The quarantine camps
If any bioterror weapon posed an opportunity for a country to exercise control over its citizens it is the threat of smallpox. A CNN headline report reads: “Single smallpox case would trigger federal response.”  The government has plans to quarantine more than its first victim. Another report says as few as 50–100 cases would likely cause widespread concern and would require national emergency control measures including mass immunizations and strict quarantine. 
We live in a country where the federal government has, by virtue of its vast ability to burdensomely tax the public, gained control of public health. While the Constitution indicates these services and powers are to be left to the states and local authorities, it is the federal government that has the money and authority to purchase vaccines and set standards for their production and usage.
The Centers for Disease Control have published a scenario of what would happen in a smallpox outbreak which includes mass quarantine for populations at risk.  The plan would become law and would empower states to enact emergency powers to address a public health crisis. Individuals with contagious diseases such as smallpox would have no right of appeal nor be able to refuse treatment of vaccination under the law. The law would give the public the right to appeal any decision to quarantine or isolate them. Anyone who refused to comply with treatment would likely be quarantined. The wording of the law, drafted by university-based public health experts, advises states to withhold public benefits from those who refuse to cooperate rather than impose incarceration.  The latest federal directive calls for one million people to be vaccinated within just 10 days. The burden to deliver inoculations would fall on local health clinics, which would be overwhelmed with patients. The nation’s vaccine stockpile would ship 75 million doses of the vaccine in one day and 280 million doses in five to seven days.  The states would enact this law to avoid criticism of a “big brother” federal government. Some sort of proof of vaccination and re-vaccination would also need to be produced which could, in effect, become a national identification card.
A World Health Organization fact sheet says “patients diagnosed with smallpox should be physically isolated.” Then all persons who have come in contact with them should be inoculated. “The best method of stopping a smallpox outbreak, should it occur, remains the same – search and containment. This means identifying persons with smallpox, identifying those people who have been in contact with them, and vaccinating them.”  Government would have the right to search your home, circumventing the Constitution’s protections from unwarranted search and seizure.
Let’s just suppose for a moment that political figures wanted to ensure their re-election, or squelch any dissent in the country, let’s say for an unpopular war or a declining economy. All they need do is infect one individual with smallpox. The smallpox virus is in the hands of politically-influenced organizations like the World Health Organization and the Centers for Disease Control. So smallpox might be more easily secreted away by those in power than obtained by any terrorist. It would be easy to spread panic in the population by mistakenly identifying a case of the chicken pox with smallpox, which has similar symptoms, then issuing a directive that all people who came in contact with the infected person be vaccinated and quarantined. Expert doctors have mistaken chicken pox for smallpox.  Public announcements would warn the public they only have four days to get vaccinated, or else. Smallpox has a 14-day incubation period from first exposure, but vaccination within four days avoids the disease in most instances.
In other countries health authorities have been able to encircle outbreaks of disease like smallpox and vaccinate toward its center. But in a modern society where there are so many people traveling by automobile and airplane in and out of a geographical area, it may be more convenient for health authorities to remove the people who are at risk and take them to a quarantine zone. In times past these were called concentration camps. The federal government has over the past few years drafted preliminary plans to lock up masses of people at mothballed military bases should an insurrection occur. Attorney General John Ashcroft has recently asked for the establishment of tent camps.
The US Constitution was largely drafted to limit the powers of government, to provide checks and balances, to delegate most powers to the states. But with scenarios like smallpox outbreaks the Constitution is cast aside. The opportunity to use bioterror as a political weapon is unique. Smallpox outbreaks occurred in the past in the U.S. and the public didn’t panic, nor were they forced to undergo mass vaccination. Public health authorities ran the show then, not politicians. The difference today is the political control of bioterror weapons like the smallpox virus and its antidotes, the vaccines.
Ah, it will never happen you say? Recall that President Gerald Ford suggested the entire US population be vaccinated for the swine flu back in 1976. It was called “the epidemic that never was.” Just one soldier died of it at an Army base. Mass vaccination was a tactic used to help Ford get re-elected. Ford announced the inoculation campaign one day following his loss to Ronald Reagan in a North Carolina primary election. Over 40 million were vaccinated against swine flu. Mass vaccination backfired. Within days several people who took the vaccine were seriously ill. Many people developed a nerve disorder, called guillain barre syndrome. More than $3.5 billion in damages were paid out by the vaccine manufacturers to compensate 4000 victims. 
