Smallpox

From: Subject: Smallpox Date: Tue, 19 Nov 2002 19:14:39 +0200 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0085_01C28FFF.E843DFF0"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1106 This is a multi-part message in MIME format. ------=_NextPart_000_0085_01C28FFF.E843DFF0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.hopkins-biodefense.org/pages/agents/agentsmallpox.html Smallpox <= /TABLE> ------=_NextPart_000_0085_01C28FFF.E843DFF0 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://www.hopkins-biodefense.org/images/head_agents.gif R0lGODlhRAJPALMAAAAAALy8vJlMAD4+PpmZmYSEhP///2ZmZubm5iEZEdmMP7CwsMxmAFJSUuKp b9bOyCH5BAQUAP8ALAAAAABEAk8AAAT/EMhJq7046827/2AojmRpnmiqrmzrvnAsf0ISCnOu73zv /8CgcEhMJRi2UKJWbDqf0Kh0Sq26BAzcCJu0er/gsHhM9mK1JAayzG673/B4+7guYevyvH7P7/s/ 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<= FONT=20 size=3D2>Anthrax =B7 Bot= ulinum=20 Toxin =B7 Pl= ague =B7 = Smallpox =B7 Tularemia =B7 VHF

Smallpox

Fact=20 Sheet Info

Smallpox, because of its high case-fatality rates and=20 transmissibility, now represents one of the most serious=20 bioterrorist threats to the civilian population. Over the = centuries,=20 naturally occurring smallpox, with its case-fatality rate of = 30=20 percent or more and its ability to spread in any climate and = season,=20 has been universally feared as the most devastating of all = the=20 infectious diseases.

Smallpox was once worldwide in scope; before vaccination = was=20 practiced almost everyone eventually contracted the disease. = In=20 1980, the World Health Assembly announced that smallpox had = been=20 eradicated and recommended that all countries cease = vaccination.=20 That same year, the Soviet government embarked on an = ambitious=20 program to grow smallpox in large quantities and adapt it = for use in=20 bombs and intercontinental ballistic missiles. That = initiative=20 succeeded.

Russia still possesses an industrial facility that is = capable of=20 producing tons of smallpox virus annually and also maintains = a=20 research program that is thought to be seeking to produce = more=20 virulent and contagious strains.

An aerosol release of smallpox virus would disseminate = readily=20 given its considerable stability in aerosol form and = epidemiological=20 evidence suggesting the infectious dose is very small. Even = as few=20 as 50-100 cases would likely generate widespread concern or = panic=20 and a need to invoke large-scale, perhaps national emergency = control=20 measures.

Several factors fuel the concern: the disease has = historically=20 been feared as one of the most serious of all pestilential = diseases;=20 it is physically disfiguring; it bears a 30 percent = case-fatality=20 rate; there is no treatment; it is communicable from person = to=20 person; and no one in the U.S. has been vaccinated during = the past=20 25 years. Vaccination ceased in this country in 1972, and=20 vaccination immunity acquired before that time has = undoubtedly=20 waned.

Smallpox spreads directly from person to person, = primarily by=20 droplet nuclei expelled from the oropharynx of the infected = person=20 or by aerosol. Natural infection occurs following = implantation of=20 the virus on the oropharyngeal or respiratory mucosa.

Contaminated clothing or bed linen could also spread the = virus.=20 Special precautions need to be taken to insure that all = bedding and=20 clothing of patients are autoclaved. Disinfectants such as=20 hypochlorite and quaternary ammonia should be used for = washing=20 contaminated surfaces.

A smallpox outbreak poses difficult problems because of = the=20 ability of the virus to continue to spread throughout the = population=20 unless checked by vaccination and/or isolation of patients = and their=20 close contacts.

Between the time of an aerosol release of smallpox and = diagnosis=20 of the first cases, an interval of as much as two weeks is = apt to=20 occur. This is because there is an average incubation period = of 12=20 to 14 days.

After the incubation period, the patient experiences high = fever,=20 malaise, and prostration with headache and backache. Severe=20 abdominal pain and delirium are sometimes present. A = mascopapular=20 rash then appears, first on the mucosa of the mouth and = pharynx,=20 face and forearms, spreading to the trunk and legs. Within = one or=20 two days, the rash becomes vesicular and later pustular. The = pustules are characteristically round, tense and deeply = embedded in=20 the dermis; crusts begin to form about the eighth or ninth = day. When=20 the scabs separate, pigment-free skin remains, and = eventually pitted=20 scars form.

Approximately 140,000 vials of vaccine are in storage at = the=20 Centers for Disease Control and Prevention, each with doses = for=20 50-60 people, and an additional 50-100 million doses are = estimated=20 to exist worldwide. This stock cannot be immediately = replenished,=20 since all vaccine production facilities were dismantled = after 1980,=20 and renewed vaccine production is estimated to require at = least=20 24-36 months.

In 2000, CDC awarded a contract to Oravax of Cambridge,=20 Massachusetts to produce smallpox vaccine. Initially = producing 40=20 million doses, Oravax anticipates delivery of the first full = scale=20 production lots in 2004.

Treatment of smallpox is limited to supportive therapy = and=20 antibiotics as required for treating secondary bacterial = infections.=20 There are no proven antiviral agents effective in treating=20 smallpox.

Recommendations of the Working Group include testing and = ultimate=20 consideration for FDA approval of a vaccinia strain grown in = tissue=20 culture rather than on calves, finding a rapid diagnostic = test for=20 smallpox virus in the asymptomatic early stages, and = developing a=20 more attenuated strain of vaccine.

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Copyright =A9 2002 The Johns Hopkins = University=20 on behalf of its Center for Civilian Biodefense Strategies. = All=20 rights reserved.