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Smallpox Safety and Health Topics:
Smallpox
Smallpox, also called variola virus, is a highly contagious disease unique to humans. To sustain itself, the virus must pass from person to person in a continuing chain of infection by direct contact or inhalation of air droplets or aerosols. Obtaining the smallpox virus is difficult because the virus exists only in two high-security laboratories. However, if obtained and deliberately released, smallpox could cause a public health catastrophe. It is estimated that no more than 20 percent of the population has any immunity from previous vaccination. There is no treatment, and because the disease can be transmitted by air, victims require negative-pressure isolation. Therefore, the limited isolation resources in medical facilities would be easily overwhelmed.

The following commonly asked questions link to resources that provide useful safety and health information about smallpox. Related Safety and Health Topics What is smallpox?
  • Smallpox. Centers for Disease Control and Prevention (CDC). Contains multiple links that address basic facts (Smallpox Overview), symptoms, bioterrorist threat, vaccine recommendations and availability, etc.  
  • WHO Fact Sheet on Smallpox. World Health Organization (WHO) (2001, October). Contains information on history, disease symptoms, prognosis, transmission, treatment, vaccines, and potential outbreaks.   
  • Smallpox Inoculation, Vaccination, Eradication: An Online Exhibit. University of California, Los Angeles Biomedical Library (2000). History, disease effects, inoculation, and discovery of smallpox vaccination.
  • Assessment of Future Scientific Needs for Live Variola Virus. Institute of Medicine, Board on Global Health (1999). Discussion of the need for live variola virus, general orthopoxvirus facts, clinical features of smallpox, epidemiology, history and eradication of smallpox.
Is smallpox a bioterrorist threat?
  • Smallpox as a Biological Weapon. Henderson, D.; Inglesby, T.; and Bartlett, J. et al. (1999, June 9). JAMA 281(22):2127-2137. Focuses on medical and public health aspects of smallpox. Includes information about pathogenesis, clinical presentation, and diagnosis. 
  • Smallpox: An Attack Scenario. O'Toole, T. (1999, July - August). Emerging Infectious Diseases Vol.5, No.4, 12 pages. This article presents a scenario in which a smallpox attack and subsequent epidemic strikes a city of 2.5 million people.
  • Modeling Potential Responses to Smallpox as a Bioterrorist Weapon. Meltzer, M.; Damon, I.; and LeDuc, J. et al. (2001, November - December). Emerging Infectious Diseases Vol. 7, No. 6. A mathematical model describing the spread of smallpox after a deliberate release of the virus.
  • Variola Virus (Smallpox). Texas Department of Health, 2 pages. This page provides information on symptoms, diagnosis and treatment available in the event smallpox virus is used as a bioterrorist weapon.
  • Smallpox and bioterrorism. CDC (2001, April 6), 15 KB PDF, 3 pages. Addresses Smallpox as a biological weapon -- the disease, risk, prevention, and treatment.
How would the medical community respond to a smallpox outbreak?
  • Smallpox: Clinical and Epidemiologic Features. Henderson, D.A. (1999, July - August). Emerging Infectious Diseases, Vol. 5, No. 4. Provides a description of smallpox including its availability and potential consequences if used in a bioterrorist attack.
  • Evaluating Patients for Smallpox. U.S. Department of Health and Human Services (DHHS) (2002, January 31), 1.2 MB PDF, 1 page. This poster describes risks, symptoms, and criteria for smallpox. Includes flow charts and images as well as methods to differentiate from chickenpox.  
  • Aftermath of a Hypothetical Smallpox Disaster. Bardi, J. (1999, July - August). Emerging Infectious Diseases Vol. 5, No. 4. This page presents the responses of four professional panels to different stages of the scenario given in Smallpox: An attack Scenario. This page illustrates the difficulties in making decisions during an epidemic situation.
  • Smallpox Virus (Variola). University of Florida, Medical Microbiology and Infectious Diseases (1999, May 12), 2 pages. Evaluates the smallpox virus, diagnostics, virulence, treatment, and prevention.
  • Smallpox, Medical Aspects of Chemical and Biological Warfare. U.S. Army Medical Nuclear-Biological-Chemical (1997), 114 KB PDF, 21 pages. Chapter 27 of Medical Aspects of Chemical and Biological Warfare. Discusses biology, pathogenesis, diagnosis and medical management of smallpox. 
Historical smallpox outbreaks How can smallpox be prevented or controlled?