Reports about smallpox now being published only heighten public fear. One June 22–23, 2001, the various health and governmental agencies conducted an exercise called Dark Winter which mimicked a future (December 9, 2002) smallpox bioterror attack that begins in Oklahoma and spreads rapidly through 25 states and 15 foreign countries, killing thousands.  But authorities admit Dark Winter was an “extreme example of what might happen in a worst-case scenario.” 
Steven Milloy, who publishes at www.junkscience.com, reveals that a new study issued from the Centers for Disease Control indicates “smallpox appears much less infectious than commonly thought.” The report calls into question the Dark Winter scenario of widespread death and disease. The assumption that each smallpox victim will infect 10 others is questioned. Most smallpox outbreaks averaged less than two persons infected per infectious person with some cases never infecting another person. The last naturally-occurring smallpox outbreak was in October of 1977 and of 161 persons who had contact with the infected person, 12 had face-to-face contact. None of the 12 developed smallpox. 
The pox bites back
On the other hand, a terrorist could strike a deadly blow with the re-introduction of smallpox, now a conquered disease that hasn’t occurred in the US since the late 1940s. Smallpox is a potent viral weapon. It killed 500 million people in the 20th century prior to its eradication. A suicide terrorist could intentionally infect himself with smallpox and then spread it to others around him. A biomartyr could cough and sneeze his way into infamy. The terrorist could simply infect himself and then visit a health clinic past the 4-day vaccination period and receive treatment and sympathy as the world’s first new case of smallpox in decades. Smallpox would be an unwise choice as a bioterror weapon since it is a communicable disease which can, thanks to modern transportation, encircle the planet in a short time and infect human populations on every continent. It would likely come back and bite the homeland of any political terrorist.
Another possible scenario is a government that wants to employ smallpox as a bioterror weapon against its own population and escape culpability. Intelligence agencies could detect but intentionally not interfere with a bioterrorist, permitting a smallpox outbreak to occur to spread fear in the population and give government authority to invoke draconian measures against its citizens. The government could blame it all on bioterrorists.
What is smallpox?
For whatever reason, the US began ordering more smallpox vaccine months ago as if it knew there would be bio-terrorist attack coming. While the only remaining stocks of the smallpox virus are in the Novosibirsk region of Russia and at the Centers for Disease Control in Atlanta, politicians and health officials say they cannot be sure terrorists have not obtained a sample of smallpox. Stocks of camelpox virus, another pathogenic virus similar to smallpox, were found during the Gulf War in 1991. Infectious disease specialists are on guard. In 1970 the World Health Organization indicated the smallpox virus could be produced in large quantities in the laboratory and freeze-dried and preserved for months or years. If intelligence agencies knew that a pox virus was in the hands of terrorists they would not likely tell the American populace because the US stopped vaccinating all of its citizens for smallpox in 1972. Therefore the population at large is vulnerable.
Smallpox is a communicable disease. You will only have four days to get vaccinated for smallpox should you be exposed to this deadly virus.  You won’t have time to educate yourself on the safety of the vaccine. Smallpox has a 14-day incubation period and you must be inoculated within a 4-day time frame to prevent the disease. There is no conventional treatment for smallpox once infected. Oh, there is a drug, Cidofovir (Vistide, Gilead Sciences, Foster City, Ca.), which has been shown to be effective against the monkeypox, but it is unproven against smallpox and for ethical reasons no human clinical trials can be performed. Modern medicine has nothing in its armamentarium against smallpox except the troublesome vaccine. 
In 1998 there were an estimated 90 million doses of smallpox vaccine in the world. Most of it is reserved for military personnel. Earlier in the year the US had just 15 million doses of existing smallpox vaccine, made in 1982. The ideal time for a bioterrorist to attack would have been when the stocks of vaccine were low. The US government has upped its order of smallpox vaccine from 40 to 300 million doses. That much vaccine will cost over $500 million, enough to vaccinate every American. Until the new vaccine becomes available, attempts to dilute the existing stock and see if it provides immunity are underway, so that more people could be vaccinated now.  Politicians appear to be pushing for war against Iraq knowing full well it may trigger a bioterrorist response. Why President George W. Bush is pushing for war before there are adequate stocks of smallpox vaccine goes unexplained.
