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U.S. Smallpox Vaccination Strategy Makes Sense, Duke Expert Says

Federal health officials' plan to vaccinate the entire United States population against smallpox within five days of an outbreak is a sensible strategy that could prevent an epidemic, said a Duke University professor who has written a book on the disease.

"If the threat of biological warfare is real, it's clearly necessary to have such a plan," said history professor Elizabeth Fenn, author of Pox Americana: The Great Smallpox Epidemic of 1775-82 (Hill and Wang, 2001). "I think they're doing exactly the right thing -- they're not vaccinating everybody now, but it's there if they need it."

According to news reports, federal health officials have prepared a manual intended as a guide for state and local health officials nationwide to operate mass vaccination clinics if an outbreak occurs.

People infected with smallpox are symptom-free and not contagious for 12 days after infection. In this era of air travel, the virus's 12-day incubation period creates the potential for a "global pandemic the likes of which have never, ever been seen," said Fenn, an assistant professor of history at Duke who teaches a class on the history of epidemics in America.

However, strategies such as mass vaccination make that epidemic scenario unlikely. "Vaccination works," she said.

She said the government is wise not to do mass vaccinations before an outbreak because of the danger posed by the vaccine itself. The smallpox vaccine is a live virus, and can cause serious complications, she said.

Fenn can be reached for additional comment at (919) 684-2192 or by e-mail at efenn@duke.edu.