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Kahn PA, Ying X, Virata M, Magahis P, Li S, Mathis WS. Availability and Accessibility of Live Nonreplicating Smallpox/Mpox Vaccine. JAMA Netw Open 2023; 6:e237873. [PMID: 37027158 PMCID: PMC10082399 DOI: 10.1001/jamanetworkopen.2023.7873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
This cross-sectional study compares the availability and accessibility of mpox vaccine sites with the number of reported cases and allocated vaccines.
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Affiliation(s)
- Peter A. Kahn
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaohan Ying
- Department of Medicine, NewYork Presbyterian–Weill Cornell, New York, New York
| | - Michael Virata
- Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut
| | - Patrick Magahis
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Sunnie Li
- University of North Carolina at Chapel Hill
| | - Walter S. Mathis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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2
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Abstract
Widespread vaccination programmes led to the global eradication of smallpox, which was certified by the World Health Organisation (WHO), and, since 1978, there has been no case of smallpox anywhere in the world. However, the viable variola virus (VARV), the causative agent of smallpox, is still kept in two maximum security laboratories in Russia and the USA. Despite the eradication of the disease smallpox, clandestine stocks of VARV may exist. In a rapidly changing world, the impact of an intentional VARV release in the human population would nowadays result in a public health emergency of global concern: vaccination programmes were abolished, the percentage of immunosuppressed individuals in the human population is higher, and an increased intercontinental air travel allows for the rapid viral spread of diseases around the world. The WHO has authorised the temporary retention of VARV to enable essential research for public health benefit to take place. This work aims to develop diagnostic tests, antiviral drugs, and safer vaccines. Advances in synthetic biology have made it possible to produce infectious poxvirus particles from chemicals in vitro so that it is now possible to reconstruct VARV. The status of smallpox in the post-eradication era is reviewed.
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Affiliation(s)
- Hermann Meyer
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Rosina Ehmann
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Geoffrey L. Smith
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK;
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Delaune D, Iseni F, Ferrier-Rembert A, Peyrefitte CN, Ferraris O. The French Armed Forces Virology Unit: A Chronological Record of Ongoing Research on Orthopoxvirus. Viruses 2017; 10:E3. [PMID: 29295488 PMCID: PMC5795416 DOI: 10.3390/v10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 01/04/2023] Open
Abstract
Since the official declaration of smallpox eradication in 1980, the general population vaccination has ceased worldwide. Therefore, people under 40 year old are generally not vaccinated against smallpox and have no cross protection against orthopoxvirus infections. This naïve population may be exposed to natural or intentional orthopoxvirus emergences. The virology unit of the Institut de Recherche Biomédicale des Armées (France) has developed research programs on orthopoxviruses since 2000. Its missions were conceived to improve the diagnosis capabilities, to foster vaccine development, and to develop antivirals targeting specific viral proteins. The role of the virology unit was asserted in 2012 when the responsibility of the National Reference Center for the Orthopoxviruses was given to the unit. This article presents the evolution of the unit activity since 2000, and the past and current research focusing on orthopoxviruses.
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Affiliation(s)
- Déborah Delaune
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Frédéric Iseni
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Audrey Ferrier-Rembert
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Christophe N Peyrefitte
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Olivier Ferraris
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
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Abstract
International efforts to eradicate smallpox in the 1960s and 1970s provided the foundation for efforts to expand immunization programmes, including work to develop immunization supply chains. The need to create a reliable system to keep vaccines cold during the lengthy journey from the manufacturer to the point of use, even in remote areas, was a crucial concern during the early days of the Expanded Programme on Immunization. The vaccine cold chain was deliberately separated from other medical distribution systems to assure timely access to and control of vaccines and injection materials. The story of the early development of the vaccine cold chain shows how a number of challenges were overcome with technological and human resource solutions. For example, the lack of methods to monitor exposure of vaccines to heat during transport and storage led to many innovations, including temperature-sensitive vaccine vial monitors and better methods to record and communicate temperatures in vaccine stores. The need for appropriate equipment to store and transport vaccines in tropical developing countries led to innovations in refrigeration equipment as well as the introduction and widespread adoption of novel high performance vaccine cold-boxes and carriers. New technologies also helped to make injection safer. Underlying this work on technologies and equipment was a major effort to develop the human resources required to manage and implement the immunization supply chain. This included creating foundational policies and a management infrastructure; providing training for managers, health workers, technicians, and others. The vaccine cold chain has contributed to one of the world's public health success stories and provides three priority lessons for future: the vaccine supply chain needs to be integrated with other public health supplies, re-designed for efficiency and effectiveness and work is needed in the longer term to eliminate the need for refrigeration in the supply chain.
