Wednesday, April 9, 2014

The 1970 Outbreak of Smallpox in a German Hospital

"In an extraordinary outbreak in Meschede, West Germany in 1970, a patient with undiagnosed smallpox infected 17 other persons in the hospital without having had direct contact with an of them." Donald R. Hopkins, The Greatest Killer: Smallpox in History


representation/smallpox
Author's note: In 2006 I delivered a presentation in Dubai on the Soviet Biopreparat program to the UAE Ministry of Public Health. On the panel with me were two virologists from WHO and a leading smallpox expert from the United States. The US expert Michael Lane, provided one of the most detailed analysis of the smallpox outbreak in Menschede, West Germany that I have ever seen presented. When we consider the risk posed by offensive biological weapon research in states such as Syria, Iran and North Korea, smallpox tops the list of concerns.

The Menschede outbreak teaches us that we can never be too careful in our national assessments. Moreover, although Germany at the time probably had considerable standards of hygiene and knowledge of smallpox, they did not take appropriate precautions. One hopes today that the issues which allowed this tragedy to occur have been resolved, however as smallpox has been eradicated and diagnosis could therefore be more complicated, we have to consider that this remains an issue.Smallpox is the first disease in human history to be eradicated and humans are the only known host. In 1979, the disease was eradicated. In 1980 the World Health Organization formally announced its eradication. Its easy to forget that just over 25 years ago, smallpox was still infecting, blinding, scaring and killing its victims.

This is a brief overview of the German hospital smallpox outbreak. We should consider that if an accidental or deliberate release were occur in an undeclared lab today, we could face a re-emerging scourge for which there is now very low herd immunity, as global vaccination programs ended 25 years ago.



"Since 1960, smallpox has been introduced into 10 European countries on 28 separate occasions. Most commonly, the index case was infected in Asia and returned to Europe by air during the period December—May. Subsequent cases have occurred mainly among persons exposed by direct, face-to-face, contact in the household or hospital. Medical and hospital personnel, patients and visitors constituted approximately half of all cases in these outbreaks. "(see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427800/) "In a recent outbreak in Meschede, Federal Republic of Germany, detailed epidemiological studies have clearly indicated that 17 of the 20 cases were infected by virus particles disseminated by air over a considerable distance within a single hospital building. Several features believed to be of importance in this unusual pattern of transmission were common to a similar outbreak in the Federal Republic of Germany in 1961 in which airborne transmission also occurred. These features include a source case with extensive rash and cough, low relative humidity in the hospital and air currents which caused rapid dissemination of the virus. While airborne transmission of this sort is rarely observed in smallpox outbreak, it is important to recognize that it may occur under certain circumstances." See: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427800/

"The case in Meschede (West) Germany is an interesting one to revisit. Even though the patient was placed on an infectious diseases isolation ward on the ground floor of a three story hospital, confined to his room and only came in contact with two nurses, 20 people fell ill. Once smallpox was confirmed (initially it was suspected he had Typhoid Fever), the personnel who had been in contact with him were vaccinated and transferred for observation. All other staff and patients both in the isolation unit and on the upper floors were immunized and a quarantine was imposed. Of the 20 patients exposed, four died. Of the four patients who died, three were unconfimred as having previous vaccination against smallpox. Ventilation of the rooms was via open windows and in a smoke study it was concluded that transmission in some of the cases was via this route. In two of the cases the patients had been in direct contact with the index case. 17 had no contact." For complete analysis of the outbreak see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427800/?page=2



CDC

The German hospital case of an airborne outbreak of smallpox is certainly interesting and should serve as a lesson regarding the possible re-emergence of this disease. While the remaining stocks exist officially only at two repositories CDC and Vector, the US IC in 2002 issued statements with regard to undeclared stocks in countries of concern remain Syria, Iran and North Korea. 
Dragon voice recognition

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