Donald A. Henderson

Complications of Smallpox Vaccination

ALTHOUGH vaccination against smallpox has been practiced in the United States since 1800, little is known in this country regarding the frequency of resulting complications. Greenbergs1 review of ...

Smallpox Vaccination: A Review, Part II. Adverse Events

Smallpox vaccination of health care workers, military personnel, and some first responders has begun in the United States in 2002-2003 as one aspect of biopreparedness. Full understanding of the spectrum of adverse events and of their cause, frequency, identification, prevention, and treatment is imperative. This article describes known and suspected adverse events occurring after smallpox vaccination.

Complications of smallpox vaccination. I. National survey in the United States, 1963.

ALTHOUGH vaccination against smallpox has been practiced in the United States since 1800, little is known in this country regarding the frequency of resulting complications. Greenbergs1 review of ...

Epidemic Neuromyasthenia — Clinical Syndrome?

DURING the past ten years an impressive number of outbreaks of bizarre, clinically similar illnesses have been reported from several areas of the world. The cases have shared the features of a prot...

Smallpox Vaccination: A Review, Part I. Background, Vaccination Technique, Normal Vaccination and Revaccination, and Expected Normal Reactions

Because smallpox could be a factor in bioterrorism, the United States has provided guidelines for smallpox vaccination of certain members of the population, including health care workers and first responders, as well as military personnel. A plan for more extensive vaccination, if it is needed in the event of a bioterrorist attack, is being developed under the aegis of the Centers for Disease Control and Prevention. The characteristics of smallpox vaccine, the technique of administration, and the expected reactions to primary vaccination and revaccination are outlined in this article.

Countering the Posteradication Threat of Smallpox and Polio

After eradication, there is a small but finite risk that smallpox and/or poliomyelitis viruses could accidentally escape from a laboratory or be released intentionally. The reintroduction of either virus into a highly susceptible population could develop into a serious catastrophe. To counter such an occurrence will require the use of vaccine, perhaps in substantial quantities. In the United States, new stocks of smallpox vaccine are being procured and arrangements are being made for a standby production facility. Similar provisions need to be considered for polio. To counter an epidemic of polio will require the use of the oral vaccine, which is presently the World Health Organization-recommended vaccine of choice for countries throughout the developing world. In these countries, its continued use is advised because of its ability to induce intestinal immunity, its ability to spread to other susceptible household members and to protect them, its ease of administration, and its low cost.

Return of Epidemic Dengue in the United States: Implications for the Public Health Practitioner

Conditions that facilitate sustained dengue transmission exist in the United States, and outbreaks have occurred during the past decade in Texas, Hawaii, and Florida. More outbreaks can also be expected in years to come. To combat dengue, medical and public health practitioners in areas with mosquito vectors that are competent to transmit the virus must be aware of the threat of reemergent dengue, and the need for early reporting and control to reduce the impact of dengue outbreaks. Comprehensive dengue control includes human and vector surveillance, vector management programs, and community engagement efforts. Public health, medical, and vector-control communities must collaborate to prevent and control disease spread. Policy makers should understand the role of mosquito abatement and community engagement in the prevention and control of the disease.

Smallpox: The Death of a Disease

This fascinating book was initially planned as a record of the Herculean effort led by Dr Henderson, when at the World Health Organization (WHO), to eradicate the scourge of smallpox. As such it fulfils its ambition and the greater part of the book is dedicated to this. However, it is the final few chapters that take the reader to a completely different world, that of smallpox as a weapon, post 11 September 2001. WHO was engrossed in an unsuccessful attempt to rid the world of malaria when, in 1967, Dr D. A. Henderson, a young American epidemiologist, convinced the organization that smallpox would be a much better target. Allowed only a small budget but armed with determination and hard-working colleagues, a dream became reality when the last natural case of smallpox occurred in October 1977. In just 10 years, a disease that claimed 10 million cases a year worldwide had been reduced to nothing and the whole world rejoiced. In his account, Dr Henderson details the triumphs and disasters of the campaign and gives credit to all the major contributors. The keys to eradication being that smallpox has no known animal reservoir and also the technique of recognition/vaccination/containment. The narrative takes the reader around the world following each arm of the programme; it is written in plain style but is nonetheless engaging and with a hint of a detective novel as smallpox outbreaks are identified and eradicated. However, it is the final chapters that catch the imagination, a brief mention of Dr David Kelly inspecting a laboratory in the then Union of Soviet Socialist Republics, prepares the reader for an explanation of why smallpox is an even bigger threat now than ever. Dr Henderson details the facts known to him, including a frightening mock biological weapons attack just prior to the twin towers. Finally, he concludes the book with a studied debate regarding recommencing smallpox vaccination and the future for WHO-led expanded programmes of immunization. On first appearance, this is a factual digest about the eradication of a single disease, but there is a deeper interest to this book, a highly knowledgeable account of the potential of biological warfare. The lack of an UK English version is occasionally irritating, but overall, it is a good read, almost in the page turning way of a novel rather than as a book of science. Smallpox eradication was a feat of epidemiology and public health medicine, as an example of this and of how to achieve success in the face of bureaucratic as well as natural adversity the book has a bearing on, even if not immediately clinically relevant to, occupational health.

Recent Events and Observations Pertaining to Smallpox Virus Destruction in 2002

To destroy all remaining stocks of variola virus on or before 31 December 2002 seems an even more compelling goal today than it did in 1999, when the 52d World Health Assembly authorized temporary retention of remaining stocks to facilitate the possible development of (1) a more attenuated, less reactogenic smallpox vaccine and (2) an antiviral drug that could be used in treatment of patients with smallpox. We believe the deadline established in 1999 should be adhered to, given the potential outcomes of present research. Although verification that every country will have destroyed its stock of virus is impossible, it is reasonable to assume that the risk of a smallpox virus release would be diminished were the World Health Assembly to call on each country to destroy its stocks of smallpox virus and to state that any person, laboratory, or country found to have virus after date x would be guilty of a crime against humanity.

Preventing the Use of Biological Weapons: Improving Response Should Prevention Fail

This article presents an overview of the nature and scope of the challenges posed by biological weapons, and offers ways by which the infectious diseases professional community might address the challenges of biological weapons and bioterrorism.