Warning of smallpox terror risk

By Ben Aris in Moscow, Roger Highfield and Philip Delves Broughton in New York (Filed: 06/11/2001)

THE Russian scientist in charge of one of the last known deposits of the smallpox virus called yesterday for the reintroduction of mass vaccination, saying terrorists could easily lure underpaid former Soviet researchers to turn it into a weapon.

"Smallpox is a very dangerous weapon in the hands of terrorists and you don't need some clever way of delivering it," said Dr Lev Sandakhchiyev, director of Russia's Vektor Institute. The Siberian centre holds one of only two official samples of the extinct disease.

"All you need is a sick fanatic to get to a populated place. The world health system is completely unprepared for this."

The disease claimed around one billion lives before being declared extinct in 1980. Inoculation has not been routine for decades but, in the light of heightened fears of bioterrorism, worldwide vaccination should be reintroduced, Dr Sandakhchiyev said.

In the past few weeks, following the anthrax attacks in the United States, moves by American and British authorities have underlined how smallpox is considered more than a theoretical concern.

However, Prof Harry Smith, chairman of the Royal Society working group on biological weapons, said the call for worldwide vaccination was "going over the top". But he added: "On the other hand, I think smallpox vaccine needs to be ready to immunise key people and deal with any outbreak, if it occurs."

This week, the United States Centre for Disease Control (CDC) in Atlanta, Georgia, began a series of training courses on smallpox for some employees and state and local health workers. It also vaccinated 140 doctors and nurses against smallpox over the weekend. They will act as shock troops against any signs of an epidemic.

"We are putting together several teams that could be quickly dispatched to the field if we did see a suspected case of smallpox," said its spokesman, Tom Skinner.

At the end of October, the American government asked pharmaceutical companies if they could produce 300 million doses of smallpox vaccine. However, there has been a reluctance to introduce widespread vaccination because of side effects which, though rare, can be serious, including still births.

Interim guidance issued by the Public Health Laboratory Service referred to the "serious threat" from the disease. Unlike anthrax, smallpox can spread from person to person and there is "no specific treatment", it said. Suspected patients must be put in a special isolation facility, with negative air pressure, and filtered ventilation.

Vektor is one of only two official repositories for smallpox, the other being the CDC. However, it is possible that other facilities still have the virus, such as plants in Kirov, Yekaterinburg, Sergiev Posad and St Petersburg. There may even be other sources - for example, the corpse of a person killed by smallpox and preserved in the Arctic permafrost.

Vektor was a leading centre in the Soviet biological weapons programme which studied the genetic code of the virus, genetic modification of the virus and tested it as a potential bio-weapon as late as 1990. Various initiatives have been made by the West to find peaceful work for former weapons scientists.

But Dr Sandakhchiyev said that, like most Russian scientists, those at Vektor earn a pitiful £75 a month and so could be tempted to sell the virus and work on it by a well-funded terrorist group. "Everything is possible in today's world," he said.

"If the question is, 'Do Russian scientists work in Iran or Iraq?' my answer is no. Do Iraqis work at Vektor? The answer is no," he said.

"But only the devil knows with whom they meet. Our scientists sit at international conferences as part of large government delegations with a large team from Vektor."

His concerns were echoed by Anatoly Vorobyov, a former general at Moscow's secret bio-weapons programme in the 80s. "In principle, the whole population needs to be vaccinated, not only in the United States, but in Russia and everywhere in the world," he said.

As the American authorities stepped up their attempts to hunt down the source of the anthrax, another sample was found yesterday at a small post room in the Pentagon.

-- seeker (searching@low.and.high), November 06, 2001

Answers

Just curious.....with all the negative info re: vaccinations, would you get one if they were readily available?

-- Food (For@Thought.com), November 06, 2001.

Yup.

-- helen (getcher@matching.scars.here), November 06, 2001.

Had one 'bout 40 years ago...time for a booster???...you bet. And would vacinate my children too!

-- Peg (pegmc@mediaone.net), November 06, 2001.

make that vaccinate.

ABSO-FRICKEN-LUTELY!

-- Peg (pegmc@mediaone.net), November 06, 2001.

Unequivocially no.

