A biological attack involving the smallpox virus would be a "nightmare for every health facility anywhere in the world," an expert on medical disasters told a church group yesterday.

And Bermuda is more prepared than many other jurisdictions to deal with a medical disaster involving biological agents.

In a wide-ranging presentation on germ warfare and the implications for Bermuda Dr. Roslyn Bascombe-Adams, an emergency physician at the King Edward Memorial Hospital, told her audience of 30 that "smallpox sends chills up our spines".

Bermuda has become preoccupied lately with the possibility of weaponised anthrax finding its way onto the Island.

Government has consistently repeated the message that the Island is highly unlikely to be the direct target of an attack using chemical or biological agents.

Government Chief Medical Officer Dr. John Cann yesterday confirmed that the smallpox vaccine has not been given locally for at least two decades.

"The World Health Organisation (WHO) now are actively reconsidering the situation," he said. "It has long been thought that smallpox was eradicated in the world." Dr. Cann said that as a result, manufacturers halted production of the vaccine and he said that only a few samples are known to exist in laboratories in the US and Russia.

Smallpox is caused by the variola major virus, and is marked by fever, headache and widespread blisters.

Unlike anthrax, it is highly contagious. However, vaccinations can be effective in treating the disease even after it has been contracted.

Dr. Bascombe-Adams, a member of the hospital's disaster committee, said that smallpox, along with anthrax, botulism and plague could all be weaponised and used by terrorists.

"This virus is one of the most contagious viruses known to man because you don't have to be within three feet," she said. "You just have to share the same air space."

She said that despite the fact that the virus had been eradicated thanks to the efforts of the World Health Organisation, the threat of it being used in warfare still exists because the only source of smallpox is in weaponised stockpiles.

"It is highly contagious. There are stockholdings of it in certain areas of the world," Dr. Bascombe-Adams said. She reminded the audience that biological warfare is not new.

"The crusaders when they went into the Americas used to get pox covered blankets and give it to the American Indians. They took the blankets in good faith to keep warm and then they got sick and they died."

She said that it is not known if antiviral agents for viruses such as herpes will be effective for smallpox symptoms because the last case of smallpox was many years ago.

And people old enough to have been vaccinated are not protected either, because booster shots are needed to keep the vaccine effective.

"It's not a pretty disease to look at," she said describing the symptoms. "It is easy to diagnose because it gives a characteristic lesion. And we can't treat it. It's just supportive care to prevent superimposed infection but we have to keep the person away from everybody else and away from the hospital."

She said that the Centers for Disease Control had a stockpile of available vaccines (which protects people where exposure does not exceed three days) and would make them available to countries that need it.

She said that Bermuda had identified a number of isolation facilities in the event that a smallpox case entered the Island.

Officials say that Bermuda is unlikely to be directly targeted by any biological threat. But the Island would be bound to respond to emergencies on air or naval traffic within our vicinity.

She told the meeting she had just returned from a conference for emergency physicians last week, which included bioterrorism, and came to the realisation that "at the moment Bermuda is in a pretty good position compared to many other countries - even in other American cities".

"The persons who are in a position to do something about it have been proactive and have tried to put things in place to identify early, treat early and minimise the threat so that there is less of a chance of having anything nasty happen to us."