, Volume 26, Issue 5, pp 263–269 | Cite as

Smallpox: Gone but not forgotten

  • P. D. Ellner


Smallpox represents both the acme of man’s efforts to combat infectious diseases and one of his greatest fears. The disease emerged in prehistoric times to spread throughout the world causing blindness and death in millions of people. An acute infection caused by variola virus, one of the Orthopoxviruses, with skin eruption and marked toxemia had an average case fatality rate of 30%. Variola minor, a milder form of the disease, had a case fatality of one percent. Humans are the sole host, and survival confers lifelong immunity. Immunization was practiced since ancient times by inoculation with the variola virus untilJenner’s demonstration of the efficacy and safety of vaccination with vaccinia virus. Following an intensive eradication effort by the World Health Organization, the world was declared to be free of smallpox in 1979. The decision to destroy all remaining stocks of variola virus in 1999 has met with some controversy.


Vaccinia Smallpox Biological Warfare Smallpox Vaccine Variola Virus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Falkow, S.: What is a pathogen? ASM News 63 (1996) 359–365.Google Scholar
  2. 2.
    Hopkins, D. R.: Princes and peasants: smallpox in history. University of Chicago Press, Chicago 1983, pp. 13, 6, 158, 18, 29, 200, 277, 91.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention: Human monkeypox—Kasai Oriental. Democratic Republic of Congo. MMWR 46 (1997) 1168–1171.Google Scholar
  4. 4.
    Douglas, N. J., Richardson, M., Dumbell, K. R.: Evidence for recent genetic variation in monkeypox viruses. J. Gen. Virol. 75 (1996) 1303–1309.CrossRefGoogle Scholar
  5. 5.
    Kinman, T. J.: Risks connected with the use of conventional and genetically engineered vaccines. Vet. Q. 14 (1992) 110–118.Google Scholar
  6. 6.
    Czerny, C. P., Eisbinger, A. M., Mayr, A., Schneeweis, W. E., Pfeiff, B.: Animal poxviruses transmitted from cat to man: current event with lethal end. Zentralbl. Veterinarmed. 38 (1991) 421–431.Google Scholar
  7. 7.
    Duncan, C. J., Duncan, S. R., Scott, S.: Oscillatory dynamics of smallpox and the impact of vaccination. J. Theor. Biol. 183 (1996) 447–454.PubMedCrossRefGoogle Scholar
  8. 8.
    Ruffer, M. A.: Pathologic note on the royal mummies of the Cairo museum. In:Moodie, R. I. (ed.). Studies in the paleopathology of Egypt. University of Chicago Press, Chicago 1921, pp. 175–176.Google Scholar
  9. 9.
    Fenner, F., Henderson, D. A., Arita, I., Jezek, Z., Ladnyi, I. D.: Smallpox and its eradication. WHO, Geneva 1988, pp. 219, 216, 61, 38, 66, 245, 331, 1323, 1097, 239.Google Scholar
  10. 10.
    Rosenthal, R.: The history and nature of smallpox. Journal Lancet (Minneapolis) 79 (1959) 498–505.Google Scholar
  11. 11.
    Fenner, F.: Poxviruses. In:Fields, B. N., Knipe, D. M., Hawley, P. M., Channock, R. M., Melnick, J. M., Monath, T. P., Roizman, B., Straus, S. E. (eds.): Field’s virology. 3rd ed. Lippincott-Raven, Philadelphia 1996, chapt. 83.Google Scholar
  12. 12.
    Brenner, S., Horne, R. W.: A negatively staining method for high resolution electron microscopy of viruses. Biochimica et Biophysica Acta 34 (1959) 103–110.PubMedCrossRefGoogle Scholar
  13. 13.
    Cruickshank, J. G., Bedson, H. S., Watson, D. H.: Electron microscopy in the rapid diagnosis of smallpox. Lancet ii (1966) 527–530.CrossRefGoogle Scholar