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Smallpox in the post eradication era. Wkly Epidemiol Rec 2016; 91:257-64. [PMID: 27209648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Martínez-Martínez PJ, Tuells J, Colmenar-Jarillo G. [The late media emergency of smallpox vaccine, news coverage of Spanish press (1999-2004)]. Rev Esp Quimioter 2015; 28:125-131. [PMID: 26032996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Discussions on the need for smallpox virus preservation in 1999 focused attention on an eradicated disease 20 years ago. Smallpox was replaced as a potential candidate to be used as a bioterrorist weapon because of the international alarm scenario produced after the 11/9 events in USA. The reactivation of a vaccine which remained forgotten was the direct consequence. The initial target groups were the security forces of America. Spain was also among the countries that were interested in acquiring the smallpox vaccine. The aim of this study is to analyze the considerable media coverage of smallpox obtained in our country. METHODS Systematic review of published news in the four largest national daily newspapers (ABC, El Mundo, El País and La Vanguardia) for the period 1999-2004 of the Dow Jones Factiva document database. "Smallpox" were used as a key word. From the obtained data, a qualitative and quantitative analysis was done. RESULTS 416 reviews were analyzed; the newspaper El Mundo was the most interested in these news (158 citations, 37.98%). Most of the news were published in 2003 (152, 36.5%) The year with more news about smallpox (2003) coincides with the purchase of vaccines in Spain. The type of messages in the news was highly changeable over this six-year period. Those related to "politics and diplomacy", "epidemiological risk", "bioterrorism" and "vaccine" were predominant. CONCLUSIONS The alarm raised around the smallpox vaccination was a media phenomenon due to political strategy issues rather than a real public health problem.
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Affiliation(s)
| | - José Tuells
- José Tuells, Cátedra Balmis de Vacunología, Facultad de Ciencias de la Salud - Campus de San Vicente Raspeig Ap.99. E-03080, Alicante, Spain.
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Oleksiewicz MB, Steenhard NR, Hansen JES. Author's response. Am J Disaster Med 2015; 10:363-366. [PMID: 27352451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Kiss L. [History of Smallpox Vaccination and of the Vaccine Supply in Hungary, up to 1890]. Orvostort Kozl 2015; 61:69-86. [PMID: 26875290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
One of the preconditions for the spread of vaccination against pox diseases was making vaccination available. The first vaccinations were carried out using original cowpox lymph sent by Jenner. For further vaccinations the vaccine was extracted from the blisters of those who had been successfully inoculated. In order to provide vaccine continuously six vaccine centres were set up in 1804 in the following cities: Pest, Buda, Kassa, Gyula, Pozsony and Zágráb (Croatia). Detailed information is available only about the centre in Pest which operated in Rókus Hospital under the leadership of the hospital director András Bossányi. Besides regular vaccination they also provided vaccine for the countryside. From 1824 the vaccine was relocated to the medical faculty of the university in Pest and Ferenc Gebhardt, an instructor of surgeons, became its head. The centre operated in the building of the medical faculty and vaccinations were given on Thursdays and Sundays. After the retirement of Gebhardt in 1860, the centre was taken over by the dermatologist Ferenc Poor for a short time, then by Ignác Semmelweis. From 1863 Gergely Patrubány was responsible for managing the centre. In 1874 the central vaccine institution moved to the Hospital for Poor Children in Pest where it was led first by Lázár Wittman, then by Géza Hainiss. In the 1880s private institutions appeared, the best known were Dani Pécsi's centre in Pest and Béla Intze's one in Tirgu Lapus (Romania). Between 1873 an 1889 András Kreichel ran a vaccine centre in Nálepkovo (Slovakia).
