Assessing the Smallpox Threat

LOS ANGELES (Ivanhoe Newswire) -- A smallpox expert writing in this week's New England Journal of Medicine attempts to put the threat of a widespread terrorist attack using smallpox into perspective.

According to Thomas Mack, M.D., M.P.H., from the Keck School of Medicine at the University of Southern California, "Smallpox as a terrorist weapon corresponds more closely to a grenade than to a catastrophic 'dirty' bomb or even a dissemination of anthrax spores."

The virus, he writes, is not nearly as infectious as people may believe. Since the disease causes marked symptoms, infected people can be quickly identified and sequestered, which helps stem transmission. The relatively long interval between exposure to the virus and infection (one to three weeks) also makes it easy for people who have been in contact with an infected person to receive preventive treatment, particularly in economically developed countries where communications are rapid. In the last European outbreaks, for example, smallpox transmission was quickly brought under control, and the disease disappeared within a few months.

Given the limited effect of any attack and the excessive number of deaths that would occur from complications of the vaccine, he suggests a massive campaign to vaccinate the entire population is not warranted. Instead, Dr. Mack recommends a program in which limited numbers of older, previously vaccinated field investigators, law enforcement workers, and health care personnel would be recruited to serve as first responders in any smallpox outbreak. These individuals -- about 15,000 -- would receive the vaccination and then be sent to the site of outbreaks to control further transmission of the disease.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

SOURCE: New England Journal of Medicine, 2003; 348:460-462