  14. 14.
    Nagler, F. P. O., Rake, G.: The use of the electron microscope in diagnosis of variola, vaccinia and varicella. J. Bacteriol. 55 (1948) 45–51.PubMedGoogle Scholar
  15. 15.
    Peters, D., Nielsen, G., Bayer, M. E.: Variola, reliability of rapid electron microscopic diagnosis. Deutsche medizinische Wochenschrift 87 (1962) 2240–2246.PubMedCrossRefGoogle Scholar
  16. 16.
    Rao, A. R., Sukumar, M. S., Kamalakski, S., Paramasivam, T. V., Shantha, M., Parasuraman, A. R.: Precipitation in gel test in diagnosis of smallpox. Indian I. Med. Res. 58 (1970) 271–282.Google Scholar
  17. 17.
    Downie, A. W., Dumbell, K. R.: The isolation and cultivation of variola virus on the chorio-allantois of chick embryos. J. Pathol. Bacteriol. 59 (1947) 169–198.Google Scholar
  18. 18.
    Ropp, S. L., Jin, Q., Knight, J. C., Massung, R. F., Esposito, J.J.: PCR strategy for identification and differentiation of smallpox and other orthopoxviruses. J. Clin. Microbiol. 33 (1995) 2069–2076.PubMedGoogle Scholar
  19. 19.
    Douglas, N. J., Dumbell, K. R.: DNA sequence variation as a clue to the phylogenesis of orthopoxviruses. J. Gen. Virol. 77 (1996) 947–951.PubMedCrossRefGoogle Scholar
  20. 20.
    Moss, B.: Poxviridae: the viruses and their replication. In:Fields, B. N., Knipe, D. M., Hawley, P. M., Channock, R. M., Melnick, J. M., Monath, T. P., Roizman, R., Straus, S. E. (eds.): Field’s virology. 3rd ed. Lippincott-Raven, Philadelphia, chapt. 83.Google Scholar
  21. 21.
    Massung, R. F., Lieu, L. I., Qi, J., Knight, J. C., Yuran, T. E., Kerlavage, A. R., Parsons, J. M., Venter, J. C., Esposito, J. J.: Analysis of the complete genome of smallpox variola major virus strain Bangladesh-1975. Virology 201 (1994) 215–240.PubMedCrossRefGoogle Scholar
  22. 22.
    Massung, R. F., Loparev, V. N., Knight, J. C., Totmenin, A. V., Chizhikov, V. E., Parsons, J. M., Safronov, P. F., Gutorov, V. V., Shchelkunov, S. N., Esposito, J. J.: Terminal region sequence variations in variola virus DNA. Virology 221 (1996) 291–300.PubMedCrossRefGoogle Scholar
  23. 23.
    Massung, R. F., Knight, J. C., Esposito, J. J.: Topography of variola smallpox virus inverted terminal repeats. Virology 211 (1995) 350–355.PubMedCrossRefGoogle Scholar
  24. 24.
    Shchelkunov, S.N., Totmenin, A. V., Sandakchiev, L. S.: Analysis of the nucleotide sequence of 23.8 kbp from the left terminus of variola major virus strain India-1967. Virus Res. 40 (1996) 169–183.PubMedCrossRefGoogle Scholar
  25. 25.
    Shchelkunov, S. N., Bhinmore, V. M., Rosenchuk, S. M., Totmenin, A. V., Olenina, L. V., Chirikova, G. B., Sandakhchiev, L. S.: Analysis of the nucleotide sequence of 53 kbp from the right terminus of the genome of variola major virus strain India-1967. Virus Res. 34 (1994) 207–236.PubMedCrossRefGoogle Scholar
  26. 26.
    Esposito, J. J., Knight, J. C.: Orthopox virus DNA: a comparison of restriction profiles and maps. Virology 143 (1985) 230–251PubMedCrossRefGoogle Scholar
  27. 27.
    Razzell, P. E.: The conquest of smallpox. Caliban Books, London 1977, chapts 2, 3.Google Scholar
  28. 28.
    Beall, O. T., Shryock, R. H.: Cotton Mather. First significant figure in American medicine. John Hopkins Press, Baltimore 1954, chapt, 7.Google Scholar
  29. 29.
    Jenner, E.: An inquiry into the causes and effects of the variolae vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cowpox. 1778. Reprinted in:Camac, L. N. B. (ed.): Classics of medicine and surgery. Dover Press, New York 1959, pp. 213–240.Google Scholar
