Smallpox in the post-eradication era

Smallpox is a recently extinct human viral infection for which herd immunity has rapidly waned. The threat of smallpox during a bioterrorist event using caches of virus outside reference repositories would lead to epidemics of great and predictable mortality. The result would be short-term societal chaos. Control of smallpox requires vaccination and quarantine, the same measures that eliminated this disease in the 1970's. Extensive coordination and planning would be needed among the healthcare infrastructure, law enforcement agencies and political leadership for effective responses to this public health threat. Despite this challenge, we must remind ourselves that smallpox transmission and vaccinia effectiveness are well understood. Strategies that successfully eradicated smallpox 25 years ago, if appropriately implemented again, would undoubtedly lead to its elimination once again.