The Coming Small Pox Attacks?
- Dear Friends,
Love and Light.
The Coming Smallpox Attacks
Did anyone order smallpox?
by James Randerson
The smallpox virus last wreaked havoc on the human population in 1977 before a World Health Organisation programme eradicated it from the planet. It now exists only in government laboratories in the US and Russia.
But ordering part of this long-dead pathogen's DNA proved easier than anyone dared imagine. All it took was a invented company name, a mobile phone number, a free email address and a house in north London to receive the order by post.
The investigation makes clear that anyone, without attempting to prove a link to a legitimate research organisation, can order DNA sequences from any potential pathogen without fear of extensive questioning. In our case VH Bio Ltd did not realise it was supplying part of the smallpox genome, but many scientists argue that it is the responsibility of companies selling custom-made pieces of DNA to check their orders for potentially dangerous sequences.
Without modifications that prevented the strand ordered by the Guardian ever forming part of a functional gene, it would probably have fallen foul of the Anti-Terrorism, Crime and Security Act 2001. This lists so-called Schedule 5 pathogens and toxins, including smallpox virus, ebola virus and the plague bacterium. It is illegal to keep or use these, along with any DNA "associated with the pathogenicity of the micro-organism", without first notifying the authorities.
Last November New Scientist magazine surveyed 12 gene synthesis companies in North America and Europe. Only five said they always screened their orders for suspect sequences, and three said they never did. These were all doing relatively large-scale synthesis, providing sequences a few hundred letters long, but there are many more companies such as VH Bio Ltd which make so-called oligonucleotides, sequences around 100 letters or smaller.
Of three UK-based sequencing companies other than VH Bio Ltd canvassed by the Guardian, one did not screen customers or sequences, one carried out checks on customers only, and a third checked customers and had carried out a pilot study on screening DNA orders but is not currently doing so. Screening shorter sequences is more difficult because a chance match to a suspect piece of DNA is more likely. "Because they are short, sequence screening can pick those up, but the false positive rate is high," said Robert Jones at Craic Computing in Seattle, which produces software to screen sequence orders against a database of DNA from nasty pathogens.
The Guardian's investigation has sparked calls for DNA synthesis companies to be better regulated.
Edward Hammond, a biological weapons expert with the Sunshine Project, an NGO that campaigns against the development of biological weapons, said: "The most worrisome thing . . . is that [the field of synthetic biology] is going to enable people to create potentially very dangerous diseases that don't otherwise exist or to re-create ones that have been wiped off the face of the Earth."
The emerging science of synthetic biology holds great potential for medicine and other fields. There are, for example, research projects to develop synthetic bacteria that seek and invade tumour cells, and yeast cells that produce a malaria drug.
Eckard Wimmer at the State University of New York in Stony Brook said the 2002 experiment to make polio virus from scratch by stitching together short strands of DNA was fairly easy. "We did it as a wake-up call," he said. "It's surprising to me, after all these discussions for at least four years, that no more urgent recommendation has gone out to these companies saying that if you don't [carry out more rigorous checks] you may be in trouble," he said.
At a synthetic biology conference in Berkeley, California, last month delegates discussed how to minimise misuse of the technology. Delegates are currently consulting on four "resolutions", which include an effort to develop improved and freely available software tools to screen DNA orders for potentially dangerous sequences and a pledge to "encourage individuals and organisations to avoid patronising companies that do not systematically check their DNA synthesis orders".
But synthetic biologists have defended their efforts to regulate the field. "If scientists are willing to get the ball rolling when few others are acting, then they should be encouraged," said George Church, a leading synthetic biologist at Harvard. He argued that voluntary regulation would be quicker than legislation and would not preclude new laws.
Comment: There have been persistent rumors on the internet that a Muslim group has obtained from a Swiss firm, the ingredients as per this article to manufacture smallpox. There have been no specifics mentioned but the general opinion is that Israel is the prime target with their strong supporters, the United States, running a close second. BH
The Harry Brunser Report: July 3, 2006
Smallpox as a current bio-terror weapon
The Bush Administration has been boasting for nearly five years that their Draconian alterations to the Constitutional laws of the United States, coupled with the brilliance and determination of our intelligence and counter-intelligence agencies such as the DHS, the FBI and various DoD super secret agencies, have prevented further terrorist attacks on the United States.