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Tanaka S, Sugita S, Marui E. [A study on the 1946 smallpox epidemic in Japan and measures taken against it]. Nihon Ishigaku Zasshi 2014; 60:247-259. [PMID: 25608437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In early 1946, immediately after World War II, there was a smallpox epidemic in Japan. In this paper we investigated trends in the occurrence of smallpox by week and region using official documents of the General Headquarters, Supreme Commander for the Allied Powers (GHQ/SCAP), which are stored in the National Diet Library Modern Japanese Political History Materials Room, and summarized the measures taken against this epidemic. The following two points were clarified: 1) The 1946 smallpox epidemic peaked in Week 13 (March 24-30; 1,405 new patients), and the highest morbidity during this epidemic was seen in Hyogo Prefecture, followed by Osaka Prefecture, Aichi Prefecture, Tokyo Prefecture, and Hokkaido Prefecture. 2) Measures taken against this epidemic were classified into the following three stages: 1. "Vaccine shortage/Manufacture acceleration stage," 2. "Vaccine sufficiency/Smallpox vaccination program implementation stage," and 3. "Detection of defects in vaccination technique/Reimplementation of the smallpox vaccination program stage".
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Reina J. [The smallpox vaccines and the definitive destruction of the last virus strains]. Med Clin (Barc) 2011; 137:308-10. [PMID: 21605878 DOI: 10.1016/j.medcli.2011.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 11/19/2022]
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Nau JY. [Procrastination of the destruction of smallpox vaccines]. Rev Med Suisse 2011; 7:1286. [PMID: 21751730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Duraffour S, Andrei G, Snoeck R. Tecovirimat, a p37 envelope protein inhibitor for the treatment of smallpox infection. IDrugs 2010; 13:181-191. [PMID: 20191435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Since the eradication of naturally occurring smallpox in 1980, the fear that variola virus could be used as a biological weapon has become real. Over the last 10 years, emergency preparedness programs have been launched to protect populations against a smallpox outbreak or the possible emergence in humans of other orthopoxvirus infections, such as monkeypox. Vaccination against smallpox was responsible for its eradication, but was linked with high rates of adverse events and contraindications. In this context, intensive research in the poxvirus field has led to the development of safer vaccines and to an increase in the number of anti-poxvirus agents in the pipeline. SIGA Technologies Inc, under license from ViroPharma Inc, is developing tecovirimat (ST-246). Tecovirimat is a novel antiviral that inhibits the egress of orthopoxviruses by targeting viral p37 protein orthologs. The development of tecovirimat during the last 5 years for the treatment of smallpox and for its potential use as adjunct to smallpox vaccine is reviewed here.
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Affiliation(s)
- Sophie Duraffour
- Katholieke Universiteit Leuven, Rega Institute for Medical Research, Minderbroedersstraat 10, 3000 Leuven, Belgium
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Abstract
Our objectives were to document and to analyze the U.S. Navy's smallpox vaccination program before Operation Iraqi Freedom, discerning lessons for future mass vaccination programs. This research scrutinized the challenges inherent in vaccinating approximately 40,000 personnel at diverse locations within a few weeks. We interviewed and observed participants at multiple locations throughout the vaccination process, while also collecting documentation. Subsequently, we analyzed how the Navy addressed the challenges of mass vaccination on a compressed timeline. We found that the population was vaccinated with no significant logistical challenges, few medical complications, almost no refusals, and minimal operational impact. Our analysis led us to conclude that two primary factors contributed to the vaccination program's success; both of these can be replicated in future mass vaccination programs. The first factor was a strong educational program, which repeated consistent messages via multiple communications channels. The second factor was vocal, demonstrative, high-level support for vaccination.
