title: The new cell culture smallpox vaccine should be offered to the general population.
abstract: A series of major factors must be weighed in deciding whether or not, and to what extent, a particular country should consider pre-exposure vaccination for smallpox. These include the risk of a bioterrorist attack using smallpox, the risk of secondary spread from another country, the risks and benefits of vaccination, the effectivenes s of vaccination pre- and post-exposure, the prevalence of immunocompromised persons, the capacity of the medical care delivery system and the wealth of a nation. We review here the issues and variables relevant for policy making, propose a framework for country-specific decision making and suggest the World Health Organization has a key role to play, particularly with regard to lower-income countries. In doing so, we support the proposition.
authors.affiliation: Department of International Health, School of Public Health, Boston University, USA. wbicknel@bu.edu
authors.forename: William
authors.initials: W
authors.lastname: Bicknell
authors.forename: Kenneth
authors.initials: K
authors.lastname: James
mesh_terms: D023482:Bioterrorism; D006801:Humans; D032541:Mass Vaccination / Q000379:methods*; D011634:Public Health; D012899:Smallpox / Q000453:epidemiology / Q000517:prevention & control*; D012900:Smallpox Vaccine / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology / Q000592:standards; D014481:United States / Q000453:epidemiology; D014944:World Health Organization
chemical_list: D012900:Smallpox Vaccine