I regret to say that all of this is nonsense, political hype and very wishful thinking. I have in front of me, précis of three official documents/studies on what is probably the most serious threat ever uttered against the United States. None of these reports, which are from official U.S. intelligence and health agencies, are for public consumption and in point of fact, are all marked extensively that they may not be copied or otherwise disseminated and may not be given to any person not authorized to have them. Therefore, I am giving a summation rather than supplying direct quotes.
Specific mention is made of the American press, to include the New York Times, the Washington Post and the Los Angeles Times, all of whom are suspected of seeking out and publishing government documents that could be considered to be of a danger to American intelligence programs and could cause unnecessary public concern.
Let me say that the subject of this article can be summed up thusly:
Persons or entities deemed to be hostile to the United States, and its allies, have obtained and manufactured smallpox virus which said persons or entities plan to introduce, specifically, into the general populations of both the United States and Israel. This is a direct quote and was published under date of 1 June, 2006.
To commence this study, let us quote from a speech given by the President on December 13, 2002:
President Delivers Remarks on Smallpox
Remarks by the President on Smallpox Vaccination
Dwight D. Eisenhower Executive Office Building
Room 450 Office of the Press Secretary
December 13, 2002
2:12 P.M. EST
THE PRESIDENT: Good afternoon. Since our country was attacked 15 months ago, Americans have been forced to prepare for a variety of threats we hope will never come. We have stepped up security at our ports and borders, we've expanded our ability to detect chemical and biological threats, we've increased support for first responders, we made public -- made our public health care system better able to track and treat disease. By preparing at home and by pursuing enemies abroad, we're adding to the security of our nation. I thank the members of my team who are here who are adding to the security of our nation. One potential danger to America is the use of the smallpox virus as a weapon of terror. Smallpox is a deadly but preventable disease. Most Americans who are 34 or older had a smallpox vaccination when they were children. By 1972, the risk of smallpox was so remote that routine vaccinations were discontinued in the United States. In 1980, the World Health Organization
declared that smallpox had been completely irradiated and, since then, there has not been a single natural case of the disease anywhere in the world.
We know, however, that the smallpox virus still exists in laboratories, and we believe that regimes hostile to the United States may possess this dangerous virus. To protect our citizens in the aftermath of September the 11th, we are evaluating old threats in a new light. Our government has no information that a smallpox attack is imminent. Yet it is prudent to prepare for the possibility that terrorists would kill indiscriminately -- who kill indiscriminately would use diseases as a weapon. .
Now, let me set down the basic reasons for serious concerns about the use of this disease as a bio-terror weapon. This information is current as of 1 June, 2006:
The Central Intelligence Agency has become deeply alarmed about the use of smallpox as a global bio-terrror weapon.. Since 1995, a number of leading American biologists and public-health doctors have been given classified national-security briefings on smallpox. They have been shown classified evidence that as recently as 1992 Russia had the apparent capability of launching strategic-weapons-grade smallpox in special biological warheads on giant SS-18 intercontinental missiles that were targeted on the major cities of the United States. North Korea has previously fired a ballistic missile over Japan in a test, and the missile fell into the sea. Now, it is known, that North Korea is threatening to test fire another missile but with a far longer range. Some knowledgeable observers thought that the missile could have been designed to carry a biologic warhead. If it had carried smallpox and landed in Japan, it could have devastated Japan's population: Japan has almost no
smallpox vaccine on hand and its government seems to have no ability to deal with a biological attack. The United States government keeps a list of nations and groups that it suspects either have clandestine stocks of smallpox or seem to be trying to buy or steal the virus. The list is classified, but includes Russia, China, India, Pakistan, Israel, North Korea, Iraq, Iran, Cuba, and Serbia. The list may also includes the terrorist organization of Osama bin Laden and the Aum Shinrikyo sect of Japan
It was reliably reported in 2003 that a group identified with Osama bin Laden had obtained active samples of smallpox through a contact in a Swiss lab. These few samples were then cultivated and sufficiently altered as to render existing vaccines null and void. This work was done in a laboratory in Pakistan with supplemental work performed in Iran. If a destructive weapon is developed to force concessions from another individual or state, it is necessary to inform said individual or state that such and such a weapon has been developed and to make such demands as the possessors wish. In the present case, the United States, at the highest level, was informed of this developed bio terrorism weapon and negotiations were commenced using third parties as surrogates. Now, it is reliably reported, with the actions of the IDF in Gaza and probably Palestine itself, the possessors of this bio-weapon have unilaterally terminated the talks and there are certain indications that they
might be in a position to implement the release of this genetically-altered disease.
