Journal
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
Volume 2, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fcimb.2012.00150
Keywords
smallpox; bioterrorism; biodefense; variola virus; air microbiology; communicable diseases; airborne infection transmission; contact infection transmission
Categories
Funding
- Alfred R Sloan Foundation
- Association of Schools of Public Health Cooperative Agreement
- Centers for Disease Control, National Institute for Occupational Safety and Health
- National Institute of Allergy and Infectious Diseases [R21-AI053522]
- National Institute for Environmental Health Sciences Center [2P30ES00002]
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The mode of infection transmission has profound implications for effective containment by public health interventions. The mode of smallpox transmission was never conclusively established. Although, respiratory droplet transmission was generally regarded as the primary mode of transmission, the relative importance of large ballistic droplets and fine particle aerosols that remain suspended in air for more than a few seconds was never resolved. This review examines evidence from the history of variolation, data on mucosal infection collected in the last decades of smallpox transmission, aerosol measurements, animal models, reports of smallpox lung among healthcare workers, and the epidemiology of smallpox regarding the potential importance of fine particle aerosol mediated transmission. I introduce briefly the term anisotropic infection to describe the behavior of Variola major in which route of infection appears to have altered the severity of disease.
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