Vaccinations
  • OSHA Recordkeeping Requirements for Smallpox Vaccinations. OSHA (2003, May), 3 pages. This document contains answers to frequently asked questions about OSHA's recordkeeping requirements for smallpox vaccinations.
  • Safe Administration of Vaccines - Frequently Asked Questions: OSHA’s Occupational Exposure to Bloodborne Pathogens Standard (29 CFR 1910.1030) and Smallpox Vaccination Programs. OSHA (2003, March), 4 pages.
  • President Delivers Remarks on Smallpox. The White House (2002, December 13), 2 pages. President Bush's comments regarding the threat of a bioterrorist smallpox release and the current vaccination policy. 
  • Smallpox Vaccine Overview. CDC (2002, December 9), 3 pages. Description of vaccine, its protective capacity, method of administration, safety considerations, and vaccine availability. 
  • Vaccine Info Database, Smallpox. National Network for Immunization Information (2003, January 3), 6 pages. Basic smallpox facts as well as information and news related to smallpox vaccines. 
  • Smallpox Response Plan and Guidelines. CDC (2002, November 26). Provides links to documents pertaining to smallpox that will help private and public health-care providers develop plans to prepare for and respond to acts of bioterrorism. Includes the following sections related to vaccination:
    • Guide B - Vaccination Guidelines for State and Local Health Agencies. (2003, February 2). Three-part document, available in Word® or PDF format. Includes: vaccination guidelines, vaccination strategies, indications for vaccination, contraindications for vaccination, reconstitution, administration, and storage of vaccine, recognition of expected vaccine reactions/take, recognition of adverse reactions, indications and guidelines for VIG administration, contingencies for re-sterilization of bifurcated needles.
    • Annex 2 - Guidelines for Smallpox Vaccination Clinics. Available in Word® or PDF format. This document provides detailed guidelines for conducting smallpox vaccination clinics.
    • Annex 3 - Smallpox Vaccination Clinic Guide. (2002, September 16). Available in Word® or PDF format. Logistical considerations and guidance for state and local planning for emergency, large-scale, voluntary administration of smallpox vaccine in response to a smallpox outbreak. Also provides details on all aspects of immunization clinic operations and staffing with an example of a model smallpox vaccination clinic.
    • Annex 4 - Vaccine Adverse-Events Reporting. Addresses vaccine safety: monitoring and reporting of adverse events following smallpox vaccination.
  • Contract to Produce Smallpox Vaccine. U.S. Department of Health and Human Services (DHHS) (2001, November 28). HHS awarded a $428 million contract to produce 155 million doses of smallpox vaccine by the end of 2002. The article also addresses recent experiments with current vaccine stock dilution.
  • Vaccinia (Smallpox) Vaccine, Recommendations of the Advisory Committee on Immunization Practices (ACIP). CDC, Morbidity and Mortality Weekly Report (MMWR) (2001, June 22), 29 pages. Recommendations regarding vaccination of persons working with vaccinia and other Orthopoxviruses as well as in the event of a terrorist-related outbreak. 
  • Recommendations for Using Smallpox Vaccine in a Pre-Event Vaccination Program. CDC, MMWR (2003, February 26), 23 pages. Supplemental Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). This report supplements the 2001 statement by the ACIP (see link above). 
  • Responding to the Threat of Smallpox Bioterrorism: An Ounce of Prevention is Best Approach. de Rugy, V. and Pena, C. (2002, April 18). Cato Institute Policy Analysis 434:1-16. This article argues against the current ring containment strategy for vaccination. Instead, it promotes the notion of making the vaccine available to the public on a voluntary basis. 
Virus Destruction Emergency Response
  • Smallpox Response Plan and Guidelines. CDC (2002, November 26). Provides links to documents pertaining to smallpox that will help private and public health-care providers develop plans to prepare for and respond to acts of bioterrorism.
What additional resources are available?
 
Revised: 25 February 2004
 
 
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