Smallpox (also known by the Latin names Variola or Variola vera) is a highly contagious and generally fatal infectious disease. The name smallpox is derived from the Latin word for spotted and refers to the raised bumps that appear on the face and body of an infected person.
There is no specific treatment for smallpox disease, and the only prevention is vaccination. This disease unique to humans caused by two virus variants called Variola major and Variola minor. V. major is the more deadly form, with a typical mortality of 20-40 percent of those infected. The other type, V. minor, only kills 1% of its victims. Many survivors are left blind in one or both eyes from corneal ulceration, and persistent skin scarring - pockmarks - is nearly universal. Smallpox has been responsible for an estimated 300-500 million deaths in the 20th century. As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease and that two million died in that year Smallpox was once worldwide in scope, and before vaccination was practiced, almost everyone eventually contracted the disease. There were 2 principal forms of the disease, Through the end of the 19th century, variola major predominated throughout the world.
However, at the turn of the century, variola minor was first detected in South Africa and later in Florida, from whence it spread across the United States and into Latin America and Europe. Smallpox spreads from person to person, primarily by droplet nuclei or aerosols expelled from the oropharynx of infected persons and by direct contact. Contaminated clothing or bed linens can also spread the virus. There are no known animal or insect reservoirs or vectors. There is at present heightened concern that the variola virus might be used as an agent of bioterrorism. For this reason, the U.S. government has been attempting to take precautions for dealing with a smallpox outbreak;
Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Humans are the only natural hosts of variola. Smallpox is not known to be transmitted by insects or animals.
A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person becomes most contagious with the onset of rash. At this stage the infected person is usually very sick and not able to move around in the community. The infected person is contagious until the last smallpox scab falls off.
Smallpox may be contagious during the prodrome phase, but is most infectious during the first 7 to 10 days following rash onset.
Historically, the rapidity of smallpox transmission throughout the population was generally slower than for such diseases as measles or chickenpox. Patients spread smallpox primarily to household members and friends; large outbreaks in schools, for example, were uncommon. This finding was accounted for in part by the fact that transmission of smallpox virus did not occur until onset of rash. By then, many patients had been confined to bed because of the high fever and malaise of the prodromal illness. Secondary cases were thus usually restricted to those who came into contact with patients, usually in the household or hospital.
The patient was most infectious from onset of rash through the first 7 to 10 days of rash. As scabs formed, infectivity waned rapidly. Although the scabs contained large amounts of viable virus, epidemiological and laboratory studies indicate that they were not especially infectious, presumably because the virions were bound tightly in the fibrin matrix.
Natural infection occurs following implantation of the virus on the oropharyngeal or respiratory mucosa. The infectious dose is unknown but is believed to be only a few virions. After the migration of virus to and multiplication in regional lymph nodes, an asymptomatic viremia develops on about the third or fourth day, followed by multiplication of virus in the spleen, bone marrow, and lymph nodes. A secondary viremia begins on about the eighth day and is followed by fever and toxemia. The virus, contained in leukocytes, then localizes in small blood vessels of the dermis and beneath the oral and pharyngeal mucosa and subsequently infects adjacent cells.