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Affiliation(s)
- Scott Savitz
- Center for Naval Analyses, Alexandria, VA 22311, USA
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Abstract
Smallpox vaccine was the most important tool in the successful eradication of smallpox. In 1980, this achievement made it possible for all nations to cease smallpox vaccination. However, the threat of smallpox bioterrorism has made it necessary to reconsider the need for vaccination. Over the past 3 years, many nations have set up action plans for use in the event of such an attack. The setting up of these plans was not simple. Several factors needed to be considered, including the judgement of risk, vaccine complications, conventional vaccines versus new vaccines, optimal stockpile of smallpox vaccine, and its use for different target populations in different emergency situations. Here, I review measures taken by the USA, Japan, and other nations, and discuss likely national and global efforts in 2005 and subsequently, in view of the fact that half of the world's population is now apparently unvaccinated and that this proportion will increase with time.
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Affiliation(s)
- Isao Arita
- Agency for Cooperation in International Health (ACIH), Kumamoto City, Kumamoto, Japan.
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Heegaard ED, Fomsgaard A. [Smallpox preparedness in Denmark]. Ugeskr Laeger 2005; 167:3384-7. [PMID: 16159487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Although the likelihood of a deliberate release is considered to be minor, smallpox virus poses a worldwide terrorism security risk because it (1) can easily be disseminated and transmitted from person to person; (2) results in high mortality rates and has the potential to create a major public health impact; (3) might cause public panic and social disruption; and (4) requires special action for public health preparedness. Consequently, Statens Serum Institute and the National Board of Health have developed a Danish smallpox preparedness plan. This article discusses critical aspects of the plan, including risk analysis and a multi-tiered action plan, vaccination, analysis of clinical specimens, the establishment of active surveillance teams and generic contingency elements.
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Affiliation(s)
- Erik Deichmann Heegaard
- Statens Serum Institut, Medicinsk Sektion, Center for Biologisk Beredskab, og Molekylaervirologisk Laboratorium, Virologisk Afdeling, København S.
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Abstract
In keeping with current standards, we urge that old smallpox vaccines that were
made in animal skin and are still a key part of our strategic national stockpile
be tested for adventitious infectious agents. The advisory especially applies to
viruses that have the potential for zoonotic transmission to human vaccine
recipients.
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Affiliation(s)
- Frederick A Murphy
- School of Veterinary Medicine, University of California, Davis, California 95616, USA.
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Kohrs B. Bioterrorism defense: are state mandated compulsory vaccination programs an infringement upon a citizen's constitutional rights? J Law Health 2005; 17:241-270. [PMID: 15853127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Tryland M. [Should the human smallpox virus (variola) be destroyed?]. Tidsskr Nor Laegeforen 2004; 124:2642-3. [PMID: 15534643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Smallpox, caused by variola virus, was a terror for civilizations around the world for more than 3000 years. Although the disease is eradicated, hundreds of variola virus isolates are kept in two WHO-collaborating facilities, one in USA and one in Russia. In spite of several agreements on destruction, it is now doubtful that these virus isolates will be destroyed. Variola virus may exist in other places and may be used as a biological weapon in war or for terror. Further research on variola virus is thus essential in order to achieve a better understanding of the pathogenicity of the virus and to develop new anti-variola virus vaccines and antiviral drugs.
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Affiliation(s)
- Morten Tryland
- Seksjon for arktisk veterinaermedisin, Institutt for mattrygghet og infeksjonsbiologi, Norges veterinaerhøgskole, Postboks 6204, 9292 Tromsø.