Just so you have advance warning, it’s a live vaccine, which means it’s a little bit of a virus (actually the vaccinia virus, a virus similar to the smallpox virus) wrapped up in an antiseptic package. The vaccine was scheduled to be delivered by mid-2004, but efforts are being made to speed up that delivery date. 
No security in the vaccine
The availability of the new vaccine will not make you feel more secure. First, health officials are not going to inoculate the population en masse until there is an outbreak of smallpox. There hasn’t been a case of smallpox in the US since the 1940s and the last case in the world was reported in the 1970s. Because of severe side effects, the World Health Organization says the vaccine won’t be used unless smallpox re-emerges.
Second, the adverse reaction rate is sufficiently high to avoid vaccination for groups that are not at risk. The vaccine is contraindicated in pregnant females, persons with immune disorders or undergoing immunosuppression therapy (organ transplants), people fighting viral infections such as HIV or herpes, people with leukemia, lymphoma, cancer, individuals undergoing cancer therapy or taking steroids, and persons with a history of skin conditions such as eczema, impetigo, shingles and dermatitis. The Dryvax vaccinia vaccine (Wyeth Labs), which is what is currently available to inoculate against smallpox, contains trace amounts of polymyxin B sulfate, streptomycin sulfate, chlortetracycline hydrochloride and neomycin sulfate. Sensitive individuals should avoid vaccination. 
We forget that the US ceased smallpox vaccinations in 1972 because many people were experiencing side effects. If the US were to vaccinate 300 million people it would guarantee the death of 300 people, says Stuart Isaacs, a pox virus specialist at the University of Pennsylvania School of Medicine. Another 3000 would develop painful boils and scars and 600 people would suffer brain damage from encephalitis.  Fever is common in adults and children and is experienced by 70% of children following inoculation. Some 15–20% experience swelling in the lymph glands.
In March of 1947 a businessman traveled by bus from Mexico City to New York City, infected with the smallpox virus. When the pox broke out, panic ensued and 6 million Americans were vaccinated in one month. But the vaccine turned out to be more deadly than the smallpox itself. The virus killed two people, but the vaccine killed six.
From 1991 to 1996 Israeli Defense Force recruits received smallpox vaccinations. The overall complication rate was 0.4 per 10,000 vaccinees. That would equal about 11,200 adverse events should the US population of 280 million undergo vaccination. [18,19] Among 14 million people vaccinated for smallpox in a study published in 1968, 9 deaths occurred.  US military personnel have refused the smallpox vaccine because of its side effects and an estimated 400 have undergone court martial or resigned rather than submit to vaccination. 
Third, the vaccinia immune globulin is required for treatment of side effects. Vaccinia immune globulin can treat the side effects but it has to be obtained from a blood sample of people recently vaccinated. Since routine smallpox vaccinations ceased in 1972, the immune globulin is in short supply. Its only current source is recently inoculated military personnel. The existing immune globulin supply turned yellow in storage so health authorities won’t permit its use. 
Fourth, the vaccine only prevents smallpox for 10 years. Fifth, about 3% of the vaccinated still die. Sixth, the new vaccine will be an unproven one. New methods of manufacture are being employed. Since human studies would be unethical, the first test of this new vaccine would be in an actual bioterror situation. Our defenses against biological weapons are often unproven. Seventh, Australian scientists stumbled onto a way to insert a gene into the smallpox virus so as to overcome vaccinated immunity. 
The variola virus
Smallpox is caused by the variola virus. There are two major strains, variolia major and variola minor. Variola major causes death in 30% of cases whereas variola minor only has a 1% fatality rate.  It is spread by water droplets containing the virus. An infected person exhales into the air and the new victim inhales into the lungs. People within 6 feet of the infected can breathe smallpox viruses into their lungs. It can also be transmitted by direct contact such as sexual contact, kissing and exchange of body fluids. Bedding and clothing may also be sources of infection.
Within 12–14 days of infection flu-like symptoms begin and red rashes are its most dominant feature. It looks like hundreds of pimples on the skin. Headache, fever, vomiting, muscle pains, chills, are other common symptoms. Kidney damage, pneumonia, scars, blindness make this a disease that is often not worth surviving. The most serious complications are convulsions in young children leaving the child with permanent brain damage and paralysis, or severe onset of symptoms with loss of consciousness, convulsions and coma.
Smallpox is part of a family of pox viruses that include camelpox, cowpox, monkeypox, with the latter posing the most serious threat to human health. The variola virus in aerosol form can stay active for hours if not exposed to sunlight.
