Smallpox vaccines for biodefense: need and feasibility

Abstract

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.

Keywords::

• bioterrorism
• myopericarditis
• smallpox
• smallpox vaccine
• vaccine safety
• vaccinia

Acknowledgements

The authors wish to acknowledge Katherine Bollesen and Margo Katz for administrative assistance with the manuscript.

Financial & competing interests disclosure

AW Artenstein has served as a consultant to Acambis, Inc., but has no ongoing financial relationship with the company. JD Grabenstein is an employee of Merck & Co., Inc., which does not manufacture vaccinia or any related vaccine. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.