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Talbot TR, Stapleton JT, Brady RC, Winokur PL, Bernstein DI, Germanson T, Yoder SM, Rock MT, Crowe JE, Edwards KM. Vaccination success rate and reaction profile with diluted and undiluted smallpox vaccine: a randomized controlled trial. JAMA 2004; 292:1205-12. [PMID: 15353533 DOI: 10.1001/jama.292.10.1205] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Additional smallpox vaccine doses are needed to augment current US national stockpile. Aventis Pasteur smallpox vaccine (APSV), initially manufactured in the 1950s from the New York Board of Health vaccinia strain in a frozen preparation, appears as effective as lyophilized vaccine but the effectiveness of diluted doses of APSV is unclear. OBJECTIVE To compare the vaccination success rate and the reaction profile of various APSV dilutions. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized controlled trial of 340 healthy vaccinia-naive adults aged 18 to 32 years from 3 academic medical centers who were vaccinated with 1 of 3 strengths of APSV dilutions (undiluted, 1:5, and 1:10) between October 9, 2002, and February 24, 2003. Volunteers were followed up every 3 to 5 days until the vaccination site healed for bandage changes, vaccine response assessment, and adverse event evaluation, followed by 1- and 2-month clinic evaluations and 6-month telephone interview. MAIN OUTCOME MEASURES Successful vaccination, defined by presence of a vesicle or pustule at the inoculation site 6 to 11 days postvaccination, and local and systemic reactions to vaccination. RESULTS A total of 340 volunteers were vaccinated (vaccine dose: undiluted, n = 113; 1:5 dilution, n = 114; and 1:10 dilution, n = 113). Following vaccination, 99.4% (95% confidence interval [CI], 97.9%-99.9%) of all volunteers had successful vaccinations. Success rates did not differ between the dilution groups (undiluted, 100.0%; 95% CI, 96.8%-100.0%; 1:5 dilution, 98.2%; 95% CI, 93.8%-99.8%; 1:10 dilution, 100.0% 95% CI, 96.8%-100.0%; P =.33). Overall, 99.7% of volunteers reported at least 1 local symptom at the vaccination site, and 61.8% had axillary lymphadenopathy, 15.0% developed satellite lesions, and 7.6% developed a rash away from the vaccination site. Fever developed in 21.5%. No differences were noted in local or systemic reactions between the 3 dilution groups (P>.05 for each comparison). A total of 25% of volunteers missed scheduled duties due to vaccine-related symptoms. CONCLUSIONS Even at diluted doses, APSV is an effective smallpox vaccine, allowing for expansion of the current stockpile. However, reactogenicity was not reduced with dilution of the vaccine and, as with other smallpox vaccines, may impair daily activities.
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Affiliation(s)
- Thomas R Talbot
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.S
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Abstract
The Bush administration's campaign to vaccinate health care workers against smallpox has proved unpopular, largely because of concerns about the safety of the vaccine and who would pay for any needed medical treatment. State health departments have destroyed about 61,000 doses of expired vaccine--substantially more than the number actually administered.
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Clements TI. Smallpox vaccination and the nurse. Kans Nurse 2003; 78:5-7. [PMID: 12830676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Thomas I Clements
- Bureau of Epidemiology and Disease Prevention, Kansas Department of Health and Environment, USA
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Silverman RD, May T. Terror and triage: prioritizing access to mass smallpox vaccination. Creighton Law Rev 2003; 36:359-74. [PMID: 15199933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
In response to the threat of a smallpox attack on the United States, the Centers for Disease Control and Prevention ("CDC") recommended the establishment of smallpox clinics designed to distribute a vaccine to the entire U.S. population in a ten day period. However, a number of potential obstacles raise questions about the feasibility of this plan. What is needed is a plan that applies principles of triage to smallpox vaccine distribution following a bioterrorism attack. Only in this way can those most vulnerable--the previously unvaccinated--be protected from a significantly increased risk due to delays that might arise in executing the CDC plan.