Types of vaccines
Because there is need to develop safer vaccines, the current stock of smallpox has been retained rather than destroyed. . This decision has been widely criticized.
Only calf lymph vaccine is currently available in the US (Dryvax, Wyeth Labs).  Because of the drawbacks of the current vaccine, there is an effort to improve it. The newest version of the smallpox vaccine would be produced using a new technique “that grows the vaccine material in clean laboratory cultures without the risk of outside bacteria or viruses.”  If that phrase skipped past you, what it means is that other viruses or bacteria have hitch-hiked on previous vaccines cultured from animals and are responsible for some of the side effects. Of course, the vaccine manufacturers aren’t going to tell us about that, even though they are protected from liability by the National Vaccine compensation program. The new vaccine will be derived from a human cell culture (grown in a lab dish) rather than being derived from calf lymph tissue.
Federal health officials fear the same mistake made with the polio vaccine. Polio shots harbored another virus, called the simian 40 (SV40), which is now believed to be responsible for 3000 cases of chest cancer (mesothelioma) annually. Over 100 million people were given the polio vaccine and millions acquired the of SV40. The government never officially informed the citizenry of this problem. 
Of course, the best vaccine would be a killed virus, which the National Institutes of Health is attempting to develop. But even a killed vaccine doesn’t ensure the virus is dead. Formalin and other agents are used to kill the virus, but may not be totally effective in every batch.
A strange contrast: AIDS and Smallpox
At the beginning of the 21st century mankind find itself in a strange predicament. Another viral pandemic began in 1981. It was called Acquired Immune Deficiency Syndrome, or AIDS. About 450,000 Americans have died of AIDS since its identification. On a world scale the AIDS death toll has reach 22 million. An estimated 16,000 new cases of AIDS are reported daily. Of the 34 million AIDS-infected cases worldwide, more than 80% are in the poorest of the poor (largely sub-Saharan Africa) who live on less than $2 per day.  This may provide evidence of a nutritional link to the disease. Where malnutrition prevails so do certain diseases. World health authorities are clamoring for a vaccine as the only way of stopping the spread of AIDS. We must ask why health authorities are planning to quarantine outbreaks of smallpox should they occur, even though we have a vaccine (though admittedly it is in short supply and the majority of the population is unvaccinated), while there is no vaccine for AIDS and yet no quarantine is even suggested. A strict quarantine would have been employed for any other viral pandemic.
The importance of nutrition
A well nourished modern population may not be anywhere near as vulnerable to smallpox as previous generations, or human populations in third-world countries where malnourishment is common.
It is startling to observe that the smallpox vaccine may be withheld from individuals with immune problems, but nothing will be done to improve their immunity. The medical literature is replete with credible evidence that nutrients can be used to enhance immunity, both to enable immune-compromised individuals to receive vaccines with reduced complications and to inhibit viral infection altogether.
For example, advancing age is known to adversely affect the immune system. In healthy older adults the provision of 200 mg of vitamin E enhanced immunity and improved response to tetanus vaccine.  Vitamin E and iron levels have been shown to improve the percentage of elderly nursing home patients who achieve immunity from the flu vaccine.  Elderly institutionalized adults exhibited a better response to the flu vaccine and fewer respiratory infections when given zinc, selenium, vitamin C, vitamin E and beta carotene.  With all of this evidence, one wonders why elderly flu-shot recipients are not told of the importance of nutrition by their doctors.
Adequate nutrition and an optimal immune function may prevent viral infections altogether. “The increase in severity from and susceptibility to infectious disease in malnourished hosts is thought to be the result of an impaired immune response,” says a report published in the Journal of the American College of Nutrition. Says another source: “Nutritional influences on immune responses are of great consequence in aged individuals, even in the very health elderly.” 
For example, mice deficient in selenium, a trace mineral, have been found to be more susceptible to the flu and the coxsackie virus.  Chicks immunized against Newcastle disease virus achieve higher cellular immune responses when given supplemental selenium and vitamin E.  MA Beck of the University of North Carolina reports that “outbreaks of disease attributed to a nutritional deficiency may actually result from infection by a virus that has become pathogenic by replicating in a nutritionally deficient host.  Laboratory studies reveal that viruses can undergo mutation in a host who is deficient in selenium, leading a normally harmless virus becoming virulent.  Not only do animals that are malnourished and lack selenium and vitamin E exhibit a weak immunity, but the actual virus itself undergoes irreversible genetic mutations which cause susceptibility to disease even in well-nourished animals.  In a study of hospitalized children with respiratory syncytial virus, those who were supplemented with selenium experienced faster clearance of their symptoms than children who were not given selenium. 