-- Aunt Bee (Aunt__Bee@hotmail.com), November 06, 2001.

I would definitely get vaccinated if smallpox shows up in the U.S.

Being dead is even worse than some possible side effects.

-- seeker (searching@low.and.high), November 06, 2001.

Why not Aunt Bee? You've lived through it once.

-- Uncle Deedah (unkeeD@yahoo.com), November 06, 2001.

Yes, I would. My concern, though, is the smallpox may be weaponized or altered like that last batch of anthrax.

-- Pammy (pamela_sue57@hotmail.com), November 07, 2001.

Pammy, don't worry about it being weaponized. If it's weaponized and you know you've been exposed, just make sure you sneeze near people you really don't like. >=}

-- helen (spreading@love.joy.light.and.pox), November 07, 2001.

I wouldn't get the vaccine. You can call me stupid, but I think societal hygiene and over-crowding had a lot to play in the outbreaks of the past.

SO and I were talking about this recently. He thought we'd all been vaccinated as children, but I don't remember anyone sticking 15 little pricks into my arm in a circle, and I don't have any scars to disprove my poor memory. I don't have any chicken pox scars, either, and I don't remember having that as a child, but when at least one of my kids got it, I didn't get it either. I think SO's vaccination came from the military. His memory is just catching up with mine.

-- Anita (Anita_S3@hotmail.com), November 07, 2001.

lol @ Helen

I'll keep that in mind.

-- Pammy (pamela_sue57@hotmail.com), November 07, 2001.

Being a military brat I was vaccinated for small pox and remember having the scar, which is now gone. I think they used this thing with a lot of needles on it to poke on my arm a number of times, after putting the drop on the skin.

I would definatly get my kids vaccinated and go without so more people would be able to get a "first" dose, since I have had it at least once.

In watching hearings on the hill since the anthrax outbreak I have noticed the high degree of concern about smallpox that the government is desplaying. (Watching one right now on C-Span). I don't believe this is an idle concern.

From the CDC

Special Issue

Smallpox: Clinical and Epidemiologic Features

D. A. Henderson
Johns Hopkins Center for Civilian Biodefense Studies, Baltimore, Maryland, USA

Clinical and Epidemiologic Characteristics of Smallpox

Smallpox is a viral disease unique to humans. To sustain itself, the virus must pass from person to person in a continuing chain of infection and is spread by inhalation of air droplets or aerosols. Twelve to 14 days after infection, the patient typically becomes febrile and has severe aching pains and prostration. Some 2 to 3 days later, a papular rash develops over the face and spreads to the extremities . The rash soon becomes vesicular and later, pustular. The patient remains febrile throughout the evolution of the rash and customarily experiences considerable pain as the pustules grow and expand. Gradually, scabs form, which eventually separate, leaving pitted scars. Death usually occurs during the second week.

Figure 1. Most cases of smallpox are clinically typical and readily able to be diagnosed. Lesions on each area of the body are at the same stage of development, are deeply embedded in the skin, and are more densely concentrated on the face and extremities.

The disease most commonly confused with smallpox is chickenpox, and during the first 2 to 3 days of rash, it may be all but impossible to distinguish between the two. However, all smallpox lesions develop at the same pace and, on any part of the body, appear identical. Chickenpox lesions are much more superficial and develop in crops. With chickenpox, scabs, vesicles, and pustules may be seen simultaneously on adjacent areas of skin. Moreover, the rash in chickenpox is more dense over the trunk (the reverse of smallpox), and chickenpox lesions are almost never found on the palms or soles.

In 5% to 10% of smallpox patients, more rapidly progressive, malignant disease develops, which is almost always fatal within 5 to 7 days. In such patients, the lesions are so densely confluent that the skin looks like crepe rubber; some patients exhibit bleeding into the skin and intestinal tract. Such cases are difficult to diagnose, but they are exceedingly infectious.

Smallpox spreads most readily during the cool, dry winter months but can be transmitted in any climate and in any part of the world. The only weapons against the disease are vaccination and patient isolation. Vaccination before exposure or within 2 to 3 days after exposure affords almost complete protection against disease. Vaccination as late as 4 to 5 days after exposure may protect against death. Because smallpox can only be transmitted from the time of the earliest appearance of rash, early detection of cases and prompt vaccination of all contacts is critical.