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Norrby R, Fredlund H, Tüll PJ. [Society's planning against smallpox virus attacks. The apprehension should not be overestimated, but the threat exists]. Lakartidningen 2003; 100:1114-6. [PMID: 12705154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Schmitz H, Peters S. [Preparing for bioterrorism. Smallpox panic? (interview by Marion Kaden)]. MMW Fortschr Med 2003; 145:8. [PMID: 12619353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Kozma CM. Can smallpox response teams use the experience of disease management programs? Manag Care Interface 2003; 16:45-6. [PMID: 12647526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Any attempt to widely disperse smallpox vaccinations will necessitate educating people about the risks and benefits of vaccination. Most disease management programs have extensive experience in distributing educational materials and programs to health care workers and patients as well as in tracking response to interventions. Can this experience lend a hand in the event of widespread vaccination?
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Affiliation(s)
- Chris M Kozma
- Strategic Outcomes Services, CareScience, Inc., Research Triangle Park, North Carolina, USA
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Pennington H. Smallpox and bioterrorism. Bull World Health Organ 2003; 81:762-7. [PMID: 14758439 PMCID: PMC2572332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Smallpox was declared to be eradicated on 8 May 1980, during the Thirty-third World Health Assembly. However, concerns about the possible use of the virus as a weapon of bioterrorism have increased in recent years. Governments have responded by initiating selective vaccination programmes and other public health measures. This review uses historical data from 20th century outbreaks to assess the risks to current populations (which have declining immunity) from a deliberate release of virus. The data presented supports the conclusion of a previous reviewer (Mack) that "smallpox cannot be said to live up to its reputation. Far from being a quick-footed menace, it has appeared as a plodding nuisance with more bark than bite." Its R value (the average number of secondary cases infected by a primary case) is lower than that for measles, human parvovirus, chickenpox, mumps, rubella, and poliomyelitis; only the value for severe acute respiratory syndrome (SARS) is lower. Like SARS, close person-to-person contact is required for effective spread of the disease, and exposure to the virus in hospitals has played an important role in transmission for both viruses. In the present paper the dangers of mass vaccination are emphasized, along with the importance of case isolation, contact tracing, and quarantine of close contacts for outbreak control. The need for rapid diagnosis and the continued importance of maintaining a network of electron microscopes for this purpose are also highlighted.
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Affiliation(s)
- Hugh Pennington
- Department of Medical Biology, University of Aberdeen, Medical School Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
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Huerta M, Balicer RD, Leventhal A. SWOT analysis: strengths, weaknesses, opportunities and threats of the Israeli Smallpox Revaccination Program. Isr Med Assoc J 2003; 5:42-6. [PMID: 12592958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated "first responders" among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached, we conducted a SWOT analysis of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. SWOT analysis--a practical tool for the study of public health policy decisions and the social and political contexts in which they are reached--revealed clear and substantial strengths and weaknesses of the current smallpox revaccination program, intrinsic to the vaccine itself. A number of threats were identified that may jeopardize the success of the current program, chief among them the appearance of severe complications of vaccination. Our finding of a lack of a generation of knowledge on smallpox vaccination highlights the need for improved physician education and dissipation of misconceptions that are prevalent in the public today.
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Affiliation(s)
- Michael Huerta
- Israel Defense Force Medical Corps, Army Health Branch, Tel Hashomer, Israel
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Raghunath D. The danger of resurgence of smallpox due to deliberate introduction: the need for a national policy. Natl Med J India 2003; 16:51. [PMID: 12715964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Web site launched to educate public about immunization. AIDS Policy Law 2002; 17:9. [PMID: 12510651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Abbott A. Europe urged to provide boost for bioterror research. Nature 2002; 420:450. [PMID: 12466800 DOI: 10.1038/420450b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Are you ready to carry out smallpox vaccine plans? ED Manag 2002; 14:137-9. [PMID: 12491758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
New recommendations for smallpox vaccination have addressed key concerns of emergency department (ED) managers. The program would be voluntary. Vaccinated staff would not be quarantined. Fifteen or more ED staff members at each hospital would receive the vaccine as part of a total team of 40 or more, with the exact number varying according to individual needs.