There is a reason why smallpox reached epidemic levels in geographical areas of the world. These were undernourished populations. In 1977 researchers reported on the use of the smallpox vaccine in chronically starved, undernourished adults after inoculation of live smallpox vaccine. A major adverse effect was observed in all subjects. The development of specific cellular immunity against vaccinia was remarkably poor, indicating smallpox vaccination in these subjects might be less effective against variola infection. Poor protein consumption which produced low albumin levels and low white blood cell (lymphocyte) counts were the most important indicators of poor immunity from the vaccine.  The last case of smallpox in the US was reported in the late 1940s, but the disease wasn’t eradicated till the late 1970s. Given that there vaccination rates probably weren’t 100% for smallpox during those years, something else has to explain why smallpox disappeared from the American landscape years prior to its eradication in the rest of the world. The US began fortifying its foods with vitamins in the 1930s and 1940s, which may be an explanation.
One researcher has offered a list of nutrients essential for the maintenance of an optimal immune system, which include vitamin C, vitamin E, copper, zinc, selenium and sulfur-bearing amino acids methionine and cysteine. 
What about anti-viral drugs?
Smallpox is a virus. The number of anti-viral drugs is much more limited compared with antibiotics for bacteria. The problem in developing an anti-viral drug is that it has to be designed to enter a living cell and destroy an on-board virus without killing the host cell. So the effectiveness of the drug may be limited to containment rather than a cure. The viral infection can recur. Drugs like ganciclovir, foscarnet and acyclovir interfere with DNA production and prevent the virus from replicating. Other drugs, like sequinavir, are called protease inhibitors, prevent the action of an enzyme that is needed for the virus to produce mature viral particles. About $12.5 billion of anti-viral drugs are sold annually.
However, nature also provides potent anti-viral remedies which are widely available as over-the-counter remedies in health food stores. Quercetin, a substance found in red apples and red onions, has been found to enhance the antiviral effects of Zovirax, an antiviral medication.  Quercetin has been shown to “powerfully block” the polio virus.  In one study, the antiviral activity of quercetin was only exhibited when combined with vitamin C.  Quercetin inhibits reverse transcriptase like many of the anti-HIV drugs. 
Fresh-cut garlic, rich in allicin, has been found to be active against viruses such as vaccinia, influenza, herpes simplex and human rhinovirus.  Allicin in garlic pills is listed as “allicin potential” and there is skepticism if these products even provide much allicin at all. A recent study of 24 popular brands of garlic pills revealed little if any allicin was produced from these products when tested in an acid environment simulating the human gastric tract.  A pure allicin garlic extract would be desirable and has just now become available. 
It is difficult to administer vitamins and minerals to small children who may need to be vaccinated. So drug companies often place their antibiotics in flavored syrups. Berries, cherries and grapes have natural anti-viral properties. Elderberry syrup (Sambucol brand) has been shown to inhibit viruses.  A complete cure was achieved within 2–3 days in 90% of a group with the flu given the elderberry syrup compared to 6 days in a comparison group. 
This report falls short of providing evidence that any vitamin, mineral or herb is effective specifically against smallpox (though there is one report that garlic does kill vaccinia). The problem is, for ethical reasons no human test can be performed and animal tests cannot be conducted because they are not sensitive to smallpox. Other pox viruses must be employed in animal tests. Conventional medicine has no cures either. It would be callous and irresponsible to neglect the data which shows that nutritional factors could improve the effect of a vaccine and would likely aid the immune-compromised for whom the smallpox (vaccinia) vaccine is contraindicated. Furthermore, should a pox virus outbreak occur prior to the availability of a vaccine, or a human population be exposed to an engineered smallpox virus that is resistant to a vaccine, and humanity is left with no defense, the nutritional measures may deserve a re-evaluation.