At the end of the 12- to 14-day incubation period (range, 7-17 days), the patient typically experiences high fever, malaise, and prostration with headache and backache. Severe abdominal pain and delirium are sometimes present. A maculopapular rash then appears on the mucosa of the mouth and pharynx, face, and forearms, and spreads to the trunk and legs. Within 1 to 2 days, the rash becomes vesicular and, later, pustular. The pustules are characteristically round, tense, and deeply embedded in the dermis; crusts begin to form on about the eighth or ninth day of rash. As the patient recovers, the scabs separate and characteristic pitted scarring gradually develops. The scars are most evident on the face and result from the destruction of sebaceous glands followed by shrinking of granulation tissue and fibrosis.
The lesions that first appear in the mouth and pharynx ulcerate quickly because of the absence of a stratum corneum, releasing large amounts of virus into the saliva.Virus titers in saliva are highest during the first week of illness, corresponding with the period during which patients are most infectious. Although the virus in some instances can be detected in swabs taken from the oropharynx as many as 5 to 6 days before the rash develops, transmission does not occur during this period.
Except for the lesions in the skin and mucous membranes and reticulum cell hyperplasia, other organs are seldom involved. Secondary bacterial infection is not common, and death, which usually occurs during the second week of illness, most likely results from the toxemia associated with circulating immune complexes and soluble variola antigens. Encephalitis sometimes ensues that is indistinguishable from the acute perivascular demyelination observed as a complication of infection due to vaccinia, measles, or varicella.
Neutralizing antibodies can be detected by the sixth day of rash and remain at high titers for many years. Hemagglutinin-inhibiting antibodies can be detected on about the sixth day of rash, or about 21 days after infection, and complement-fixing antibodies appear approximately 2 days later. Within 5 years, hemagglutinin-inhibiting antibodies decline to low levels and complement-fixing antibodies rarely persist for longer than 6 months.
Although at least 90% of smallpox cases are clinically characteristic and readily diagnosed in endemic areas, other forms of smallpox are difficult to recognizehemorrhagic and malignant. Hemorrhagic cases are uniformly fatal and occur among all ages and in both sexes, but pregnant women appear to be unusually susceptible. Illness usually begins with a somewhat shorter incubation period and is characterized by a severely prostrating prodromal illness with high fever and head, back, and abdominal pain. Soon thereafter, a dusky erythema develops, followed by petechiae and frank hemorrhages into the skin and mucous membranes. Death usually occurs by the fifth or sixth day after onset of rash.
In the frequently fatal malignant form, the abrupt onset and prostrating constitutional symptoms are similar. The confluent lesions develop slowly, never progressing to the pustular stage but remaining soft, flattened, and velvety to the touch. The skin has the appearance of a fine-grained, reddish-colored crepe rubber, sometimes with hemorrhages. If the patient survives, the lesions gradually disappear without forming scabs or, in severe cases, large amounts of epidermis might peel away.
The illness associated with variola minor is generally less severe, with fewer constitutional symptoms and a more sparse rash. A milder form of disease is also seen among those who have residual immunity from previous vaccination. In partially immune persons, the rash tends to be atypical and more scant and the evolution of the lesions more rapid.
There is little information about how individuals with different types of immune deficiency responded to natural smallpox infection. Smallpox was eradicated before human immunodeficiency virus (HIV) was identified and before suitable techniques became available for measuring cell-mediated immunity. However, it is probable that the underlying cause of some cases of malignant and hemorrhagic smallpox resulted from defective immune responses. Vaccination of immune-deficient persons sometimes resulted in a continually spreading primary lesion, persistent viremia, and secondary viral infection of many organs. One such case is documented to have occurred in a vaccinated soldier who had HIV infection.
The discovery of a single suspected case of smallpox must be treated as an international health emergency and be brought immediately to the attention of national officials through local and state health authorities.
A smallpox outbreak poses difficult public health problems because of the ability of the virus to continue to spread throughout the population unless checked by vaccination and/or isolation of patients and their close contacts.