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Mayor S. Chief medical officer confirms key health workers will be vaccinated against smallpox. BMJ 2002; 325:855. [PMID: 12386031 PMCID: PMC1124377 DOI: 10.1136/bmj.325.7369.855/b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Charatan F. US health officials recommend offering smallpox vaccination to all. BMJ 2002; 325:794. [PMID: 12378724 PMCID: PMC1169554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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ED managers are planning for smallpox vaccine. ED Manag 2002; 14:101-2. [PMID: 12236014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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ED managers react to smallpox vaccine update. ED Manag 2002; 14:90-1. [PMID: 12221785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
In updated recommendations, a Centers for Disease Control and Prevention advisory committee says that a small group of predesignated personnel should receive smallpox vaccinations, but not the general public or other health care workers. Some managers insist that any group who could be exposed without advance notice should be vaccinated. There is a concern about time off for vaccination if an exposure occurs. The risk of side effects is a concern.
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Abstract
Smallpox is a disease that followed humanity for thousands of years up until 30 years ago. It was possible to eradicate, because an effective live vaccine from crossreacting vaccinia could be developed. Twenty years have passed since vaccinations stopped and very few people are protected against the disease today. Variola today has become an object of discussion due to the possibility that it can be used as a bioweapon. Due to the number of complications that can be expected a general vaccination is probably not possible. Research is ongoing to develop new vaccines. Many countries are improving their capabilities to respond to a renewed threat of a smallpox epidemic.
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Affiliation(s)
- A Tegnell
- Department of Epidemiology, Swedish Institute for Infectious Disease Control (SMI), Solna, Sweden
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Capriotti T. Smallpox vaccine revisited. Medsurg Nurs 2002; 11:193-7. [PMID: 12219432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Teri Capriotti
- Villanova University College of Nursing, Villanova, PA, USA
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Piotrowski J. Diplomatic immunity. Smallpox safeguard for healthcare workers plagued by logistical issues. Mod Healthc 2002; 32:32-3. [PMID: 12195666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Robb-Nicholson C. By the way doctor. I was relieved to read that the United States will soon have enough smallpox vaccine for everyone. Should my family and I be vaccinated? Harv Womens Health Watch 2002; 9:8. [PMID: 12138026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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NIH study supports diluting smallpox vaccine stockpile. Expert Rev Vaccines 2002; 1:5. [PMID: 12908505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Tegnell A, Wahren B, Elgh F. [Smallpox--eradicated disease and a potential terrorist weapon]. Lakartidningen 2002; 99:2145-9. [PMID: 12082927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Smallpox is a disease that followed humanity for thousands of years up until thirty years ago. It was possible to eradicate, since an effective live vaccine from crossreacting vaccinia could be developed. Twenty years passed since vaccinations stopped and very few people are protected against the disease today. Variola today has become an object of discussion due to the possibility that it can be used as a bioweapon. Due to the number of complications that can be expected a general vaccination is probably not possible. Research is ongoing to develop new vaccines. Many countries are improving their capabilities to respond to a renewed threat of a smallpox epidemic.
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Affiliation(s)
- Anders Tegnell
- Kunskapscentrum för mikrobiologisk beredskap (KCB), Smittskyddsinstitutet (SMI), Solna
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Smallpox: we'll soon have enough vaccine...but how should it be used? Child Health Alert 2002; 20:1-2. [PMID: 15329945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Spake A. Smallpox redux. We suddenly find ourselves with plenty of vaccine. Should we go ahead and inoculate everyone now? US News World Rep 2002; 132:46. [PMID: 11951339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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