Smallpox still poses a threat
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* H. Roslyn Devlin

Although Erica Weir's recent public health article on smallpox is very informative, it does not actually answer the question posed in the title: Does smallpox still pose a threat?1 As long as there are stockpiles of smallpox in the world, it poses a real, if small, threat. Smallpox could be released into the population as a result of a bioterrorist attack or if one person with access to the stockpile becomes mentally unstable and decides to release the virus. One syringe of this pathogen released into a crowded subway would be sufficient to produce several cases of smallpox. Failure to contain even one of these cases could lead to a chain reaction. 

I am particularly concerned about the well-being of our first responders. Nurses and physicians under 30 years of age have not been vaccinated. Although protective clothing would provide some protection, it would not be fail-safe. In addition, medical staff might use limited barrier precautions while treating patients with difficult-to-diagnose forms of smallpox until the diagnosis is made.2

We require a strategic plan to contain smallpox that would ensure the protection of front-line workers. There is a also a need for more widespread vaccination, possibly with a re-engineered vaccine that has the necessary epitopes to protect without producing toxicity. 

**H. Roslyn Devlin** Medical Microbiologist St. Michael's Hospital Toronto, Ont.

## References

1.  1. Weir E. Does smallpox still pose a threat? CMAJ 2001;165(10):1380.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTY1LzEwLzEzODAiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTY2LzgvMTAxMi4xLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  2. Henderson D, Inglesby T, Bartlett J, Ascher M, Eitzen E, Jahrling P, et al. Smallpox as a biological weapon: medical and public health management. JAMA 1999;281:2127-37.
    
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    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10367824&link_type=MED&atom=%2Fcmaj%2F166%2F8%2F1012.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000080668000036&link_type=ISI)