Five groups of persons are ordinarily considered at special risk of smallpox vaccine complications:
(1) persons with eczema or other significant exfoliative skin conditions;
(2) patients with leukemia, lymphoma, or generalized malignancy who are receiving therapy with alkylating agents, antimetabolites, radiation, or large doses of corticosteroids;
(3) patients with HIV infection;
(4) persons with hereditary immune deficiency disorders; and pregnant women.
(5) If persons with contraindications have been in close contact with a smallpox patient or the individual is at risk for occupational reasons, VIG, if available, may be given simultaneously with vaccination in a dose of 0.3 mL/kg of body weight to prevent complications. This does not alter vaccine efficacy. If VIG is not available, vaccine administration may still be warranted, given the far higher risk of an adverse outcome from smallpox infection than from vaccination.
Edward Jenner developed a smallpox vaccine by using cowpox fluid (hence the name vaccination, from the Latin vaca, cow); his first inoculation occurred on May 14, 1796. After independent confirmation, this practice of vaccination against smallpox spread quickly in Europe. The first smallpox vaccination in North America occurred on June 2, 1800. National laws requiring vaccination began appearing as early as 1805. The last case of wild smallpox occurred on September 11th, 1977. One last victim was claimed by the disease in the UK in September 1978, when Janet Parker, a photographer in the University of Birmingham Medical School, contracted the disease and died. A research project on smallpox was being conducted in the building at the time, though the exact route by which Ms. Parker became infected was never fully elucidated. After successful vaccination campaigns, the WHO in 1980 declared the eradication of smallpox, though cultures of the virus are kept by the Centers for
Disease Control and Prevention (CDC) in the United States, in Russia, and Switzrland.
Smallpox vaccination was discontinued in most countries in the 1970s as the risks of vaccination include death (~1 per million), among other serious side effects. Nonetheless, after the 2001 anthrax attacks took place in the United States, concerns about smallpox have resurfaced as a possible agent for bioterrorism. As a result, there has been increased concern about the availability of vaccine stocks.
Moreover, the President of the United States has ordered all American military personnel to be vaccinated against smallpox and has implemented a voluntary program for vaccinating emergency medical personnel who would likely be the first people to respond in case of a bioterrorist attack
Unfortunately, it has been disclosed, both by the CDC and the WHO, that this specific vaccine, used to innoculate members of the U.S. military and senior members of the United States government, has degenerated and is no longer considered to be effective as a preventative measure.
In the United States, a limited reserve supply of vaccine that was produced by Wyeth Laboratories, Lancaster, Pa, in the 1970s is in storage. This supply is believed to be sufficient to vaccinate between 6 and 7 million persons. This vaccine, now under the control of the CDC, consists of vaccine virus (New York Board of Health strain) grown on scarified calves. After purification, it was freeze-dried in rubber-stoppered vials that contain sufficient vaccine for at least 50 doses when a bifurcated needle is used. It is stored at -20°C (James LeDuc, PhD, oral communication, 1998). Although quantities of vaccine have also been retained by a number of other countries, none have reserves large enough to meet more than their own potential emergency needs. WHO has had 500,000 doses on hand but these have now been proven to be useless.
There are no manufacturers now equipped to produce smallpox vaccine in large quantities. The development and licensure of a tissue cell culture vaccine and the establishment of a new vaccine production facility is estimated to require at least 36 months Because of the small amounts of vaccine available, a preventive vaccination program to protect individuals such as emergency and health care personnel is not an option at this time. When additional supplies of vaccine are procured, a decision to undertake preventive vaccination of some portion of the population will have to weigh the relative risk of vaccination complications against the threat of contracting smallpox.
A further deterrent to extensive vaccination is the fact that presently available supplies of vaccinia immune globulin (VIG), also maintained by the CDC, are very limited in quantity. The working group recommends VIG for the treatment of severe cutaneous reactions occurring as a complication of vaccination. Vaccinia immune globulin has also been given along with vaccination to protect those who needed vaccination but who were at risk of experiencing vaccine-related complications. It has been estimated that if 1 million persons were vaccinated, as many as 250 persons would experience adverse reactions of a type that would require administration of VIG How much VIG would be needed to administer with vaccine to those at risk is unknown.
