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Could Smallpox Return?

12/19/2013

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by Denise Croote '16
PictureNot your mama's SpaghettiOs. [image via]
It seems as though the Mayans made a slight miscalculation. In 2012 we narrowly escaped a meteor storm and a black hole to live another day, but we’re definitely not free from danger. Certain dangers we can see and fear, like tornadoes and sandstorms, but other hazards are far less evident.

Viruses are very good at slipping under our radar, mainly because we can’t see them, and only become aware of their presence when they infect our population. Smallpox, an infectious disease responsible for an estimated 300 to 500 million deaths in the 20th century, might just be back to haunt us (1).

When the WHO organization announced the universal eradication of smallpox in 1980, smallpox vaccinations were discontinued in the United States and several other industrialized countries. By 1985, routine vaccinations were eliminated across the globe. This act reduced health care costs, but left us with a population susceptible to a smallpox outbreak (1). 

If the smallpox virus were to fall into the wrong hands, it would be a deadly bio-terror weapon. Our vulnerable population would guarantee the rapid propagation of the disease and to this date there is no known cure. Smallpox begins with a simple fever and quickly proceeds to a systemic rash. The rash develops into firm pustules that eventually crust over and scar. Approximately 30% of those who are infected with smallpox die from the disease. This would undoubtedly result in mass sickness and widespread panic if ever released in the United States (2).  

In an attempt to prevent a bio-terror attack, the Center for Disease Control in Atlanta and the Prevention and the Research Institute for Virus Preparation in Moscow were designated as the official storage centers for the smallpox virus in 1983 (1). However, the likelihood that these two facilities are the only locations currently housing the smallpox virus is very slim. In 1992, shortly after Ken Alibek of Russia disclosed that the Soviet Biologic Weapons Program was conducting smallpox research, several Russian researchers working on a covert smallpox bio-terror program disappeared. Their disappearance was promptly followed by rumors of Iraq, Iran, Syria, and Libya culturing their own smallpox stocks and manipulating the already deadly virus to harbor Ebola as well (1).

If the virus is indeed locked in a freezer in Atlanta or in Moscow, we need not fear it, but in the hands of a terrorist organization, we have reason to be alarmed. This raises the question: Should we start vaccinating citizens again?

Vaccination, however, isn’t an easy solution, especially with a growing portion of our population immune-suppressed. When initially offered, fewer members of the United States population were afflicted with HIV/AIDS. Physicians have indicated that the current smallpox vaccination will overwhelm HIV/AIDS patients’ immune systems, and therefore recommend that if routine vaccinations are to be enacted, those in close contact with immune-suppressed individuals refrain from receiving the vaccination as well. This includes family members, co-workers, teachers, and classmates of HIV/AIDS and cancer patients, among other weakened individuals (1).

Estimating that approximately 20% of our population cannot be vaccinated, this still leaves 80% susceptible and capable of receiving immunization (1). Should we begin routine vaccinations? Not only is the mere cost of vaccinating an issue, but we must also consider the safety of those receiving the vaccine as well as the safety of those around them. Would it be advantageous to be proactive or more practical to develop a rapid vaccination and response plan in the event that we are attacked (2)?

  1. Oldstone MBA. Viruses, Plagues, & History: Past, Present, and Future. New York: Oxford University Press Inc.; 2010. 
  2. Hildreth CJ. “Smallpox,” The Journal of the American Medical Association. 2009; 301(10):1086. doi:10.1001/jama.301.10.1086. 

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