Smallpox: No Big Deal?

When it comes to biological weapons, smallpox has been described as one of the deadliest that could be unleashed on mankind.

But experts and those who lived through it say it's not all that bad after all, despite the annoying itching.

Rajnikant Amlani, a 62-year-old medical technician living in Hoboken, N.J., contracted smallpox when he was six or seven years old and living in India.

"I think I am one of many who had smallpox," Amlani told "I don't think anybody died … they didn't worry — most of the people are recovered."

The first week was almost insufferable as Amlani tried not to scratch the lesions and scabs that formed all over his body.

"In India, at that time, there is nothing for it," he said, so his mother covered his hands in cloth to keep him from itching.

But Amlani, like many others in India at the time, survived.

"It’s a rare disease but you shouldn't worry," he said. "I don't think you should worry too much now."

Smallpox is an infectious disease that can result in death if left untreated. The World Health Organization, however, declared the disease eradicated in 1980 after it launched a global program to wipe out the disease.

It's spread mainly through respiratory droplets from infected patients. Victims are most contagious during the first week of illness but remain infectious until lesions covering the body have scabbed over and fallen off. Only those who come within six feet or so of an infected person are considered at risk.

But now, with the United States chasing terrorists of all kinds to all corners of the globe, there is an increased fear that smallpox and other biological or chemical agents could be used as weapons that could kill thousands if they're unleashed on the American population.

But it seems as if the fear just isn't adding up to the hype.

"Unless something more definite came out, I certainly wouldn't get" a vaccination, said Lance Donaldson-Evans. "I don't think I'd rush out and get one yet anyway. I'm not convinced there's an immediate threat."

Donaldson-Evans holds this view even though he lived through the time when smallpox was regarded globally as a dangerous disease.

When he and his wife tried to bring their new baby to Australia to meet her grandparents in the 1970s, they were whisked off to a quarantine station because the baby wasn't vaccinated for smallpox. At the time, smallpox vaccinations were required for international travelers and Australia wasn't admitting visitors without it.

"We spent two weeks there, isolated from the world," Donaldson-Evans said of his experience in the station. The family stayed in a hut surrounded by a barbed wire fence with a view of the Sydney Harbor. "It was like an internment camp," he said.

But now?

"I don't know if I feel particularly worried about it," he said.

The Centers for Disease Control and Prevention in November said that smallpox appears much less infectious than commonly thought.

CDC researchers looked at data from various outbreaks around the world in the 1960s and 1970s and said most averaged less than two persons infected per infectious person. Most outbreaks recorded less than one person infected per infectious person. In all outbreaks, some infected persons didn't event transmit a symptomatic case of smallpox to another person.

This calls into question the widely publicized results of the 2001 bio-terrorism war game called "Dark Winter."

The point of the exercise was to show how an outbreak of the disease can spread like wildfire and could compromise national security. The simulation started with 20 confirmed cases in Oklahoma City and within two weeks, there were 16,000 reported cases in 25 states and 1,000 had died. Outbreaks were also reported in 10 other countries. In another three weeks, it was estimated that there would be 300,000 total victims, with 100,000 deaths.

It was a rude awakening for many in the media, law enforcement and government.

"This was very revealing to me — that there is something out there that can cause havoc in my state that I know nothing about — and, for that matter, the federal family doesn't know a whole lot [about] either," Oklahoma Gov. Frank Keating said of the drill.

So not only can some of the fear surrounding how the disease would affect the U.S. population be put to rest, the chances of it being used by terrorists may do more to quash some fear, as well.

"The technical expertise required to engineer smallpox as a bioweapon is higher than that needed to weaponize anthrax," Senate Majority Leader Bill Frist, the Senate's only doctor, wrote in his bioterror book, When Every Moment Counts, which was published last year.

Frist, while warning that smallpox needs to be taken seriously, noted that because smallpox is so contagious, terrorists would have to take many risks of infecting themselves while trying to weaponize it.

But, just in case, the United States produced enough vaccines to vaccinate the entire U.S. population after the Sept. 11 terrorists attacks and subsequent anthrax attacks.