The Department of Health and Human Services (H.H.S.) has been given the responsibility by the White House for producing a stockpile of smallpox vaccine large enough to protect the American civilian population in case of a bioterror event; originally, the idea was for H.H.S. to consider hiring the military's contractor, Dynport, to make forty million extra doses, in addition to the three hundred thousand that Dynport was making for the Pentagon. (Any such initiative would require competitive bidding and the current Administration is opposed to competitive bidding, preferring, instead, to give lucrative contracts to political supporters.)
At a series of meetings at H.H.S., a top Dynport executive said that forty million doses could be quite expensive. One scientist asked if a group of knowledgeable people could be drawn together to come up with an estimate of costs. The Dynport man answered, "Yes, we can do a study that will list the questions that need to be asked. It will cost two hundred and forty thousand dollars and will take six weeks."
The C.E.O. of Dynport, Stephen Prior, said that the situation is more complicated. The civilian population is very different from the military. There's an age spread from newborns to the elderly, there's more compromised immunity, with AIDS, chemotherapy, and organ transplants. And possibly thirty-five per cent of people have never been vaccinated. So it's not just scaling up the manufacturing.
Until recently, the United States' national stockpile of smallpox vaccine is a collection of four cardboard boxes that sit on a single pallet behind a chain-link fence inside a walk-in freezer in a warehouse in Lancaster County, Pennsylvania, near the Susquehanna River, at a facility owned by Wyeth-Ayerst Laboratories. The vaccine has almost totally deteriorated until it is useless for immunization purposes.. The Food and Drug Administration has put a hold on this smallpox vaccine, and presently, no one can use it -- not even emergency personnel or key government leaders.
The vaccine is owned by the federal government and is managed by Wyeth-Ayerst, which is the company that made it, twenty-five to thirty years ago. It is stored in glass vials. The vials contain freeze-dried nuggets of live vaccinia virus. Vaccinia is a mild virus. When you are infected with it by vaccination, it causes a pustule to appear, and afterward you are immune to smallpox for some years. People who have been vaccinated have a circular scar the size of a nickel on their upper arm, left by the vaccinia-virus pustule they had in childhood after vaccination. Some adults can remember how much the pustule hurt.
The vials once held fifteen million good doses, but now they are totally worthless.
:If there's a bioterror event, and someone releases enough smallpox to create a hundred cases it would be a national emergency. The demand for vaccine would be beyond all belief. In Yugoslavia in 1972, the outbreak was started by one man, and eighteen million doses of vaccine were needed -- one for almost every person in the country.
Newly developed antidotes and their storage at St. Michaels, Md.
Once it was discovered that the existing examples of smallpox vaccine was badly deteriorated due to age and poor storage conditions, there was an urgent demand for more and effective vaccine to be produced. The national leadership, including the President, Vice President, Secretary of Defense and their families and supporters were on the primary vaccination list, followed by key members of Congress, the government and most especially, U.S. military and civilian medical personnel. As of 1 June, 2006, only 10, 000 effective smallpox vaccine doses have been produced. They are currently stored on the properties of the Vice President and the Secretary of Defense, located at St. Michaels in Maryland. This is a small, upscale former fishing town on the Chesapeake Bay about 45 miles east of Washington, accessible via U.S. 50 and Maryland Rte 33. The top leadership, as indicated, has already been vaccinated but at the present time, there is insufficient vaccine to cover the U.S.
military and medical personnel, and certainly nothing for the rest of the population of the United States. (See the link for a map of the areas in question. Ed.)
