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Smallpox

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Physician’s Guide to Terrorist Attack

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Abstract

Smallpox is a febrile exanthematous illness caused by the variola virus, a member of the Poxviridae family. Smallpox was endemic in developing regions and periodically epidemic worldwide until the late 1970s. It is thought to have had among the greatest impacts on humanity of any infectious disease. The origin of the disease is unknown, but evidence of potential infection dates well back into ancient history. Several Egyptian mummies, including that of Ramses V from the 18th Egyptian Dynasty (16th-14th centuries BC), bear scars suggestive of smallpox (1,2). Smallpox has been proposed as the source of several ancient epidemics, including the Plague of Athens in 430 BC described by Thucydides. Chinese writings from the 4th century AD and Indian writings from some 300 years later confirm the presence of the disease in these regions, although there are suggestions of its presence centuries earlier (1). Smallpox reached its peak in the crowded cities of 18th century Europe, taking 400,000 lives per year and killing five reigning European monarchs (2,3). During this period, 10% of Swedish infants died of smallpox each year, and 10% of all deaths in London were attributable to the disease (2).

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as representing the position of the Department of the Navy or the Department of Defense.

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References

  1. Fenner F, Henderson DA, Arita I, Jezek Z, Ladayi ID. Smallpox and Its Eradication. World Health Organization, Geneva, 1988.

    Google Scholar 

  2. Radetsky M. Smallpox: a history of its rise and fall. Pediatr Infect Dis J 1999;18:85–93.

    Article  PubMed  CAS  Google Scholar 

  3. Dixon CW. Smallpox. J & A Churchill, London, 1962.

    Google Scholar 

  4. Henderson DA, Inglesby TV, Bartlett JG, et al. Smallpox as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA 1999;281:2127–2137.

    Article  PubMed  CAS  Google Scholar 

  5. Gellman B. 4 nations thought to possess smallpox. Washington Post, Washington, DC, November 5, 2002:A01.

    Google Scholar 

  6. Diamond J. Guns, Germs, and Steel: The Fates of Human Societies. WW Norton. New York. 1999.

    Google Scholar 

  7. Breman JG, Henderson DA. Diagnosis and management of smallpox. N Engl J Med 2002;346: 1300–1308.

    Article  PubMed  Google Scholar 

  8. Henderson DA. Smallpox: clinical and epidemiologic features. Emerg Infect Dis 1999;5:537–539.

    Article  PubMed  CAS  Google Scholar 

  9. Anonymous. CDC Smallpox Response Plan and Guidelines. Draft 3.0. U. S. Centers for Disease Control and Prevention, Atlanta, GA, 2002.

    Google Scholar 

  10. Esposito JJ, Obijeski JF, Nakano JH. Orthopoxvirus DNA: strain differentiation by electrophoresis of restriction endonuclease fragmented virion DNA. Virology 1978;89:53–66.

    Article  PubMed  CAS  Google Scholar 

  11. Esposito JJ, Knight JC. Orthopoxvirus DNA: a comparison of restriction profiles and maps. Virology 1985;143:230–251.

    Article  PubMed  CAS  Google Scholar 

  12. Enserink M. Biowarfare. Did bioweapons test cause a deadly smallpox outbreak? Science 2002;296: 2116–2117.

    Article  PubMed  CAS  Google Scholar 

  13. Heiner GG, Fatima N, McCrumb FR Jr. A study of intrafamilial transmission of smallpox. Am J Epidemiol 1971;94:316–326.

    PubMed  CAS  Google Scholar 

  14. Mack TM. Smallpox in Europe, 1950–1971. J Infect Dis 1972;125:161–169.

    Article  PubMed  CAS  Google Scholar 

  15. Thomas DB, McCormack WM, Arita I, Khan MM, Islam S, Mack TM. Endemic smallpox in rural East Pakistan. I. Methodology, clinical and epidemiologic characteristics of cases, and intervillage transmission. Am J Epidemiol 1971;93:361–372.

    PubMed  CAS  Google Scholar 

  16. Moss B. Poxviridae: the viruses and their replication. In: Knipe DM, Howley PM, eds. Fields Virology. Lippincot Williams & Wilkins, Philadelphia, 2001, pp. 2849–2883.

