S 10

POXVIRUSES - A PRESENT DANGER?

N. Gelderblom
Consultant Lab for Diagnostic EM in Infectious Diseases, Robert Koch Institute Berlin, Germany

Although smallpox had been considered extinct for more than two decades, the fear of the scourge is still deeply embedded in the memory of mankind. The last case in the field occurred in 1977 in Somalia. When two years later under enhanced surveillance no new cases had been observed, on December 09, 1979 the WHO certified “that smallpox has been eradicated from the world”. Virus left over in the laboratories was destroyed or partly collected in two WHO Smallpox Collaborating Centres. Consequently, vaccination was discontinued in the 80ies.

Today the threat of the scourge has been revived since variolavirus, the smallpox agent, is considered a prime candidate for bioterrorism - besides Anthrax spores. The damage following a theoretically possible re-introduction of smallpox appears disastrously high considering that the virus would hit an immunologically naïve population. Therefore preparations assuming worst-case scenarios are required, including education in proper clinical and laboratory diagnostics, vaccination policy, and case management.

In fact, a re-introduction seems unlikely. Although the WHO Smallpox Centres can be considered secure, the discussion of a possible bioterrorist attack continues. But where should the agent come from? Do we assume virus left over in laboratories, remains of a biowarfare programme, or virus contained in the dead bodies of smallpox victims in permafrost regions? The chances are low that live virus is still available. In addition, history has proven that bioterrorist attacks require sophisticated techniques to prepare and spread the agent effectively. In addition to the risks put forward by poxviruses, the diagnostics of smallpox, the clinical course, and further dangers to modern society will be discussed.

S 11

EMERGENGY PLANS FOR SMALLPOX IN AUSTRIA

F. Allerberger
Austrian Agency for Health and Food Safety, Innsbruck, Austria

In February 2002, the Austrian federal health authorities implemented plans to prepare for deliberate release of variola. The level of threat did not justify the risks of serious side effects from smallpox vaccination. Historical records indicate that a smallpox outbreak could be successfully and rapidly controlled. The disease is likely to be easily distinguishable, the virus is not highly contagious, and the interval between successive cases makes transmission of infection open to intervention. An active search and containment strategy was chosen instead of a mass vaccination policy. The ministry advocates investment in public health infrastructure to strengthen outbreak intelligence and verification, support the response to an outbreak, maintain an emergency vaccine reserve (3,000,000 doses of the NYCBH strain), and provide public health information. Response teams (consisting of a public health officer, a dermatologist and a pediatrician) are available 24 h per day in every state to verify or refute the claim of smallpox. A network of designated laboratories provides laboratory capacity (PCR and ELMI) to identify pox viruses on 365 days per year. Quality control specimens were provided for each laboratory and standard operational procedures created for specimen collection and transport. Guidelines for post-event activities including smallpox surveillance and case reporting, contact identification, tracing, vaccination, and epidemiologic investigation were drafted. The potential of smallpox as a threat of biological warfare is viewed very controversial. However, the public health system has to be prepared for the management of this eradicated infection. Since 2000, investigations by WHO had to refute 13 smallpox rumours.