarded as a real possibility. The likelihood of a terrorist attack using smallpox is thought to be very low. However, the consequences of such an attack – if it did occur – would be very serious.

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