What CDC Is Doing to Protect the Public From Smallpox

Smallpox Response Plan and Guidelines

Smallpox was declared globally eradicated in 1980; however, there are concerns that the smallpox virus could be used for bioterrorism. Strategies are under development to protect the American public should this disease be brought back as a bioterrorism weapon.

The Smallpox Response Plan and Guidelines has been developed to provide direction to state and local health officials for responding to a smallpox emergency. The plan identifies many of the federal, state, and local public health activities that need to be undertaken in a smallpox emergency. It also provides guidelines for many of the general public health activities that would be undertaken during a smallpox emergency.

Download the Executive Summary (310 KB/14 pages)

Vaccination strategies

The eradication of smallpox in the 1970s can be attributed to the vaccine and the way it was given. The following two approaches were used to eradicate the disease in the 1970s and are under consideration for the Smallpox Response Plan and Guidelines.

Mass vaccination: At first, smallpox vaccine was given to large numbers of people who often had not been exposed to smallpox. This approach was called mass vaccination. The mass vaccination strategy helped protect people from smallpox, but it wasn't enough to completely get rid of the disease. That is because not everyone got vaccinated, and those who didn't could spread the disease.

Ring vaccination: In 1967, a different plan was used. It involved finding people who were exposed to an infected person. The exposed person and those people he or she had been in contact with were then given the vaccine. That is, the smallpox vaccine was given to those people who had been, or could have been, exposed to an infected person. This approach created a "ring" of vaccinated people around the people who were infected with smallpox and stopped the spread of the disease. In the end, it was this strategy of "ring vaccination" that completely got rid of the disease.

Bioterrorism preparations

There are concerns that the smallpox virus could be used for bioterrorism. The risk for smallpox occurring as a result of a deliberate release by terrorists is not known, but is considered very low. On May 8-9, 2002, a joint working group consisting of members of the Advisory Committee on Immunization Practices (ACIP) and the National Vaccine Advisory Committee (NVAC), two groups that provide recommendations to CDC and the Department of Health and Human Services (DHHS) on vaccine use and policies, met in Atlanta as part of their review of the current smallpox vaccine recommendations. This working group was convened to review the June 2001 ACIP recommendations on smallpox vaccination in light of recent events, including the expected availability of about 286 million doses of smallpox vaccine by the end of the year. As a result, we now have in the stockpile, enough vaccine to vaccinate every person in the United States.

Draft Supplemental Recommendations of the ACIP

CDC and the Department of Health and Human Services (DHHS) requested that the Advisory Committee on Immunization Practices (ACIP), a group that advises CDC on vaccine use and policies, provide an updated set of vaccinia (smallpox) vaccine recommendations. The Draft Supplemental Recommendations of the ACIP on the Use of Smallpox (Vaccinia) Vaccine were approved by ACIP on June 20, 2002, and now have been published in the MMWR.

For more about smallpox, see Smallpox Disease.