Letter to the editor


  • Erik Heegaard, MD, PhD, DMSc
  • Martin B. Oleksiewicz, DVM, PhD
  • Nina R. Steenhard, DVM, PhD
  • John-Erik S. Hansen, MD, DMSc




vaccine stockpiles, disaster medicine


Modernizing smallpox vaccine stockpiles


Authors’ response

Author Biographies

Erik Heegaard, MD, PhD, DMSc

Biosecurity Institute, Holte, Denmark

Martin B. Oleksiewicz, DVM, PhD

Centre for Biosecurity and Biopreparedness, Copenhagen, Denmark

Nina R. Steenhard, DVM, PhD

Centre for Biosecurity and Biopreparedness, Copenhagen, Denmark

John-Erik S. Hansen, MD, DMSc

Centre for Biosecurity and Biopreparedness, Copenhagen, Denmark


Oleksiewicz M, Steenhard NR, Hansen JES: Modernizing stockpiles of medical countermeasures against smallpox: Benefits, risks, and knowledge gaps. Am J Dis Med. 2015; 10(2): 109-120.

Gaudioso JM, Brooks T, Furukawa K, et al.: Likelihood of Smallpox Recurrence. Journal of Bioterrorism and Biodefense. 2011; 2(2): 1-7.

L'vov DK, Zverev VV, Gintsburg AL, et al.: [Smallpox is a dormant volcano]. Vopr Virusol. 2008; 53(4):4-8.

Phillips KE: Climate threat: thawing tundra releases infected corpses. Available at www.livescience.com/environment/080327-smallpox-corpses.html. Accessed April 7, 2016.

Tucker.J: The smallpox destruction debate: could a grand bargain settle the issue? Available at www.armscontrol.org/act/2009_03/tucker. Accessed April 7, 2016.

Century-old smallpox scabs discovered. Available at: http://www.thefreelibrary.com/Century-old+small pox+scabs+discovered.-a0114339157. Accessed April 7, 2016.

Wolff HL, Croon JJ: The survival of smallpox virus (variola minor) in natural circumstances. Bull World Health Organ. 1968; 38(3):492-493.

Jackson RJ, Ramsay AJ, Christensen CD, et al.: Expression of mouse interleukin-4 by a recombinant ectromelia virus suppresses cytolytic lymphocyte responses and overcomes genetic resistance to mousepox. J Virol. 2001; 75(3): 1205-1210.

Shchelkunov SN, Totmenin AV, Babkin IV, et al.: Human monkeypox and smallpox viruses: genomic comparison. FEBS Lett. 2001; 509(1): 66-70.

Cello J, Paul AV, Wimmer E: Chemical synthesis of poliovirus cDNA: generation of infectious virus in the absence of natural template. Science. 2002; 297(5583): 1016-1018.

Smith HO, Hutchison CA, Pfannkoch C, et al.: Generating a synthetic genome by whole genome assembly: phiX174 bacteriophage from synthetic oligonucleotides. Proc Natl Acad Sci USA. 2003; 100(26): 15440-15445.

Tumpey TM, Basler CF, Aguilar PV, et al.: Characterization of the reconstructed 1918 Spanish influenza pandemic virus. Science. 2005; 310(5745): 77-80.

Enterlein S, Volchkov V, Weik M, et al.: Rescue of recombinant Marburg virus from cDNA is dependent on nucleocapsid protein VP30. J Virol. 2006; 80(2): 1038-1043.

Becker MM, Graham RL, Donaldson EF, et al.: Synthetic recombinant bat SARS-like coronavirus is infectious in cultured cells and in mice. Proc Natl Acad Sci USA. 2008; 105(50): 19944-19949.

Gibson DG, Benders GA, Andrews-Pfannkoch C, et al.: Complete chemical synthesis, assembly, and cloning of a Mycoplasma genitalium genome. Science. 2008; 319(5867): 1215-1220.

Gibson DG, Glass JI, Lartigue C., et al.: Creation of a bacterial cell controlled by a chemically synthesized genome. Science. 2010; 329(5987): 52-56.

Mitchell E, O'Mahony M, Watson JM, et al.: Two outbreaks of legionnaires' disease in Bolton Health District. Epidemiol Infect. 1990; 104(2): 159-170.

Final report on potential breaches of biosecurity at the Pirbright site 2007. Available at http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/07_09_07finalreporthsefandm.pdf. Accessed April 7, 2016.

Miller J: Russian Scientist Dies in Ebola Accident at Former Weapons Lab. The New York Times. May 25, 2004. Available at http://www.nytimes.com/2004/05/25/world/russian-scientistdies-in-ebola-accident-at-former-weapons-lab.html. Accessed April 7, 2016.

Canadian-made ebola vaccine used after German lab accident. The Canadian Press. Mar 20, 2009. Available at: http://www.cbc.ca/news/technology/canadian-made-ebola-vaccine-usedafter-german-lab-accident-1.827949. Accessed April 7, 2016.

Kortepeter MG, Martin JW, Rusnak JM, et al.: Managing potential laboratory exposure to ebola virus by using a patient biocontainment care unit. Emerg Infect Dis. 2008; 14(6): 881-887.

Author’s reply:

Heegaard E: Letter to the editor, regarding publication on modernizing stockpiles of medical countermeasures against smallpox. Am. J. Disaster Med. 2016; 9(4): PP-PP.

Gaudioso J, Brooks T, Furukawa K, et al: Likelihood of Smallpox Recurrence. J. Bioterr. Biodef. 2011; 2: 106.

