Although Erica Weir's recent public health article on smallpox is very informative, it does not actually answer the question posed in the title: Does smallpox still pose a threat?1 As long as there are stockpiles of smallpox in the world, it poses a real, if small, threat. Smallpox could be released into the population as a result of a bioterrorist attack or if one person with access to the stockpile becomes mentally unstable and decides to release the virus. One syringe of this pathogen released into a crowded subway would be sufficient to produce several cases of smallpox. Failure to contain even one of these cases could lead to a chain reaction.
I am particularly concerned about the well-being of our first responders. Nurses and physicians under 30 years of age have not been vaccinated. Although protective clothing would provide some protection, it would not be fail-safe. In addition, medical staff might use limited barrier precautions while treating patients with difficult-to-diagnose forms of smallpox until the diagnosis is made.2
We require a strategic plan to contain smallpox that would ensure the protection of front-line workers. There is a also a need for more widespread vaccination, possibly with a re-engineered vaccine that has the necessary epitopes to protect without producing toxicity.
H. Roslyn Devlin Medical Microbiologist St. Michael's Hospital Toronto, Ont.