Poxvirus Dilemmas — Monkeypox, Smallpox, and Biologic Terrorism

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Abstract
More than 20 years have passed since the last case of smallpox was confirmed and 18 years since the International Commission for the Certification of Smallpox Eradication of the World Health Organization (WHO) concluded that the global eradication of smallpox had been achieved.1,2 Now, new dilemmas confront the world. Could recent outbreaks of human monkeypox in the Democratic Republic of the Congo (known as Zaire from 1971 to 1997)3-5 represent the return of another form of smallpox?6 Could variola (smallpox) virus be used as a weapon of biologic terrorism? And what are the implications of the decision of the WHO to advise the destruction of all isolates of the smallpox virus in June 1999?7

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