Millions of people died during widespread smallpox epidemics in the past. Fortunately, smallpox was eradicated as a naturally occurring disease in 1980 after a successful worldwide vaccination program. There have been no cases in the United States since 1972. Most persons born before 1971 were vaccinated once against smallpox. Currently there are no recommendations for vaccination of the general public against smallpox, although there is concern that this virus could be used for bioterrorism. The United States has an adequate supply of smallpox vaccine for those who would need it in the event of such an outbreak. This includes all those known to be directly exposed, health care workers, public health workers, and volunteer responders to the crisis situation. The March 11, 2009, issue of JAMA includes an article about smallpox vaccination.