engleski

The Smallpox Vaccination Program: 30 years after the last smallpox epidemic in Croatia

The risk of biological terrorism in the world today is well recognised. The potential impact of terrorism in the Public health sector would be very high. 30 years after the last smallpox epidemic, and 23 years after virus eradication we are now implementing the preventive Smallpox vaccination program because of terrorist threat. The authors present a retrospective analysis of the last smallpox epidemic in ex-Yugoslavia and the subsequent vaccinia epidemic in Croatia in 1972. Smallpox was imported in former state Yugoslavia from the Near East. The center of epidemy was in Kosovo region with 175 cases and 35 deaths. Nearly 16 million people (72%) were vaccinated out of 22 million inhabitants of the former state. In Croatia there were no smallpox cases recorded. But a three other great epidemics occurred: the epidemy of great fear presented itself, epidemy of excessive vaccination (lver 50% of Croatian inhabitants were vaccinated) and epidemy of side effects and vaccination complications. In these circumstances there was an ongoing campaign to organize immunization of ingabitants, perform disease diagnostics and to set up quarantine hospital. At the University Hospital for Infectous Diseases a total of 1108 (0, 20% vaccinated with the Smallpox vaccine from that time) patients were examined from the wider area or Zagreb City (Croatia) who were suffering from vaccinia disease or its complications. 492 (44, 4%) patients of the total suffered from normal (regular) vaccinia disease, while 616 (55, 5%) experienced severe complications of the disease. 227 (33, 5%) of these 616 patients had cutaneous lesions, 137 (22, 2%) had high fever, malaise and headache, 79 (12, 8%) autoinoculation, 29 (4, 7%) Central Nervous System lesions, and 1 (0, 09%) died. Severe complications occurred more frequent after revaccination. After the fear of smallpox epidemy 1972, Croatian Public Health Care respond successfully, but as the terroristic event is unique, we have to be better prepared. The main requirements for rapid detection of an epidemic, is a surveillance system that is sensitive for identyfing small clusters of illness. Such systems permit identification of disease outbreaks, whether intentional or unintentional, emerging and reemerging diseases. The primary responsibility for preventing and responding to act of terrorism, of course lies with local, national and international autorities. And, as affective in the case of contagious pathogens (they know no borders) it have to be linkage to international networks. We have plan and programs, now. Are we better prepared?

Smallpox; vaccination; bioterrorism

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