Smallpox Vaccines for Biodefense: Need and Feasibility

Andrew W Artenstein; John D Grabenstein


Expert Rev Vaccines. 2008;7(8):1225-1237. 

In This Article

Abstract and Introduction


Smallpox, eradicated as a cause of natural disease through an intensive global effort in the later part of the 20th Century, has resurfaced as a possible agent of bioterrorism. For this reason, there is renewed interest in smallpox vaccines. Live vaccinia virus, an orthopoxvirus related to smallpox, has a long and successful clinical track record as an effective smallpox vaccine; however, its use is associated with uncommon yet serious adverse events. This has led to a surge of recent research into newer-generation smallpox vaccines with improved safety profiles and retained efficacy. This article will review the history of smallpox vaccines, assess the status of newer-generation vaccines and examine the overall risk-versus-benefit profile of smallpox vaccination.


Vaccines against infectious diseases, ranked first among the ten greatest public-health achievements of the 20th Century,[1] have arguably resulted in greater benefits to the health of mankind than any other cultural, social or scientific advances. Their implementation has eradicated scourges of nature and controlled a host of lethal, communicable diseases, allowing generations of children to survive, unscathed, into adulthood. Perhaps more than any other, the smallpox vaccine provides the most compelling illustration of vaccination's success. The impact of smallpox on human history is well documented and has been the subject of numerous textbooks, works of literature, objects of art and theses regarding the rise and fall of civilizations.[2,3] The eradication of smallpox and its theoretical resurgence as an agent of bioterrorism illuminate a number of controversial issues engendered by vaccines: safety, public acceptance and risk versus benefit are chief among them. This article will review the genealogy of smallpox vaccines and discuss their potential use in the arena of biodefense.


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