Smallpox, a viral disease unique to humans, is historically the most devastating of all viruses, specifically if it was to be used as a biological weapon. The potential of smallpox being used in biological warfare is extreme and the results would be devastating. These fears are fuelled by many factors. Previously, smallpox has been the most serious of all pestilential diseases. It is highly contagious and corporally disfiguring. Smallpox can be contracted through airborne aerosols and through exposure to a contagious patient or their contaminated linens. It can be transmitted in any climate, during any time of year, throughout the world. The only treatment after infection is an immediate administration of the vaccine, within two to three days. However, no symptoms of the disease occur until the incubation stage of the virus is complete, one to three weeks, making this treatment hard to administer. Common smallpox, Variola major, bears a 30 percent fatality rate. However, hemorrhagic and malignant strains of the virus exist which carry 99-100 percent death rates. Furthermore, the world is highly unprepared for an outbreak since regular vaccinations ceased completely in the 1980’s. It is not known exactly how much vaccination is in existence today; however, all vaccine production facilities were dismantled after 1980. Finally, recent terrorist attacks on the United States and the fact that stores of the virus still exist in the United States and Russia creates great concern of the possibility of biological warfare.

Outbreaks of smallpox in Europe dramatically illustrate the potential of smallpox as a biological weapon. The first outbreak, in 1970 in Meschede, Germany, illustrates how smallpox can spread quickly and widely in an aerosol environment at very low doses. In February of 1972, Yugoslavia suffered an outbreak where one case infected 11 others. On average, these patients each infected 13 more. Other outbreaks in Europe show that this explosive spread in not unusual, especially during seasonal periods of high transmission, from December through April. Thus, imagine the impact smallpox would have on our country where no one younger than 25 years has ever been vaccinated and those older, that have been vaccinated, have little residual immunity remaining.

Previously, it was mentioned that stocks of the virus still exist in the Unites States and in Russia. It was once thought that only two high security laboratories in these locations stored the virus. However, alarming speculations state otherwise. Positively, the Centers for Disease Control and Prevention in Atlanta, Georgia, and the Russian State Centre for Research on Virology and Biotechnology in Koltsovo, Novosibirsk Region hold stores of the virus. The latter facility is thought to be financially troubled. Also, it is thought that other facilities in Russia, and possibly the Middle East, may store or produce the virus. Officials of the former Soviet Union took notice of the world’s decision to cease vaccination in the 1980’s, and fuelled by a Cold War mentality, embarked on an ambitious plan to produce large quantities of smallpox for use as a weapon. At least two other laboratories in Russia are now reported to maintain smallpox virus, and one may have the capacity to produce large amounts of the virus, quickly. Moreover, unemployed Russian scientists have the opportunity to earn much profit by selling their services to rogue governments. It is also thought that Russia maintains a research program aimed at producing more virulent and contagious strains of smallpox. The threat of bio-terrorism has long been ignored and denied. The only definite way to prepare for a biological war, besides manufacturing and stockpiling vaccines, is to educate the public. It is necessary to inform the public of the symptoms, as well as the stages, of smallpox.

To begin with, the smallpox virus is passed from person to person, sustaining itself through a continued chain of infection. After contracting the disease, a patient goes through an incubation period devoid of symptoms. The virus is not contagious at this point, yet the lack of symptoms means the infected person may not know they have contracted the disease until it is too late. If vaccine is administered within three days of contracting the disease, the patient may be free from further symptoms or illness. However, if given within five days of contraction, the patient will definitely undergo the rash but avoid death. After about 12 days the first symptoms occur; however they may occur anywhere from 7-17 days after the initial contraction. By this time treatment is obsolete and the patient has no choice but to let the virus run its course. The first symptoms include severe aches, pains, fever, and possible vomiting. Thus, the disease is still hard to diagnose as this stage, and may be mistaken for influenza. About two to three days after the initial symptoms occur, a popular rash starts to develop, primarily on the face and mucous membranes. Furthermore, this rash initially looks like chickenpox and leaves room for further misdiagnosis. However, the smallpox rash develops at the same rate, whereas a chickenpox patient may exhibit scabs, vesicles, and pustules simultaneously. Further distinction between chickenpox and smallpox is seen in its bodily dispersion. Chickenpox tends to cluster more on the trunk of the body while smallpox is seen mostly on the appendages, mucous membranes, and soles and palms (chickenpox lesions are hardly ever found on the soles and palms). At this point in time, when the rash first appears, the patient becomes contagious. The smallpox rash soon becomes vesicular and then pustular. Throughout the evolution of the rash the patient has a fever. Considerable pain is often felt as the pustules of the rash grow and expand. Gradually, scabs will form, separate, and fall off, leaving pitted scars. If death occurs, which it does 30 percent of the time; it will usually occur in the second week of the rash. It is uncertain exactly how many people each case infects. The range that has been estimated, based on historic outbreaks, is anywhere from one to over 20 people infected per each patient. This means that early diagnosis and prompt vaccinations are crucial. The only means of preventing or hindering the disease are vaccination and patient isolation. However, widespread vaccination is not recommended and it is unclear how much vaccine is in existence.

Routine vaccination, at this point in time, is only being recommended for laboratory staff and some military personnel. Two reasons back these recommendations. The first reason is a fear of complications due to widespread vaccination. The vaccine has been known to have adverse effects in some situations. Secondly, the United States definitely does not have enough vaccine to immunize the entire country. It is approximated that the Centers for Disease Control and Prevention in Georgia has approximately 140,000 vials of vaccine in storage. Each vile contains enough doses for about 50-60 people. It is estimated that approximately 50-100 million doses of the vaccine exist worldwide. Furthermore, these stocks cannot be immediately replenished. Since all vaccine production facilities were dismantled after 1980, the world finds itself somewhere between a rock and a hard place when it comes to preparing for a smallpox outbreak. However, our government, as well as others, are making plans to expand the vaccine reserve. It will take about 36 months to begin producing large quantities of vaccine.