The lesions of chickenpox develop as a series of "crops" over several days and are very superficial. Papules, vesicles, pustules, and scabs can be seen adjacent to each other. The trunk is usually more affected than the face or extremities. Smallpox Vaccination

Smallpox vaccination is associated with some risk for adverse reactions; the two most serious are postvaccinal encephalitis and progressive vaccinia. Postvaccinal encephalitis occurs at a rate of 3 per million primary vaccinees; 40% of the cases are fatal, and some patients are left with permanent neurologic damage. Progressive vaccinia occurs among those who are immunosuppressed because of a congenital defect, malignancy, radiation therapy, or AIDS. The vaccinia virus simply continues to grow, and unless these patients are treated with vaccinia immune globulin, they may not recover. Pustular material from the vaccination site may also be transferred to other parts of the body, sometimes with serious results.

Routine vaccination is only recommended for laboratory staff who may be exposed to one of the orthopoxviruses. There are two reasons for this. First is the risk for complications. Second, U.S. national vaccine stocks are sufficient to immunize only 6 to 7 million persons. This amount is only marginally sufficient for emergency needs. Plans are now being made to expand this reserve. However, at least 36 months are required before large quantities can be produced.

The potential of smallpox as a biological weapon is most dramatically illustrated by two European smallpox outbreaks in the 1970s. The first occurred in Meschede, Germany, in 1970 (1). This outbreak illustrates that smallpox virus in an aerosol suspension can spread widely and infect at very low doses.

Another outbreak occurred in Yugoslavia in February 1972 (1). Despite routine vaccination in Yugoslavia, the first case in the 1972 outbreak resulted in 11 others; those 11, on average, each infected 13 more. Other outbreaks in Europe from 1958 on showed that such explosive spread was not unusual during the seasonal period of high transmission, i.e., December through April. One can only speculate on the probable rapidity of spread of the smallpox virus in a population where no one younger than 25 years of age has ever been vaccinated and older persons have little remaining residual immunity.

Where might the virus come from? At one time, it was believed that the smallpox virus was restricted to only two high-security laboratories, one at the Centers for Disease Control and Prevention in Atlanta, Georgia, and one at the Russian State Centre for Research on Virology and Biotechnology, Koltsovo, Novosibirsk Region. By resolution of the 1996 World Health Assembly (WHA), those stocks were slated to be destroyed at the end of June 1999. The desirability of such an action was reaffirmed by a World Health Organization Expert Committee in January 1999. On May 22, 1999, WHA, however, passed a resolution postponing destruction until 2002, by which time any promise of the variola virus stocks for public health research could be determined. Destruction of the virus would be at least one step to limit the risk for the reemergence of smallpox. However, despite widespread acceptance of the 1972 Bioweapons Convention Treaty, which called for all countries to destroy their stocks of bioweapons and to cease all research on offensive weapons, other laboratories in Russia and perhaps in other countries maintain the virus. Iraq and the Soviet Union were signatories to the convention, as was the United States. However, as reported by the former deputy director of the Russian Bioweapons Program, officials of the former Soviet Union took notice of the world's decision in 1980 to cease smallpox vaccination, and in the atmosphere of the cold war, they embarked on an ambitious plan to produce smallpox virus in large quantities and use it as a weapon. At least two other laboratories in the former Soviet Union are now reported to maintain smallpox virus, and one may have the capacity to produce the virus in tons at least monthly. Moreover, Russian biologists, like physicists and chemists, may have left Russia to sell their services to rogue governments.

Smallpox is rated among the most dangerous of all potential biological weapons, with far-reaching ramifications.

Dr. Henderson is a distinguished service professor at the Johns Hopkins University, holding an appointment in the Department of Epidemiology. Dr. Henderson directed the World Health Organization's global smallpox eradication campaign (1966-1977) and helped initiate WHO's global program of immunization in 1974. He also served as deputy assistant secretary and senior science advisor in the Department of Health and Human Services.

http://www.cdc.gov/ncidod/EID/vol5no4/henderson.htm

-- Cherri (jessam5@home.com), November 10, 2001.