It is important for the public to be informed and not be totally reliant upon government sources of information about health, vaccines, medicines and nutrition, which may be influenced by commercial or political forces. It is unlikely government health authorities will ever adopt these simple, inexpensive and less problematic nutritional technologies because the pharmaceutical manufacturing executives, strutting 625 lobbyists and $197 million in political campaign contributions, have secretly met with Tom Ridge, director of homeland security. Cheaper but effective generic drugs are less likely to be employed against bioterror when the politicians are so influenced. In the rush to produce anti-biological warfare pharmaceuticals, the manufacturers are asking Congress to waive extensive and prolonged research requirements.  This is what happened with AIDS drugs. The anti-AIDS drugs were developed and approved on a fast development track with pharmaceutical companies saving hundred of millions of dollars in research and development costs, but when marketed the drugs were among the highest-price pharmaceutical ever invented.
Addendum: Because of frequent questions about dosages and types of nutritional supplements, the following information is provided:
Selenium: the most stable is the organically-bound form, labeled as selenomethionine on product labels, not selenite or selenate which are inorganic forms. SelenoExcelTM is a brand of organically-bound selenium supplement that most closely resembles the way this trace mineral is provided in plant foods. The common dosage for adults is 200 micrograms.
Quercetin + vitamin C is available in most health food stores. Dosage ranges from 500–2000 mg per day.
Fresh chopped garlic cloves provide the most allicin, the active anti-viral component in garlic. Most garlic pills attempt to produce allicin by an enzymatic process that is advertised as “allicin potential.” Most of these products provide little if any allicin. A newly introduced pure allicin garlic extract is now available in the USA which provides 180 milligrams of pure allicin. For comparison, a fresh crushed garlic clove provides about 5–12 milligrams of allicin. Contact LifeSpan Nutrition at 1-800-247-5731. Be aware, purveyors of nutritional supplements are not permitted to claim their products prevent or cure disease. This right has only been given to prescription drugs.
The best form of vitamin C is the alkaline (buffered) C powder which is complexed with minerals, rather than ascorbic acid.
Most authorities believe natural-source vitamin E from soy (d-alpha tocopherol) is more potent than synthetic forms (dl-alpha tocopherol). A 200–400 IU dose is often suggested.
1. Single smallpox case would trigger federal response, CNN.com Oct. 19, 2001.
2. What is smallpox? State of South Dakota, www.state.sd.us Oct. 19, 2001.
3. O’Toole T, Smallpox: an attack scenario, Emerging Infectious Diseases, Volume 5, July-August 1999.
4. Model health law empowers states, Boston Globe, Oct. 31, 2001.
5. Stolberg S, Altman LK, New plan for smallpox attack, New York Times, Sept. 24, 2002.
6. World Health Organization announces updated guidance on smallpox vaccination, Statement WHO/16, Oct. 26, 2001.
7. Altman LK, US Sets up plan to fight smallpox in case of attack, New York Times, Nov. 4, 2001.
8. Mickle P, 1976: Fear of a great plague, The Trentonian, www.capitalcentury.com/1976.html
9. O’toole T, Inglesby T, Shining light on Dark Winter, Johns Hopkins Center for Civilian Biodefense Studies, at www.hopkins-biodefense.org .
10. Gupta S, Rowland R, Smallpox, anthrax: what could happen, CNN.com
11. Milloy S, Smallpox attack exaggerated, www.junkscience.com and www.foxnews.com, Oct. 5, 2001.
12. Berche P, The threat of smallpox and bioterrorism, Trends Microbiology 9: 15-18, 2001.
13. Rubin R, Drug may be first effective treatment for smallpox, USA Today, Oct. 20, 2001.
14. Volunteers line up to test limits of protection against smallpox, New York Times, Nov. 3, 2001.
15. US on alert for smallpox terror attack, UPI, April 23, 2001.
16. Modlin JF, Vaccinia (smallpox) vaccine recommendations of the advisory committee on immunization practices (ACIP), June 22, 2001.
17. Pelton T, The deadly lessons of smallpox, SunSpot.net Oct. 21, 2001.
18. Haim M, et al, Adverse reactions to smallpox vaccine: the Israel Defense Force experience, 1991-1996.
19. A comparison with previous surveys. Military Medicine 165: 287-89, 2000.
20. WHO fact sheet on smallpox, World Health Organization, www.who.int.
21. Maugh TH, Vaccinations Problematic, LA Times, Oct. 29, 2001.
22. Associated Press, Smallpox vaccine effort also requires side-effect medicine, Oct. 23, 2001.
23. ORent W, Today’s germ war, yesterday’s weapons, LA Times, Oct. 28, 2001.
24. Ellner PD, Smallpox: gone but not forgotten, Infection, 26: 263-69, 1998.
25. Georges AJ, et al, Biohazards due to orthopoxvirus: should be re-vaccinate against smallpox? Med Tropics 59: 483-87, 1999
26. Franz DR, et al, Clinical recognition and management of patients exposed to biological warfare agents, Journal American Medical Assn, 278: 399-411, 1997.
