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Smallpox: A Disease of the Past? Consideration for Midwives


  • Carolyn M. Constantin RNC, MSN, PhD, CDR,

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    • Carolyn Constantin, RNC, MSN, PhD, received her PhD from Emory University in Atlanta, GA, with her research emphasis on the immune system response during pregnancy. She is an experienced labor and delivery nurse, as well as a nurse educator. She is currently pursuing postdoctoral studies in the Department of Microbiology and Immunology at Emory University.

  • Angela M. Martinelli RN, DNSc,

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    • CDR Angela Martinelli, RN, DNSc, is the Response Coordinator for the Commissioned Corps Readiness Force, Office of Emergency Response, Department of Health and Human Services. She is on Active Duty in the U.S. Public Health Service and has served in the U.S. Army and Air Force. CDR Martinelli has worked as a volunteer nurse with Operating Smile International since 1994, serving in such places as Mombassa, Kenya; Santa Cruz, Bolivia; Bogotá, Columbia; and Surin, Thailand.

  • Stanley O. Foster MD, MPH,

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    • Stanley O. Foster, MD, MPH, is a Visiting Professor of International Health at Emory University's Rollins School of Public Health. As an epidemiologist at the Centers for Disease Control, he was actively involved in directing smallpox eradication programs in Nigeria (66-70), Bangladesh (72-76), and Somalia (77). He is a faculty member at Emory's Center of Health Preparedness and Research, and an expert on clinical smallpox and its control.

  • Elizabeth A. Bonney MD,

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    • Elizabeth Bonney, MD, completed medical school at Stanford University and her internship and residency at Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA. She completed a fellowship at the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), with research emphasis on maternal immunity, T-cell tolerance, antigen processing and presentation, and sexually transmitted diseases in women. She is currently an associate professor at the University of Vermont.

  • Ora L. Strickland RN, PhD, FAAN

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    • Ora L. Strickland, RN, PhD, FAAN, is the founder and senior editor of the Journal of Nursing Measurement. She has extensive research experience in the area of culturally sensitive women's health issues, as well as maternal and child health issues. Dr. Strickland is a professor at the Nell Hodgson Woodruff School of Nursing, Emory University in Atlanta, GA.

Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322-4207.


Smallpox infection was often more severe in pregnant women than in non-pregnant women or in men, regardless of vaccination status. Women with smallpox infection during pregnancy have higher rates of abortions, stillbirths, and preterm deliveries than women without the disease. Pregnant women have high incidences of hemorrhagic-type and flat-type smallpox, which are associated with extremely high fatality rates. Although smallpox was eradicated in the late 1970s, current international concern exists regarding the potential use of smallpox virus as an agent for bioterrorism. This manuscript reviews clinical aspects of smallpox, smallpox immunization, and outcomes in pregnant women.