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    The Ghost of Smallpox Past

    Despite its being dead for 25 Years, the specter of a smallpox pestilence -- via terrorism -- haunts the public.
    By
    WebMD Feature

    Smallpox is one of this year's top 10 medical stories. Not bad for a disease that's been dead for a quarter of a century.

    Ironically, it was only last October that the CDC celebrated the 25th anniversary of the last case of smallpox in the world. Smallpox is eradicated. It stands as one of mankind's greatest achievements.

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    Now we fear that one of mankind's lowest acts -- terrorism -- might resurrect what 19th-century historian Thomas Macaulay called "the most terrible of the ministers of death." We worry that Soviet Cold War-era smallpox bioweapons might find their way into the hands of terrorists. We worry that rogue states might somehow develop and distribute smallpox weapons. We worry -- and now we prepare for the worst.

    "The smallpox virus still exists in laboratories, and we believe that regimes hostile to the United States may possess this dangerous virus," President Bush said on Dec. 13. "Our government has no information that a smallpox attack is imminent. Yet it is prudent to prepare for the possibility that terrorists who kill indiscriminately would use diseases as a weapon."

    To this end, the U.S. already has begun an ambitious smallpox vaccination program. About a half-million military personnel not deferred for medical reasons must get vaccinated. Another half-million healthcare workers will get voluntary vaccinations. After that, another 10 million healthcare workers will be offered the vaccine. The general public eventually will be able to choose vaccination. But unless there's an attack, no mass vaccination program is planned.

    What is the Real Threat?

    For every million people who get the vaccine, thousands will get bad reactions and one to five people will die. As Bugs Bunny used to ask in WWII-era cartoons, is this trip really necessary?

    One person dealing with some of the issues involved is Kent A. Sepkowitz, MD, director of infection control at Memorial Sloan Kettering Cancer Center and associate professor of medicine at Weill Medical College, Cornel University, New York.

    "What is threat of smallpox? I have no idea," Sepkowitz tells WebMD. "That is the key piece. Nobody knows. That information is missing. We are asked to take on blind faith that there is a threat and to make a plan. It is our job to wrestle with the issues."

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