27. Drug makers plan for smallpox threat, MSNBC Oct. 24, 2001.
28. Bookchin D and Schumacher J, The virus and the vaccine, The Atlantic Monthly, February 2000.
29. Why a vaccine? www.seas.upenn.edu
30. Meydani SN, et al, Vitamin E supplementation and in vivo immune response to healthy elderly subjects. A randomized controlled trial, J Am Med Assn 277: 1380-86, 1997.
31. Fulop T, et al, Relationship between the response to influenza vaccination and the nutritional status in institutionalized elderly subjects, J Gerontol Biol Sci Med Sci 54: M59-64, 1999.
32. Girodon F, et al, Impact of trace elements and vitamin supplementation on immunity and infections in institutionalized elderly patients: a randomized controlled trial, Arch Internal Med 159: 748-54, 1999.
33. Lesourd B, Mazari L, Nutrition and immunity in the elderly, Proceed Nutrition Society 48: 685-95, 1999.
34. Beck MA, Antioxidants and viral infections: host immune response and viral pathogenicity, J Am College Nutrition 20: 384-88S, 2001.
35. Swain BK, et al, Effect of supplementation of vitamin E, selenium and their different combinations on the performance and immune response of broilers, British Poultry Science 41: 287-92, 2000.
36. Beck MA, Nutritionally induced oxidative stress: effect on viral disease, Am J Clinical Nutrition 71: 1676-81S, 2000.
37. Beck MA, Matthews CC, Micronutrients and host resistance to viral infection, Proceed Nutrition Society 59: 581-85, 2000.
38. Beck MA, Selenium and host defence towards viruses, Proc Nutrition Society 58: 707-11, 1999.
39. Liu X, et al, Effects of selenium supplement on acute lower respiratory tract infection caused by respiratory syncytial virus, Zhonghua Yu Fang, Beijing Friendship Hospital, 31: 358-61, 1997.
40. Saha K, et al, Undernutrition and immunity: smallpox vaccination in chronic starved, undernourished subjects and its immunologic evaluation, Scandinavian Journal Immunology, 6: 581-89, 1977.
41. Sprietsma JE, Cysteine, glutathione (GSH) and zinc and copper ions together are effective, natural, intracellular inhibitors of (AIDS) viruses, Med Hypotheses 52: 529-38, 1999.
42. Muesi I, et al, Combined effects of flavonoids and acyclovir against herpesviruses in cell cultures, Acta Microbiology Hungary 39: 137-47, 1992.
43. Castrillo JL, et al, Action of 3-methylquercetin on poliovirus RNA replication, J Virology 61: 3319-21, 1987.
44. Vrijsen R, et al, Antiviral activity of flavones and potentiation by ascorbate, J General Virology 69: 1749-51, 1988.
45. Spedding G, et al, Inhibition of reverse transcriptase by flavonoids, Antiviral Research 12: 99-110, 1989.
46. Weber ND, et al, In vitro virucidal effects of Allium sativum (garlic) extract and compounds, Planta Medica 58: 417-23, 1992.
47. Lawson LD, Wang ZJ, Low allicin release from garlic supplements: a major problem due to the sensitivities of allinase activity, J Agriculture Food Chemistry, 49: 2592-99, May 2001; Lawson LD, Wang ZJ, Papadimitriou D, Allicin release under simulated gastrointestinal conditions from garlic powder tablets employed in clinical trials on serum cholesterol, Planta Medica 67: 13-18, Feb. 2001.
48. LifeSpan Nutrition, San Dimas, California 1 800-247-5731 www.lifespannutrition.com
49. Barak V, et al, The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines, European Cytokine Network 12: 290-96, 2001.
50. Zakay-RonesZ, et al, Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (sambucus nigra L) during an outbreak of influenza B Panama, J Altern Complement Med 1: 361-69, 1995.
51. Wayne L, Petersen M, A muscular lobby tries to shape nation’s bioterror plan, New York Times, Nov. 4, 2001.