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Source: World Health Organization (WHO)

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Accidental exposure to smallpox vaccine in the Russian Federation

The recent report of illness amongst eight young children in Vladivostock who had played with discarded ampoules of smallpox vaccine, has now been confirmed by the Ministry of Health of the Russian Federation. Laboratory confirmation of the illness in the children is being sought. The report has evoked much public concern. In some of the reports, there were misconceptions about the components of the vaccine used to prevent smallpox, and about why any country might still be retaining stocks of smallpox vaccine. This note aims to clarify these issues.

1) Smallpox vaccine is not made from smallpox virus.

The vaccine which was used for centuries to vaccinate against smallpox was not made from smallpox, but from vaccinia virus. Vaccinia is a different virus from the virus that causes smallpox. However, it is a member of the same family of viruses to which the smallpox virus belongs. The smallpox virus is also known as variola virus. Mass vaccinations with smallpox vaccine made from vaccinia virus led to the eradication of smallpox announced by WHO in 1980. People vaccinated with smallpox vaccine (vaccinia) develop reactions to it which range from mild and transient to severe and, very rarely, fatal.

2) Two countries still keep smallpox virus (variola) stocks

Although smallpox disease has been eradicated, two laboratories still hold stocks of smallpox virus (variola). These are the WHO Collaborating Centres in Atlanta (USA) and Koltsovo (Russian Federation).

3) Many countries still hold smallpox vaccine (vaccinia) stocks.

WHO recommends that countries which still have stocks of smallpox vaccine (vaccinia) maintain these stocks. This recommendation has been made for two reasons. Firstly, small amounts of vaccine are still needed to vaccinate laboratory personnel handling vaccinia virus and other members of this virus family. Some of these viruses are found in nature and cause illness among animals, and some are used in research to make new, safer vaccines against a variety of infectious diseases. Secondly, smallpox vaccine (vaccinia) will also be needed in case of a deliberate or accidental release of smallpox virus (variola), which is a very unlikely event but currently of great concern to some countries.

4) Disposal of biological materials and pharmaceuticals

All biological materials and pharmaceuticals such as vaccines, drugs and diagnostic specimens should be disposed of safely. Some may require inactivation before disposal. This can be accomplished by autoclaving or incineration.

Acute haemorrhagic fever syndrome in Afghanistan

An outbreak of acute haemorrhagic fever syndrome has been reported from an isolated village in Gulran district, Afghanistan. Disease symptoms are compatible with Crimean-Congo haemorrhagic fever (CCHF). An international team, coordinated by WHO, arrived in the affected area on 16 June to control and investigate this outbreak. The team comprises experts from the WHO Collaborating Centre at the National Institute of Virology (NIV - South Africa), Epicentre (France) and WHO. Preliminary findings indicate that cases began at the beginning of May and are continuing to occur. Twenty-five suspect cases, including 15 deaths, were identified by the team. Samples were collected and transported to NIV where diagnostic laboratory tests will be performed to establish the aetiology of the outbreak.

The team has provided basic protective materials (gloves, masks), disinfectants (chlorine bleach) and instructions for their use in caring for patients with bleeding symptoms. An isolation area has been identified in the hospital in Herat to deal with haemorrhagic patients and will be equipped by WHO. Training in barrier nursing will be provided to medical and nursing staff.

E. coli O157 in Canada

The Public Health Unit for the town of Walkerton, Ontario (population 5,000) has reported an outbreak of E. coli O157. As at 30 May, 5 people had died and 27 were hospitalised. Exposure to E. coli is believed to have occurred between 12-15 May. Tests have confirmed E. coli contamination in the Walkerton water supply system. On 21 May, the Public Health Unit issued a 'Boil Water Order' to the residents of Walkerton which is still in effect. Investigations are under way by provincial and federal health and environmental authorities.


This article was published in Communicable Diseases Intelligence Volume 24, No 6, June 2000.