Commentary on Dr. Alan P. Zelicoff's Analysis (No. 5)

• Published in: Critical reviews in microbiology Vol. 29; no. 2; pp. 173 - 174
• Main Author: Merkle, Peter B.
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 01.01.2003; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Disease Outbreaks - history; History, 20th Century; Humans; Japan - epidemiology; Military Personnel - history; Smallpox - epidemiology; Smallpox - history; Smallpox - prevention & control; United States; Variola virus - pathogenicity; Virulence; United States; Japan
• ISSN: 1040-841X; 1549-7828
• DOI: 10.1080/713610426

Alan Zelicoff has done a great service by his careful study of the actual circumstances of the Aralsk outbreak. Such "forensic epidemic analysis" is critical to meeting the many challenges of defending against biological warfare (BW) and bioterrorism. In all these matters, restraint in communicating with the press is essential. Panic and fear will be as dangerous the virus itself if a new smallpox epidemic emerges. I would like to share my thoughts regarding Dr. Zelicoff's "unanswered questions." The prevalence of hemorrhagic-type disease in a smallpox outbreak is not necessarily indicative of selection for virulence. In a 1945-46 hospital-centered outbreak among U.S. military personnel in Japan, Horst Agerty reported 17 adult cases, with 10 fatalities of the hemorrhagic type. Many of the deceased had been vaccinated within three years of the outbreak, presumably with faulty technique or degraded vaccine, according to Agerty. I analyzed this outbreak as reported and supplied some figures and comments to Dr. Zelicoff. For the 1999 modeling study by John Bombardt that I managed at the Defense Threat Reduction Agency, Dr. Agerty was interviewed - he was then nearly a centenarian, but sharp as a tack.