Smallpox as a bioterror weapon
Smallpox probably was first used as a biological weapon during the French and Indian Wars (1754-1767) by British forces in North America. Soldiers distributed blankets that had been used by smallpox patients with the intent of initiating outbreaks among American Indians. Epidemics occurred, killing more than 50% of many affected tribes. With Edward Jenner's demonstration in 1796 that an infection caused by cowpox protected against smallpox and the rapid diffusion worldwide of the practice of cowpox inoculation (ie, vaccination), the potential threat of smallpox as a bioweapon was greatly diminished. A global campaign, begun in 1967 under the aegis of the World Health Organization (WHO), succeeded in eradicating smallpox in 1977.In 1980, the World Health Assembly recommended that all countries cease vaccination. A WHO expert committee recommended that all laboratories destroy their stocks of variola virus or transfer them to 1 of 2 WHO reference laboratoriesthe Institute
of Virus Preparations in Moscow, Russia, or the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga. All countries reported compliance. The WHO committee later recommended that all virus stocks be destroyed in June 1999, and the 1996 World Health Assembly concurred. In 1998, possible research uses for variola virus were reviewed by a committee of the Institute of Medicine (IOM). The IOM committee concluded, as did the preceding WHO committee, that there were research questions that might be addressed if the virus were to be retained. However, the IOM committee did not explore the costs or relative priority to be assigned to such an effort, and that committee was not asked to weigh the possible benefits resulting from such research activities contrasted with the possible benefits resulting from an international decision to destroy all virus stocks.
The deliberate reintroduction of smallpox as an epidemic disease would be an international crime of unprecedented proportions, but it is now regarded as a probability. An aerosol release of variola virus would disseminate widely, given the considerable stability of the orthopoxviruses in aerosol form and the likelihood that the infectious dose is very small. .Moreover, during the 1960s and 1970s in Europe, when smallpox was imported during the December to April period of high transmission, as many as 10 to 20 second-generation cases were often infected from a single case. Widespread concern and, sometimes, panic occurred, even with outbreaks of fewer than 100 cases, resulting in extensive emergency control measures.
A clandestine aerosol release of smallpox, even if it infected only 50 to 100 persons to produce the first generation of cases, would rapidly spread in a now highly susceptible population, expanding by a factor of 10 to 20 times or more with each generation of cases. Between the time of an aerosol release of smallpox virus and diagnosis of the first cases, an interval as long as 2 weeks or more is apt to occur because of the average incubation period of 12 to 14 days and the lapse of several additional days before a rash was sufficiently distinct to suggest the diagnosis of smallpox. By that time, there would be no risk of further environmental exposure from the original aerosol release because the virus is fully inactivated within 2 days.
As soon as the diagnosis of smallpox is made, all individuals in whom smallpox is suspected should be isolated immediately and all household and other face-to-face contacts should be vaccinated and placed under surveillance. Because the widespread dissemination of smallpox virus by aerosol poses a serious threat in hospitals, patients should be isolated in the home or other non-hospital facility whenever possible. Home care for most patients is a reasonable approach, given the fact that little can be done for a patient other than to offer supportive therapy. In the event of an aerosol release of smallpox and a subsequent outbreak, the rationale for vaccinating patients suspected to have smallpox at this time is to ensure that some with a mistaken diagnosis are not placed at risk of acquiring smallpox. Vaccination administered within the first few days after exposure and perhaps as late as 4 days may prevent or significantly ameliorate subsequent illness. An emergency
vaccination program is also indicated that would include all health care workers at clinics or hospitals that might receive patients; all other essential disaster response personnel, such as police, firefighters, transit workers, public health staff, and emergency management staff; and mortuary staff who might have to handle bodies. The working group recommends that all such personnel for whom vaccination is not contraindicated should be vaccinated immediately irrespective of prior vaccination status.
Isolation of all contacts of exposed patients would be logistically difficult and, in practice, should not be necessary. Because contacts, even if infected, are not contagious until onset of rash, a practical strategy calls for all contacts to have temperatures checked at least once each day, preferably in the evening. Any increase in temperature higher than 38°C (101°F) during the 17-day period following last exposure to the case would suggest the possible development of smallpox2 and be cause for isolating the patient immediately, preferably at home, until it could be determined clinically and/or by laboratory examination whether the contact had smallpox. All close contacts of the patients should be promptly vaccinated.
