title: [Lessons learnt from the German smallpox outbreaks after World War II].
abstract: BACKGROUND
  Even though smallpox was declared eradicated by WHO in 1980, it cannot be ruled out that the etiological variola virus could be used as a biological weapon. Undestroyed viruses from biowarfare programmes, virus strains left undetected in a freezer or dangerous recombinant poxvirus constructs could cause dangerous outbreaks in a relatively unprotected population.
  
  
  OBJECTIVE
  Despite an abundance of studies performed during the eradication of smallpox, epidemiological data for preparedness planning and outbreak control in modern, industrialized countries are scarce.
  
  
  METHODS
  Full-text hand search for the period from 1945 to 1975 in the main German public health journals.
  
  
  RESULTS
  After World War II 12 smallpox outbreaks occurred in Germany. They were studied with the focus on the period of contagiousness, the protective effect of vaccination, booster-effect of revaccination and the place of infection. A total of 95 individuals contracted smallpox, including 10 fatalities. Despite having been previously vaccinated, 81 vaccinated persons came down with smallpox, yet 91% of them developed only mild symptoms. These patients presented a high risk for spreading the infection to contact persons due to misinterpretation of symptoms and the continuing social contacts. Basically, the risk of transmission in the first 2 to 3 days after onset of symptoms was low, thus facilitating antiepidemic measures. The importance of hospital preparedness is emphasized by the fact that most infections occurred in hospitals.
  
  
  CONCLUSIONS
  The data analyzed provide valuable information for today's outbreak response planning and counter bioterrorism preparedness.
authors.affiliation: Robert Koch-Institut, Nordufer 20, 13353, Berlin, Deutschland, SasseJ@rki.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Sasse
authors.forename: Hans R
authors.initials: HR
authors.lastname: Gelderblom
mesh_terms: D023482:Bioterrorism / Q000517:prevention & control* / Q000706:statistics & numerical data; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D012899:Smallpox / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D012900:Smallpox Vaccine / Q000627:therapeutic use*; D015996:Survival Rate
chemical_list: D012900:Smallpox Vaccine