  30. 30.
    Cook, G. C.: The smallpox saga and the origin(s) of vaccination. J. R. Soc. Health 116 (1996) 253–255.PubMedCrossRefGoogle Scholar
  31. 31.
    Miller, G.: The adoption of inoculation for smallpox in England and France. Univ. of Pennsylvania Press, Philadelphia 1957, p. 137.Google Scholar
  32. 32.
    Hopkins, J. W.: The eradication of smallpox. Westfield Press, San Francisco 1989, p. 17.Google Scholar
  33. 33.
    Benbehani, A. M.: The smallpox story: life and death of an old disease. Microbiol. Rev. 47 (1983) 455–508.Google Scholar
  34. 34.
    Mack, T. M.: Smallpox in Europe, 1950–1971. J. Infect. Dis. 125 (1972) 161–169.PubMedGoogle Scholar
  35. 35.
    Jenner, E.: The origin of the vaccine inoculation, London, 1801. In:Fenner, F., Henderson, D. A., Arita, I., Jezek, Z., Ladnyi, I. D. (eds.): Smallpox and its eradication. WHO, Geneva 1988, p. 569.Google Scholar
  36. 36.
    Rubin, B. A.: Personal communication. In:Fenner, F., Henderson, D. A., Arita, I., Jezek, Z., Ladnyi, I. D. (eds.): Smallpox and its eradication. WHO, Geneva 1988, p. 576.Google Scholar
  37. 37.
    Foege, W. H., Miller, J. P., Lane, J. M.: Selective epidemiologic control in smallpox eradication. Am. J. Epidemiol. 94 (1971) 311–315.PubMedGoogle Scholar
  38. 38.
    WHO/4 Press Release 25 January 1996: WHO executive board recommends destruction of smallpox virus. Available at: Scholar
  39. 39.
    Kennedy, J.: The archeological recovery of smallpox victims in Hawaii: scientific investigation or public health threat? Perspect. Biol. Med. 37 (1994) 499–509.PubMedGoogle Scholar
  40. 40.
    McGinty, L.: Smallpox laboratories, what are the risks? New Scientist 81 (1979) 8–14.Google Scholar
  41. 41.
    Dowdle, W. R.: Exotic viral diseases. Yale J. Biol. Med. 53 (1980) 109–115.PubMedGoogle Scholar
  42. 42.
    Fein, E.: The shots heard around the world. The New York Times (21 December 1997). The Nation.Google Scholar
  43. 43.
    Preston, R.: Biology gone bad. The New York Times (7 November 1997). Op. Ed.Google Scholar
  44. 44.
    Moss, B.: Genetically engineered poxviruses for recombinant gene expression, vaccination, and safety. Proc. Nat. Acad. Sci. 93 (1996) 11341–11348.PubMedCrossRefGoogle Scholar
  45. 45.
    Kreeger, K. Y.: Smallpox extermination proposal stirs scientists. The Scientist 8 (1994) 1.Google Scholar
  46. 46.
    WHO/8 Press Release 25 January 1996: WHO executive board rectommends destruction of smallpox virus. Available at: Scholar
  47. 47.
    Joklik, W. K., Moss, B., Fields, B. N., Bishop, D. H. L., Sandakhchiev, L. S.: Why the remaining stocks should not be destroyed. Science 262 (1993) 1225–1226.PubMedCrossRefGoogle Scholar
  48. 48.
    Sandakhchiev, L. S.: We’d better think twice before eradicating all smallpox virus stocks. The Scientist 7 (1993) 11.Google Scholar
  49. 49.
    Mahy, B. W. J., Almond, J. W., Berns, K. I., Chanock, R. M., Lvov, D. K., Pettersson, R. F., Schatzmayr, H. G., Fenner, F.: The remaining stocks of smallpox virus should be destroyed. Science 262 (1993) 1223–1224.PubMedCrossRefGoogle Scholar

Copyright information

© MMV Medizin Verlag GmbH München 1998

Authors and Affiliations

  • P. D. Ellner
    • 1
  1. 1.Dept. of MicrobiologyColumbia University, College of Physicians and SurgeonsNew YorkUSA

Personalised recommendations