Although cooperation by most patients and contacts in observing isolation could be ensured through counseling and persuasion, there may be some for whom forcible quarantine will be required. Some states and cities in the United States, but not all, confer broad discretionary powers on health authorities to ensure the safety of the public's health and, at one time, this included powers to quarantine. Under epidemic circumstances, this could be an important power to have. Thus, each state and city should review its statutes as part of its preparedness activities.
It should be noted that the US vaccine supply is limited at present; and reported to be generally ineffective due to deterioration thus, effective vaccine would have to be carefully conserved and used in conjunction with measures to implement rapid isolation of smallpox patients
Patients who die of smallpox should be immediately cremated whenever possible, their clothing and bedding burnt and mortuary workers should be vaccinated
Smallpox is explosively contagious, and it travels through the air. Virus particles in the mouth become airborne when the host talks. If you inhale a single particle of smallpox, you can come down with the disease. After you've been infected, there is a typical incubation period of ten days. During that time, you feel normal. Then the illness hits with a spike of fever, a backache, and vomiting, and a bit later tiny red spots appear all over the body. The spots turn into blisters, called pustules, and the pustules enlarge, filling with pressurized opalescent pus. The eruption of pustules is sometimes called the splitting of the dermis. The skin doesn't break, but splits horizontally, tearing away from its underlayers. The pustules become hard, bloated sacs the size of peas, encasing the body with pus, and the skin resembles a cobbled stone street.
The pain of the splitting is extraordinary. People lose the ability to speak, and their eyes can squeeze shut with pustules, but they remain alert. Death comes with a breathing arrest or a heart attack or shock or an immune-system storm, though exactly how smallpox kills a person is not known.. Since the seventeenth century, doctors have understood that if the pustules merge into sheets across the body the victim will usually die: the virus has split the whole skin. If the victim survives, the pustules turn into scabs and fall off, leaving scars. This is known as ordinary smallpox.
Some people develop extreme smallpox, which is loosely called black pox. Doctors separate black pox into two forms -- flat smallpox and hemorrhagic smallpox. In a case of flat smallpox, the skin remains smooth and doesn't pustulate, but it darkens until it looks charred, and it can slip off the body in sheets. In hemorrhagic smallpox, black, unclotted blood oozes or runs from the mouth and other body orifices. Black pox is close to a hundred per cent fatal. If any sign of it appears in the body, the victim will almost certainly die. In the bloody cases, the virus destroys the linings of the throat, the stomach, the intestines, the rectum, and the vagina, and these membranes disintegrate. Fatal smallpox can destroy the body's entire skin -- both the exterior skin and the interior skin that lines the passages of the body.
Most people today have no immunity to smallpox. The vaccine begins to wear off in many people after ten years. Mass vaccination for smallpox came to a worldwide halt around twenty-five years ago. There is now very little smallpox vaccine on hand in the United States or anywhere else in the world. The World Health Organization once had ten million doses of the vaccine in storage in Geneva, Switzerland, but in 1990 an advisory committee recommended that most of it be destroyed, feeling that smallpox was longer a threat. Nine and a half million doses are assumed to have been cooked in an oven, leaving the W.H.O. with a total supply of half a million doses -- one dose of smallpox vaccine for every twelve thousand people on earth. A recent survey by the W.H.O. revealed that there is only one factory in the world that has recently made even a small quantity of the vaccine, and there may be no factory capable of making sizable amounts.
Variola virus is now classified as a Biosafety Level 4 hot agent -- the most dangerous kind of virus -- because it is lethal, airborne, and highly contagious, and is now exotic to the human species, and there is not enough vaccine to stop an outbreak. Experts feel that the appearance of a single case of smallpox anywhere on earth would be a global medical emergency.
At the present time, smallpox lives officially in only three repositories on the planet. One repository is in the United States, in a freezer at the headquarters of the federal Centers for Disease Control and Prevention, in Atlanta -- the C.D.C. Another official smallpox repository is in a freezer at a Russian virology institute called Vector, also known as the State Research Institute of Virology and Biotechnology, which is situated outside the city of Novosibirsk, in Siberia. A third repository has been in a medical research facility in Switzerland.
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