Smallpox

With the recent bioterrorist attacks on the U.S. involving anthrax, people are naturally concerned about other diseases being used as weapons. One such disease is smallpox. Here is a brief overview of this disease to help you understand how to recognize the symptoms, how it is diagnosed, why it is unlikely to even be used as a weapon, and why we cannot yet begin a mass vaccination program to protect against it.

WHY SMALLPOX IS UNLIKELY TO BE USED AS A WEAPON
The last reported case of smallpox virus was in Africa in 1977. Since that time, the virus has been kept in only a handful of research labs around the world. It is guarded by the highest possible security. The virus is handled under the most extreme sterile, protective environments only. Researchers working with the vaccine wear space-suit type gear and work in rooms sealed by airlocks (just like in the movies).

In order to grow smallpox and manufacture it into a usable weapon capable of being targeted at a city or country, a terrorist organization would need to have full access to a state-of-the-art multi-million dollar laboratory facility in order to synthesize the weapon. Anyone trying to do so under less-than-perfect conditions would probably contaminate themselves and all those around them.

SYMPTOMS OF SMALLPOX
The virus invades the lung tissue. It multiplies and then moves into the bloodstream. The incubation period (time from exposure to time of first symptoms) is 1 to 2 weeks. The first symptoms look like any other flu: fever, chills, headache, and general body aches and pains. Some will experience delirium and occasionally seizures. Some people will show a mild lacy or bumpy rash for one or two days on the abdomen, lower back, and upper thighs. These early symptoms usually last 2 to 4 days.

The classic smallpox rash begins as the above symptoms subside. It starts on the face and forearms, moves quickly to the upper arms and trunk, then finally extends down to include the legs. Note that these bumps move from the outer portions of the body into the center. This is different from chickenpox, which starts in the center, then moves to the outer portions of the body.

The rash starts as small spots, but within a matter of hours change into a bump that you can feel. Over the next day or two they form a blister, surrounded by a red halo. One to three days later the blisters begin to fill with pus and become slightly larger and intensely painful. At this time, all the initial flu-like symptoms begin to return. The pus-filled blisters then rupture and form crusts. These lesions can also appear in the mouth, throat, nose, airway, esophagus and vagina. The fatality rate is around 35%.

DIAGNOSING SMALLPOXL
Both blood and scrapings from the lesions can be tested for smallpox.

TREATING SMALLPOX
There is no really effective treatment except to support any serious complications that arise.

HOW IS SMALLPOX TRANSMITTED?
It is contagious in a manner similar to chicken pox - close contact or proximity for an extended period of time. An infected person is contagious at any time from the beginning flu symptoms all the way through to the end of the illness.

SMALLPOX VACCINE
This vaccine was used in the U.S. until 1973. At that time, smallpox was determined to be eradicated from the U.S. and the vaccine was no longer necessary. Most of us older than 30 have the little dime-sized scar on our shoulder from the vaccine.

So why can't we just begin vaccinating everyone again in order to protect out nation?

There are several reasons:

1. The older vaccine was very reactive and caused numerous uncomfortable side effects. The injection site became easily infected. Children would often rub the irritated site and then rub the vaccine into their eyes, which caused very uncomfortable eye infections. Occasionally, people would get actual smallpox lesions from spreading the vaccine liquid by itching and rubbing.
2. One of the last smallpox outbreaks in the U.S. occurred in New York City in 1947. There were 12 cases, which resulted in 2 deaths. 6 million New Yorkers got the vaccine at that time, and unfortunately 6 people died from reactions to the vaccine.
3. The risk that smallpox will be used against us is so minute that it does not make good sense to vaccinate everyone now, especially because doing so would cause some fatalities from the vaccination alone.
4. The vaccine is not available to the general public. Even if you ask your doctor to vaccinate you, he or she cannot even order the vaccine.
5. Companies are working to produce more of the vaccine in order to meet demand in the event of an outbreak.

WHAT SHOULD PEOPLE DO RIGHT NOW ABOUT THE THREAT OF SMALLPOX?
There really isn't anything you can do right now. Stay informed by watching or reading legitimate news programming. In the event of an outbreak or attack, the U.S. government does have the vaccine available for immediate use. If given within 3 days of exposure, the vaccine is very effective in preventing the disease.

The CDC and the U.S. government are currently deciding on what strategies are best to counteract any smallpox attacks. Stay informed.