Smallpox

Abstract: Monkeypox, a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. Since monkeypox in humans was initially diagnosed in 1970 in the Democratic Republic of the Congo (DRC), it has spread to other regions of Africa (primarily West and Central), and cases outside Africa have emerged in recent years. We conducted a systematic review of peer-reviewed and grey literature on how monkeypox epidemiology has evolved, with particular emphasis on the number of confirmed, probable, and/or possible cases, age at presentation, mortality, and geographical spread. The review is registered with PROSPERO (CRD42020208269). We identified 48 peer-reviewed articles and 18 grey literature sources for data extraction. The number of human monkeypox cases has been on the rise since the 1970s, with the most dramatic increases occurring in the DRC. The median age at presentation has increased from 4 (1970s) to 21 years (2010–2019). There was an overall case fatality rate of 8.7%, with a significant difference between clades—Central African 10.6% (95% CI: 8.4%– 13.3%) vs. West African 3.6% (95% CI: 1.7%– 6.8%). Since 2003, import- and travel-related spread outside of Africa has occasionally resulted in outbreaks. Interactions/activities with infected animals or individuals are risk behaviors associated with acquiring monkeypox. Our review shows an escalation of monkeypox cases, especially in the highly endemic DRC, a spread to other countries, and a growing median age from young children to young adults. These findings may be related to the cessation of smallpox vaccination, which provided some cross-protection against monkeypox, leading to increased human-to-human transmission. The appearance of outbreaks beyond Africa highlights the global relevance of the disease. Increased surveillance and detection of monkeypox cases are essential tools for understanding the continuously changing epidemiology of this resurging disease.

Abstract: Smallpox: fearsome scourge for over 3000 years, causing at least 10% of deaths in the middle ages: reduced somewhat by Jenner's discovery of 1796; over ten million cases and 59% ofthe world's population in endemic areas in 1959; abolished by a decision of the World Health Assembly in 1966? This last seems unbelievable in a world littered by declarations of piety rather than realism. Yet the 1966 decision to set up the Intensified Smallpox Eradication Programme with the goal of global eradication in ten years led to success in eleven. The story of smallpox eradication should be as well known as that of penicillin, the double helix or the heart transplant. This book is also a result ofaWHO decision, this time to record the story. It is unique, magnificent, and enthralling. Written by five men who personally contributed greatly to the campaign, but drawing on 78 others for review, this is the authoritative document on smallpox and for this reason alone should be widely available. But in the 1500 beautifully produced and illustrated pages the photographs, mini biographies and details of the successes and the failures ofthe programmes make this much more than a technical story. The presentation is superb. The maps and graphs of the control programme can be flipped quickly to get a moving picture of the battle. Vignettes throughout the text have quotations and \"human interest\"; there are pictures of patients, religious artefacts, smallpox medals, stamps, health workers, nomads, vehicles, villages,. . . It would make a fine presentation item. The technical aspects can hardly be faulted. The clinical and pathological aspects of the disease are dealt with fully, with a series of full page photographs of the progression of lesions in one patient, and discussion of the effects of vaccination, differential diagnosis, virology and immunology. The history from Egyptian mummies to the 1966 situation is dealt with fully. Then the eradication campaign in each country is described. This is not mere statistics; we read ofthe effects ofwar in Somalia and Ethiopia, new epidemics after hopes of containment in India and Bangladesh, deaths ofhealth workers in accidents, and of political and administrative problems everywhere; all leading up to the picture of Ali Maow Maalin, whose willingness to give directions to workers taking two patients to an isolation unit led to his becoming the last case of naturally occurring disease. And to my one criticism of the book-did he recover?-we are not told! The certification programme is discussed, and the final (we hope) tragedy of the Birmingham outbreak and Professor Bedson's suicide. If there are yet those who despise the past, the final chapters on related diseases and on the lessons from the programme are valuable. Those interested in global issues, be it AIDS, HFA 2000, greenhouses or ozone holes, will find much of relevance in this success story of global cooperation. One is tempted into popular reviewese by this book; \"the monumental story over many generations of triumph, despair, setback, and tragedy ... soon to be a major movie?\" Well, I hope so. This story deserves a wider audience and this book could excite an Attenborough or a Puttnam into bringing it the attention it deserves.

Abstract: These revised recommendations regarding vaccinia (smallpox) vaccine update the previous Advisory Committee on Immunization Practices (ACIP) recommendations (MMWR 1991;40; No. RR-14:1-10) and include current information regarding the nonemergency use of vaccinia vaccine among laboratory and health-care workers occupationally exposed to vaccinia virus, recombinant vaccinia viruses, and other Orthopoxviruses that can infect humans. In addition, this report contains ACIP's recommendations for the use of vaccinia vaccine if smallpox (variola) virus were used as an agent of biological terrorism or if a smallpox outbreak were to occur for another unforeseen reason.

Abstract: Although naturally occurring smallpox was eliminated through the efforts of the World Health Organization Global Eradication Program, it remains possible that smallpox could be intentionally released. Here we examine the magnitude and duration of antiviral immunity induced by one or more smallpox vaccinations. We found that more than 90% of volunteers vaccinated 25-75 years ago still maintain substantial humoral or cellular immunity (or both) against vaccinia, the virus used to vaccinate against smallpox. Antiviral antibody responses remained stable between 1-75 years after vaccination, whereas antiviral T-cell responses declined slowly, with a half-life of 8-15 years. If these levels of immunity are considered to be at least partially protective, then the morbidity and mortality associated with an intentional smallpox outbreak would be substantially reduced because of pre-existing immunity in a large number of previously vaccinated individuals.