THE JECH GALLERY

Is smallpox "in" again?

A M Torres Cantero

Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Facultad de Medicina, Campus de Sant Joan 03550 San Juan de Alicante, Spain; atorres{at}umh.es

Keywords: smallpox

The World Health Assembly in 1980 endorsed the eradication of smallpox, as previously certified by a group of respected scientists in December 1979.¹ The last case recorded of naturally occurring smallpox was in Somalia in 1977, although a laboratory accident in the United Kingdom in 1978 produced a fatal case that year. None the less, except for military stockpiles, the world was deemed to be free from the scourge.

Smallpox was causing around 10 million cases and 1.5–2 million deaths in the world every year in the mid-sixties, with costs estimated at US$ 1000 million for developing countries and US$ 350 millions for developed countries for 1967 alone. That same year the Intensified Smallpox Eradication Programme was started. Over the next decade, armed with a thermostable vaccine and mass vaccination and surveillance containment strategies, transmission of the disease was arrested. The overall cost of the eradication was estimated at US$ 97 million for developed countries and about US$ 200 million for the developing countries. After eradication was certified, on-going public health interventions to detect and control the disease ceased. Vaccination was stopped worldwide. The cost of vaccinating the US population alone just for 1967 had been $92.8 million. As a result, savings have been immense.²

The terrorist attacks of 11 September 2001 and others, have now placed smallpox back into the spotlight. Monkeypox³ (another of the orthopoxviruses) with similar clinical presentation in humans to that of smallpox has been sporadic in parts of Africa and responsible for disease outbreaks.⁴ Persons vaccinated against smallpox are protected against monkeypox.

This photograph was taken at a health centre office in Malawi in the mid-90s. At the time, it was like an odd curiosity, a relic of public health history but, unfortunately, smallpox has again become a matter of attention, study, and concern.^5,6 Will it ever be necessary for the poster to be reprinted and distributed?

1. World Health Organisation. http://www.who.int/emc/diseases/smallpox/factsheet.html.
2. Fenner F, Henderson DA, Arita I, et al. Smallpox and its eradication. Geneva: World Health Organisation, 1988.
3. World Health Organisation. http://www.who.int/inf-fs/en/fact161.html.
4. Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtl/mm5227a5.htm.
5. Henderson DA, Inglesby TV, Bartlett JG, et al. for the Working Group on Civilian Biodefense. Smallpox as a biological weapon. JAMA 1999;281:2127–37.[Abstract/Free Full Text]
6. Centers for Disease Control and Prevention. http://www.bt.cdc.gov/agent/smallpox/basics/index.asp.

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