    Google Scholar 

  17. Alcami A, Koszinowski UH. Viral mechanisms of immune evasion. Trends Microbiol 2000;8:410–418.

    Article  PubMed  CAS  Google Scholar 

  18. Esposito JJ, Fenner F. Poxviruses. In: Knipe DM, Howley PM, eds. Fields Virology. Lippincott Williams & Wilkins, Philadelphia, 2001, pp. 2885–2921.

    Google Scholar 

  19. Jahrling PB, Zaucha GM, Huggins JW. Contermeasures to the reemergence of smallpox virus as an agent of bioterrorism. In: Scheld WM, Craig WA, Hughes JM, eds. Emerging Infections 4. ASM Press, Washington, DC, 2000.

    Google Scholar 

  20. Wehrle PF, Posch J, Richter KH, Henderson DA. An airborne outbreak of smallpox in a German hospital and its significance with respect to other recent outbreaks in Europe. Bull WHO 1970;43:669–679.

    PubMed  CAS  Google Scholar 

  21. Downie AW, Saint Vincent L, Meiklejohn M, et al. Studies on the virus content of mouth washings in the acute phase of smallpox. Bull WHO 1961;25:49–53.

    PubMed  CAS  Google Scholar 

  22. Sarkar JK, Mitra AC, Mukherjee MK, De SK. Virus excretion in smallpox. 2. Excretion in the throats of household contacts. Bull WHO 1973;48:523–527.

    PubMed  CAS  Google Scholar 

  23. Downie AW, Meiklejohn M, St Vincent L, Rao AR, Sundara Babu BV, Kempe CH. The recovery of smallpox virus from patients and their environment in a smallpox hospital. Bull WHO 1965;33: 615–622.

    PubMed  CAS  Google Scholar 

  24. Henderson RH, Yekpe M. Smallpox transmission in Southern Dahomey. A study of a village outbreak. Am J Epidemiol 1969;90:423–428.

    PubMed  CAS  Google Scholar 

  25. Thomas DB, Arita I, McCormack WM, Khan MM, Islam S, Mack TM. Endemic smallpox in rural East Pakistan. II. Intervillage transmission and infectiousness. Am J Epidemiol 1971;93:373–383.

    PubMed  CAS  Google Scholar 

  26. Mack T. A different view of smallpox and vaccination. N Engl J Med 2003;348:460–463.

    Article  PubMed  Google Scholar 

  27. Weber DJ, Cohen MS, Fine J. The acutely ill patient with fever and rash. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. Churchill Livingstone, Philadelphia, 2000, pp. 633–650.

    Google Scholar 

  28. Damon I. Smallpox false alarms: lessons for the clinician. Bioterrorism Symposium Presentation, 40th Annual Meeting of the Infectious Diseases Society of America, 2002.

    Google Scholar 

  29. Gubler DJ. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev 1998; 11:480–496.

    PubMed  CAS  Google Scholar 

  30. Jezek Z, Szczeniowski M, Paluku KM, Mutombo M. Human monkeypox: clinical features of 282 patients. J Infect Dis 1987;156:293–298.

    Article  PubMed  CAS  Google Scholar 

  31. McClain DJ. Smallpox. In: Sidell FR, Takafuji ET, Franz DR, eds. Part I: Medical Aspects of Chemical and Biological Warfare. Office of the Surgeon General, U.S. Department of the Army, Washington, DC, 1997, pp. 539–559.

    Google Scholar 

  32. Henderson DA, Moss B. Smallpox and vaccinia. In: Plotkin SA, Orenstein WA, Zorab R, eds. Vaccines. WB Saunders, Philadelphia, 1999.

    Google Scholar 

  33. Anonymous. Dryvax (Smallpox Vaccine, Dried, Calf Lymph Type) Package Insert, vol 2002. Wyeth Laboratories, 2002.

    Google Scholar 

  34. LeDuc JW, Jahrling PB. Strengthening national preparedness for smallpox: an update. Emerg Infect Dis 2001;7:155–157.

    Article  PubMed  CAS  Google Scholar 

  35. Frey SE, Couch RB, Tacket CO, et al. Clinical responses to undiluted and diluted smallpox vaccine. N Engl J Med 2002; 346:1265–1274.

    Article  PubMed  CAS  Google Scholar 

  36. Frey SE, Newman FK, Cruz J, et al. Dose-related effects of smallpox vaccine. N Engl J Med 2002; 346:1275–1280.

    Article  PubMed  CAS  Google Scholar 

  37. Anonymous. HHS awards $428 million contract to produce smallpox vaccine. United States Department of Health and Human Services, Washington, DC, accessed at http://www.hhs.gov/news/press/2001pres/20011128.html, 2001, p. 2.

