Smallpox - Annual Epidemiological Report 2016 [2014 data]

surveillance report
Publication series: Annual Epidemiological Report on Communicable Diseases in Europe
Time period covered: Reporting on 2014 data retrieved from TESSy* on 19 November 2015
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European Centre for Disease Prevention and Control. Annual Epidemiological Report 2016 – Smallpox. [Internet]. Stockholm: ECDC; 2016 [cited YYYY Month DD].

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There were no reports of smallpox or potential smallpox in EU/EEA countries or other countries in 2014.

Reporting on 2014 data retrieved from TESSy* on 19 November 2015

Key facts

• There were no reports of smallpox or potential smallpox in EU/EEA or other countries in 2014.

Smallpox was declared eradicated in 1980.

Methods

Click here for a detailed description of the methods used to produce this annual report

  • Data were obtained from 27 EU/EEA countries; Croatia, Portugal and Liechtenstein did not submit data.
  • The EU case definition was used by 21 countries; three countries used an alternative case definition, and three countries did not specify the case definition.
  • Surveillance is compulsory in 26 EU/EEA countries; surveillance systems are comprehensive and mostly passive (Annex).

Epidemiology

There were no reports of smallpox or potential smallpox in EU/EEA countries or other countries in 2014.

Discussion

Smallpox is a systemic infectious disease, unique to humans, caused by either of two orthopoxvirus variants, Variola major and Variola minor. In 1980, the World Health Organization declared smallpox eradicated.

Mass smallpox vaccination campaigns have ceased after eradication. Consequently, the population that is immunologically naïve to orthopoxviruses has increased significantly, which makes it possible to consider smallpox viruses for use as a biological weapon. Legitimately, the virus exists only in two WHO reference laboratories. Any new case of smallpox would have to be the result of accidental or deliberate release. On 1 July 2014, the US National Institutes of Health (NIH) notified an episode where employees discovered vials labeled ‘variola’ in an unused portion of a storage room in a Food and Drug Administration laboratory located on the NIH Bethesda campus (Maryland, USA). There is no evidence that any of the vials were breached; onsite biosafety personnel did not identify any infectious exposure risk to lab workers or the public [1].

The disease clinically and immunologically most similar to smallpox is monkeypox, a zoonosis endemic to moist forested regions in West and Central Africa. Smallpox vaccine provided protection against both infections. The observation of monkeypox cases in humans in the Democratic Republic of Congo over several years prompts the question of whether the cessation of smallpox vaccination drives this phenomenon [2,3].

References

1. Centers for Disease Control and Prevention. CDC media statement on newly discovered smallpox specimens 2014 [cited 2014 July 8]. Available from: http://www.cdc.gov/media/releases/2014/s0708-NIH.html  

2. Petersen BW, Damon IK, Pertowski CA, Meaney-Delman D, Guarnizo JT, Beigi RH, et al. Clinical guidance for smallpox vaccine use in a postevent vaccination program. MMWR Recomm Rep. 2015 Feb 20;64(RR-02):1-26.

3. Reynolds MG, Damon IK. Outbreaks of human monkeypox after cessation of smallpox vaccination. Trends Microbiol. 2012 Feb;20(2):80-7.