Armstrong – Table of Contents

vaccinatum), generalized vaccinia in persons with healthy skin, progressive vaccinia
infection to other body organs (liver, kidneys, heart) and the dread complication of brain
(and spinal cord) involvement (post-vaccinal encephalitis) in about 1: 1,000,000 cases.
Also inadvertent escape from the vaccination site and exposure of susceptible persons,
such as infants, pregnant women and various immuno-compromised patients, represented
additional complications. With the realization that the risk of vaccination was greater
than the exposure to smallpox, the United States Public Health Service (8), in 1971,
recommended the discontinuation of routine vaccination. Routine smallpox vaccination
among the American public stopped in 1972 after the disease was declared eradicated in
the United States. Due to the success of vaccination against smallpox, the World Health
Organization (WHO) had undertaken the worldwide elimination of smallpox by means of
vaccination. The last case occurred in Somalia, Africa in 1977, and the WHO declared
that the world was officially smallpox free in 1980.
The hope that the world would continue to be free of smallpox disappeared
September 11, 2001 with the terrorist attacks on the World Trade Center in New York
City and the United States Department of Defense Headquarters, the Pentagon, in
Arlington, Virginia. These catastrophic events raised the specter of the potential use of
bioterrorism weapons of mass destruction among which smallpox was a prime candidate
in a new generation of unprotected potential victims. Following the eradication of
smallpox in 1980, samples of the virus were stored in two official locations, the Centers
for Disease Control and Prevention (CDC) in Atlanta, Georgia and a repository near
Novosibirsk in Russia (14). These stores are not a problem; however, the existence of
samples of other biologic agents, possibly salvaged when the Soviet Union reportedly