  38. Anonymous. Acambis reports successfull phase I trial of cell-culture-grown smallpox vaccine. Center for Infectious Disease Research & Policy, Minneapolis, accessed at http://www1.umn.edu/cidrap/content/bt/smallpox.news.acam.html, 2002, p. 1.

  39. Anonymous. Vaccinia (smallpox) vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001. MMWR 2001;50:1–25.

    Google Scholar 

  40. Engler RJM, Kenner J, Leung DYM. Smallpox vaccination: risk considerations for patients with atopic dermatitis. J Allergy Clin Immunol 2002;110:357–365.

    Article  PubMed  CAS  Google Scholar 

  41. Lane JM, Ruben FL, Neff JM, Millar JD. Complications of smallpox vaccination, 1968. N Engl J Med 1969;281:1201–1208.

    Article  PubMed  CAS  Google Scholar 

  42. Bartlett JG. Smallpox vaccination and patients with human immunodeficiency virus infection or acquired immunodeficiency syndrome. Clin Infect Dis 2003;36:468–471.

    Article  PubMed  Google Scholar 

  43. Lane JM, Ruben FL, Neff JM, Millar JD. Complications of smallpox vaccination, 1968: results of ten statewide surveys. J Infect Dis 1970;122:303–309.

    Article  PubMed  CAS  Google Scholar 

  44. Heiner GG, Fatima N, Daniel RW, Cole JL, Anthony RL, McCrumb FR Jr. A study of inapparent infection in smallpox. Am J Epidemiol 1971;94:252–268.

    PubMed  CAS  Google Scholar 

  45. McCarthy K, Downie AW, Bradley WH. The antibody response in man following infection with viruses of the pox group. II. Antibody response following vaccination. J Hygi 1958;56:466–478.

    Article  CAS  Google Scholar 

  46. Moller-Larsen A, Haahr S. Humoral and cell-mediated immune responses in humans before and after revaccination with vaccinia virus. Infect Immun 1978;19:34–39.

    PubMed  CAS  Google Scholar 

  47. Perrin LH, Reynolds D, Zinkernagel R, Oldstone MBA. Generation of virus-specific cytolytic activity in human peripheral lymphocytes after vaccination with vaccinia virus and measles virus. Med Microbiol Immunol 1978;166:71–79.

    Article  PubMed  CAS  Google Scholar 

  48. Demkowicz WE, Littaua RA, Wang J, Ennis FA. Human cytotoxic T-cell memory: long-lived responses to vaccinia virus. J Virol 1996;70:2627–2631.

    PubMed  CAS  Google Scholar 

  49. Geerinck K, Lukito G, Snoeck R, et al. A case of human orf in an immunocompromised patient treated successfully with cidofovir cream. J Med Virol 2001:64:543–549.

    Article  PubMed  CAS  Google Scholar 

  50. De Clercq E. Vaccinia virus inhibitors as a paradigm for the chemotherapy of poxvirus infections. Clin Microbiol Rev 2001;14:382–397.

    Article  PubMed  Google Scholar 

  51. Naesens L, Snoeck R, Andrei G, Balzarini J, Neyts J, De Clercq E. HPMC (cidofovir), PMEA (adefovir) and related acyclic nucleoside phosphonate analogues: a review of their pharmacology and clinical potential in the treatment of viral infections. Antiviral Chem Chemother 1997;8:1–23.

    CAS  Google Scholar 

  52. Plosker GL, Noble S. Cidofovir: a review of its use in cytomegalovirus retinitis in patients with AIDS. Drugs 1999;58:325–345.

    Article  PubMed  CAS  Google Scholar 

  53. Wachsman M, Petty BG, Cundy KC, et al. Pharmacokinetics, safety and bioavailability of HPMPC (cidofovir) in human immunodeficiency virus-infected subjects. Antiviral Res 1996;29:153–161.

    Article  PubMed  CAS  Google Scholar 

  54. Neyts J, De Clercq E. Efficacy of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine for the treatment of lethal vaccinia virus infections in severe combined immune deficiency (SCID) mice. J Med Virol 1993;41:242–246.

