Author Affiliations: The Center for Civilian Biodefense Studies (Drs Henderson, Inglesby, Bartlett, O'Toole, Perl, and Russell), and the Schools of Public Health (Drs Henderson, O'Toole, and Russell) and Medicine (Drs Inglesby, Bartlett, and Perl), Johns Hopkins University, Baltimore, Md; Viral and Rickettsial Diseases, California Department of Health, Berkeley (Dr Ascher); US Army Medical Research Institute of Infectious Diseases, Frederick, Md (Drs Eitzen, Jahrling, and Parker); Office of Emergency Management (Mr Hauer) and Office of Communicable Disease, New York City Health Department (Dr Layton), New York, NY; Centers for Disease Control and Prevention, Atlanta, Ga (Dr McDade); Acute Disease Epidemiology, Minnesota Department of Health, Minneapolis (Dr Osterholm); and Office of Emergency Preparedness, Department of Health and Human Services, Rockville, Md (Dr Tonat).
Objective To develop consensus-based recommendations for
measures to be taken by medical and public health professionals
following the use of smallpox as a biological weapon against a civilian
Participants The working group included 21 representatives from
staff of major medical centers and research, government, military,
public health, and emergency management institutions and agencies.
Evidence The first author (D.A.H.) conducted a literature search
in conjunction with the preparation of another publication on
smallpox as well as this article. The literature identified was
reviewed and opinions were sought from experts in the diagnosis and
management of smallpox, including members of the working group.
Consensus Process The first draft of the consensus statement was a
synthesis of information obtained in the evidence-gathering process.
Members of the working group provided formal written comments that were
incorporated into the second draft of the statement. The working group
reviewed the second draft on October 30, 1998. No significant
disagreements existed and comments were incorporated into a third
draft. The fourth and final statement incorporates all relevant
evidence obtained by the literature search in conjunction with final
consensus recommendations supported by all working group members.
Conclusions Specific recommendations are made regarding smallpox
vaccination, therapy, postexposure isolation and infection control,
hospital epidemiology and infection control, home care, decontamination
of the environment, and additional research needs. In the event of an
actual release of smallpox and subsequent epidemic, early detection,
isolation of infected individuals, surveillance of contacts, and a
focused selective vaccination program will be the essential items of an
effective control program.
Donald A. Henderson, Thomas V. Inglesby, John G. Bartlett, Michael S. Ascher, Edward Eitzen, Peter B. Jahrling, Jerome Hauer, Marcelle Layton, Joseph McDade, Michael T. Osterholm, Tara O'Toole, Gerald Parker, Trish Perl, Philip K. Russell, Kevin Tonat, for the Working Group on Civilian Biodefense. Smallpox as a Biological WeaponMedical and Public Health Management. JAMA. 1999;281(22):2127–2137. doi:10.1001/jama.281.22.2127