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A growing amount of international travel, at increasing speeds, to and from areas of the world in which smallpox is prevalent, per-, sistently threatens to introduce the disease into the United States. Recent outbreaks in other Western nations emphasize the need for attention to this problem.
A “perimeter defense" against the disease—the requirement for vaccination of people coming into the country, and public health surveillance of ports of entry— is not adquate when "the inner defense is weak." Smallpox, one of the easiest diseases to prevent, is highly contagious. The virus can be spread by coughs and sneezes or even in dust. It has even been transmitted by letter. The disease often results in severe scarring of its victims, and death results in about one out of five cases. With so much of our population lacking immunity, it only takes one case to touch off an epidemic. A soldier caused infection to spread to 100 people before it was discovered he had smallpox. A traveler from Japan seeded 65 cases and caused 20 deaths after arriving from Japan, although when he landed he showed no symptoms of the disease. Rapid increase in the amount of international travel is steadily enlarging the risk of such epidemics in the United States.
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