    Article  PubMed  CAS  Google Scholar 

  55. Bray M, Martinez M, Smee DF, Kefauver D, Thompson E, Huggins JW. Cidofovir protects mice against lethal aerosol or intranasal cowpox virus challenge. J Infect Dis 2000;181:10–19.

    Article  PubMed  CAS  Google Scholar 

  56. Smee DF, Bailey KW, Wong M, Sidwell RW. Intranasal treatment of cowpox virus respiratory infections in mice with cidofovir. Antiviral Res 2000;47:171–177.

    Article  PubMed  CAS  Google Scholar 

  57. Bray M, Martinez M, Kefauver D, West M, Roy C. Treatment of aerosolized cowpox virus infection in mice with aerosolized cidofovir. Antiviral Res 2002;54:129–142.

    Article  PubMed  CAS  Google Scholar 

  58. Davies EG, Thrasher A, Lacey K, Harper J. Topical cidofovir for severe molluscum contagiosum. Lancet 1999;353:2042.

    Google Scholar 

  59. Meadows KP, Tyring SK, Pavia AT, Rallis TM. Resolution of recalcitrant molluscum contagiosum virus lesions in human immunodeficiency virus-infected patients treated with cidofovir. Arch Dermatol 1997:133:987–990.

    Article  PubMed  CAS  Google Scholar 

  60. Perrillo R, Schiff E, Yoshida E, et al. Adefovir dipivoxil for the treatment of lamivudine-resistant hepatitis B mutants. Hepatology 2000;32:129–134.

    Article  PubMed  CAS  Google Scholar 

  61. Benhamou Y, Bochet M, Thibault V, et al. Safety and efficacy of adefovir dipivoxil in patients co-infected with HIV-1 and lamivudine-resistant hepatitis B virus: an open-label pilot study. Lancet 2001;358:718–723.

    Article  PubMed  CAS  Google Scholar 

  62. Noble S, Goa KL. Adefovir dipivoxil. Drugs 1999;58:479–487; discussion 488–489.

    Article  PubMed  CAS  Google Scholar 

  63. Kucers A, Crowe SM, Grayson ML, Hoy JF. The Use of Antibiotics. Butterworth Heineman, Oxford, 1997.

    Google Scholar 

  64. Smee DF, Huggins JW. Potential of the IMP dehydrogenase inhibitors for intiviral therapies of poxvirus infections. International Society for Antiviral Research. Eleventh International Conference on Antiviral Research, San Diego CA 1995

    Google Scholar 

  65. De Clercq E, Luczak M, Shugar D, Torrence PF, Waters JA, Witkop B. Effect of cytosine arabinoside, iododeoxyuridine, ethyldeoxyuridine, thiocyanatodeoxyuridine, and ribavirin on tail lesion formation in mice infected with vaccinia virus. Proc Soc Fxn Riol Med 1976;151:457–490

    Google Scholar 

  66. Sidwell RW, Allen LB, Khare GP, et al. Effect of 1-b-D-ribofuranosy1–1,2,4-triazole-3-carboxamide (Virazole, ICN 129) on herpes and vaccinia keratitis and encephalitis in laboratory animals. Antimicrob Agents Chemother 1973:3:242–246.

    Article  PubMed  CAS  Google Scholar 

  67. Smee DF, Bailey KW, Sidwell RW. Treatment of cowpox virus respiratory infections in mice with ribavirin as a single agent or followed seauentiallv by cidofovir. Antivir Chem Chemother 2000:11:303–309.

    PubMed  CAS  Google Scholar 

  68. Halloran ME, Longini IM Jr, Nizam A, Yang Y. Containing bioterrorist smallpox. Science 2002;298:1428–1432.

    Article  PubMed  CAS  Google Scholar 

  69. Bozzette SA, Boer R, Bhatnagar V, et al. A model for a smallpox-vaccination policy. N Engl J Med 2003;348:416–425.

    Article  PubMed  Google Scholar 

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Authors
  1. James V. Lawler MD
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  2. Timothy H. Burgess MD, MPH
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Editors and Affiliations

  1. Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Michael J. Roy MD, MPH, FACP

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© 2004 Humana Press Inc., Totowa, NJ

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Lawler, J.V., Burgess, T.H. (2004). Smallpox. In: Roy, M.J. (eds) Physician’s Guide to Terrorist Attack. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-663-8_15

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  • DOI: https://doi.org/10.1007/978-1-59259-663-8_15

  • Publisher Name: Humana Press, Totowa, NJ

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