Oleksiewicz MB, Steenhard NR, Hansen JE: Modernizing stockpiles of medical countermeasures against smallpox: Benefits, risks, and knowledge gaps. Am. J Disaster Med. 2015; 10: 109-120.

Tucker JB: Breaking the deadlock over destruction of the smallpox virus stocks. Biosecur. Bioterror. 2011; 9: 55-67.

Fenner F: Can smallpox return? World Health Forum. 1987; 8: 297-304. Available at: http://apps.who.int/iris/handle/10665/49821. Accessed April 14, 2016.

Fenner F, Henderson DA, Arita I, et al: Potential sources for a return of smallpox. 1988, World Health Organization, Geneva. In: Smallpox and its eradication, chapter 30, 1321-1345. Available at: http://apps.who.int/iris/handle/10665/39485. Accessed April 14, 2016.

World Health Organization: WHO Advisory Committee on Variola Virus Research, report of the sixth meeting. 2004. Available at: http://www.who.int/csr/resources/publications/WHO_CDS_CSR_ARO_2005_4/en/. Accessed April 14, 2016.

Scientific review of variola virus research, 1999-2010. World Health Organisation. 2010. Available at: http://whqlibdoc.who.int/hq/2010/WHO_HSE_GAR_BDP_2010.3_eng.pdf. Accessed April 14, 2016.

Paté-Cornell E, Guikema S: Probabilistic Modeling of Terrorist Threats: A Systems Analysis Approach to Setting Priorities Among Countermeasures. Military Operations Research. 2002; 7: 5-20. Available at: http://onlinepubs.trb.org/onlinepubs/archive/conferences/MB/PateCornellPaper.pdf Accessed April 14, 2016.

Committee on Methodological Improvements to the Department of Homeland Security’s Biological Agent Risk Analysis, US National Research Council: Department of Homeland Security Bioterrorism Risk Assessment: A Call for Change. 2008. Available at: http://www.nap.edu/catalog/12206/department-of-homelandsecurity-bioterrorism-risk-assessment-a-call-for. Accessed April 14, 2016.

Gryphon Scientific: Risk and Benefit Analysis of Gain of Function Research. Draft Final Report. December 2015. Available at: http://www.gryphonscientific.com/wp-content/uploads/2015/12/Final-Gain-of-Function-Risk-Benefit-Analysis-Report-12.14.2015.pdf. Accessed April 14, 2016.

Rotz LD, Khan AS, Lillibridge SR, et al: Public health assessment of potential biological terrorism agents. Emerg. Infect. Dis. 2002; 8: 225230.

MacIntyre CR, Seccull A, Lane JM, et al: Development of a risk-priority score for category A bioterrorism agents as an aid for public health policy. Mil Med. 2006; 171: 589-594.

Tomuzia K, Menrath A, Frentzel H, et al: Development of a comparative risk ranking system for agents posing a bioterrorism threat to human or animal populations. Biosecur. Bioterror. 2013; 11: Suppl 1, S3-S16.

Boddie C, Watson M, Ackerman G, et al: BIOSECURITY. Assessing the bioweapons threat. Science. 2015; 349: 792793.

Ezell BC, Bennett SP, von Winterfeldt D, et al: Probabilistic risk analysis and terrorism risk. Risk Anal. 2010; 30: 575-589.

National Science Advisory Board for Biosecurity: Working Paper Prepared by the NSABB Working Group on Evaluating the Risks and Benefits of Gain-of-Function Studies to Formulate Policy Recommendations. Deliberative draft. December 23, 2015. Available at: http://osp.od.nih.gov/office-biotechnology-activities/event/2016-01-07-130000-2016-01-08-220000/national-scienceadvisory-board-biosecurity-nsabb-meeting. Accessed April 14, 2016.

Meltzer MI: Risks and benefits of preexposure and postexposure smallpox vaccination. Emerg. Infect. Dis. 2003; 9: 1363-1370.

Banks DL, Anderson S: Combining Game Theory and Risk Analysis in Counterterrorism: A Smallpox Example. 2008. In: Department of Homeland Security Bioterrorism Risk Assessment: A Call for Change. Appendix F. Available at: http://www.nap.edu/catalog/12206/department-of-homeland-securitybioterrorism-risk-assessment-a-call-for. Accessed April 14, 2016.

German Federal Office of Civil Protection and Disaster Assistance: Method of Risk Analysis for Civil Protection. 2011. Available at: http://www.bbk.bund.de/SharedDocs/Downloads/BBK/EN/booklets_leaflets/Method_of_%20Risk_Analysis.pdf?__blob=publicationFile. Accessed April 14, 2016.

Petersen BW, Damon IK, Pertowski CA, et al: Clinical Guidance for Smallpox Vaccine Use in a Postevent Vaccination Program. MMWR Recomm. Rep. 2015; 64(RR-02): 1-26.

World Health Organization: WHO Strategic Advisory Group of Experts (SAGE) report, consultation on smallpox vaccines, final draft. 17 October 2013. Available at: http://www.who.int/immunization/sage/meetings/2013/november/1_SAGE_report_consultation_smallpox.pdf. Accessed April 14, 2016.

European Medicines Agency, Public Assessment Report, Imvanex. 2013. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Public_assessment_ report/human/002596/WC500147898.pdf. Accessed April 14, 2016.




How to Cite

Heegaard, MD, PhD, DMSc, E., M. B. Oleksiewicz, DVM, PhD, N. R. Steenhard, DVM, PhD, and J.-E. S. Hansen, MD, DMSc. “Letter to the Editor”. American Journal of Disaster Medicine, vol. 10, no. 4, Oct. 2015, pp. 354-66, doi:10.5055/ajdm.2015.0218.




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