[Smallpox, bioterrorism agent].
A CONSIDERABLE RISK: Among the infectious agents that might be used as terrorist weapons, the smallpox virus represents a sufficiently high risk, which is difficult to manage and must be seriously taken into account.
Two viral strains of the smallpox virus, which belong to the Poxviridae and orthopoxvirus-type families, are known. They are associated with various clinical presentations of smallpox, i.e., variola major and variola minor or "alastrim".
Five clinical forms of varying prognosis are described. Common smallpox, haemorrhagic smallpox (the most severe form of the disease), mild smallpox (predominantly observed in vaccinated patients), flat-type smallpox (defined by coalescent and slowly progressive lesions) and so-called "sine eruptione" smallpox.
This form is not as severe as variola major and the mortality rate is lesser.


METHODS
Smallpox must be systematically evoked on clinical elements and confirmed by electronic microscopy of a sample of liquid from a vesicle or pustule or a scab. The strains can be characterised by PCR (Polymerase Chain Reaction).


METHODS
It is symptomatic. Early vaccination, within 4 days following exposure to the virus, permits the reduction in mortality by 50%. The only efficient prevention is vaccination prior to any exposure to the virus. In the case of a bioterrorist attack, the United States and most of the EC countries propose to vaccinate only the health professionnals most exposed to the virus and those having contacted identified cases.
Bossi
Philippe
P
Service de maladies infectieuses et tropicales, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris. philippe.bossi@psl.ap-hop-paris.fr
Bricaire
François
F
D023482:Bioterrorism; D004279:DNA, Viral / Q000032:analysis; D004189:Disaster Planning; D005060:Europe; D006282:Health Personnel; D006801:Humans; D009026:Mortality; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011634:Public Health; D012720:Severity of Illness Index; D012899:Smallpox / Q000473:pathology* / Q000517:prevention & control / Q000635:transmission; D012900:Smallpox Vaccine; D014481:United States
D004279:DNA, Viral; D012900:Smallpox Vaccine