Diagnosing smallpox in possible bioterrorist attack

Cr, Madeley

doi:10.1016/s0140-6736(03)12241-6

Cited by 35 publications

(20 citation statements)

References 5 publications

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“…If an attack with smallpox occurred, the first case would develop the first symptoms around 12-14 (7-17) days (mean and range of the duration of the latency period) after the attack [9]. Because smallpox was eradicated in 1979, lack of experience could lead physicians to misdiagnose smallpox initially, delaying intervention [10,11]. Thus we assumed that time to intervention ranged between 7 and 45 days and was fixed at 25 days in the reference scenario.…”

Section: Discussionmentioning

confidence: 99%

Modelling responses to a smallpox epidemic taking into account uncertainty

et al. 2004

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SUMMARYEpidemiology and modelling are currently under pressure to build consistent scenarios of control in case of deliberate release of biological weapons. In order to assess the key parameters for the control of a smallpox outbreak in a large city (2 million inhabitants), we built a stochastic model to simulate the course of an epidemic controlled by ring vaccination and case isolation. Assuming a reference scenario with 100 index cases and implementation of intervention 25 days after the attack, the model forecasts an epidemic of 730 cases with an epidemic duration of 240 days. Setting intervention 20 days later would result in an almost fourfold increase in the epidemic size. A multivariate sensitivity analysis has selected three key parameters : the basic reproduction number (i.e. the number of secondary cases infected by one case in an entirely susceptible population, equal to 3 in the reference scenario), time to intervention, and proportion of traced and vaccinated contacts.

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Section: Discussionmentioning

confidence: 99%

Modelling responses to a smallpox epidemic taking into account uncertainty

et al. 2004

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“…In order to avoid such failures and to keep EM in the lab diagnostic armament, diagnostic EM as well as other lab diagnostic techniques need expertise and continuous education. If performed in a quality controlled way and according to good laboratory practices, EM will be indispensable in the early detection and differential diagnosis of expected and even more important unexpected, emerging pathogens (Gelderblom and Bannert, 2005;Hazelton and Gelderblom, 2003;Madeley, 2003).…”

Section: Discussionmentioning

confidence: 99%

Pitfalls in diagnosing human poxvirus infections

Nitsche

Gelderblom

Eisendle

et al. 2007

Journal of Clinical Virology

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“…By electron microscopy (EM), a pox virus can be rapidly recognised while it is abundant in the vesicular fluid and this remains the primary diagnostic tool. 13 Though polymerase chain reaction (PCR)-based tests can differentiate smallpox virus even from the very similar vaccinia virus, 14,15 and though PCR is also more sensitive than EM, it should for the moment still be seen as a research procedure able to confirm rather than make the diagnosis.…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Anticipating smallpox as a bioterrorist weapon

Mortimer

2003

Clinical Medicine

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-The treat of bioterrorism means it is important to be able to diagnose smallpox. The responsibility for the initial recognition of cases lies with clinicians, and early diagnosis is the key to the successful control of an outbreak. Unless rapidly contained, a bioterrorist release of smallpox would constitute not just a national but a global threat to health. This brief review sets smallpox in its modern context as an infection potentially spread by bioterrorists and recommends sources of information from the twentieth century that will assist clinicians in diagnosing the disease.KEY WORDS: anti-vaccinal immunoglobulin, antivirals, cell-cultured vaccine, differential diagnosis, laboratory diagnosis, lymph vaccine, patient isolation, ring vaccination, smallpox, vaccination IntroductionSmallpox was declared globally eradicated in 1980. However, it is widely feared that the virus may have fallen into the hands of international terrorists. If so, it is important that any release into the community is recognised at the earliest possible moment lest its spread becomes uncontrollable. To ensure this, today's clinicians, few of whom have encountered smallpox, need to be aware of how it presents and what steps have to be taken to contain it.Little was written about clinical or other aspects of smallpox in the latter half of the twentieth century, but there is plenty of descriptive writing from earlier times and this should enable smallpox to be quickly recognised. The historical record also contains descriptions of outbreak control procedures and discusses the pros and cons of vaccination. It has recently been argued that the great mobility of modern populations, and uncertainty about the ways in which smallpox might be released by bioterrorists, mean that previously well-tried control strategies need to be revised, 1 but what has not changed is the importance of diagnosing and isolating first cases of smallpox at the earliest opportunity, and of searching for concurrent and subsequent cases, and for contacts. A terrorist smallpox release is unlikely to be announced by the perpetrators, and any clinician, whether in general or specialist practice, may be the first to see a case. All should therefore be able to recognise smallpox and know what action to take when they do so. General sources of informationThere are two compendia of smallpox, Dixon's Smallpox 2 and Fenner and colleagues' Smallpox and its eradication. 3 The fact that they were written 40 and 20 years ago respectively does not detract from their value. The authors deal with smallpox as the global disease that it used to be: Dixon describes the history of smallpox on every continent; Fenner et al document the inception, progress and outcome of the global eradication programme of the 1960s and 1970s. Fenner et al's publisher (WHO) has now helpfully made their entire text available electronically. 4 Clinical presentationSmallpox is a prostrating illness characterised after two to three days of fever by a rash that is at first papular and then vesicular....

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Diagnosing smallpox in possible bioterrorist attack

Cited by 35 publications

References 5 publications

Modelling responses to a smallpox epidemic taking into account uncertainty

Modelling responses to a smallpox epidemic taking into account uncertainty

Pitfalls in diagnosing human poxvirus infections

Anticipating smallpox as a bioterrorist weapon

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