right|thumb|The East Wing of the [[University of Birmingham Medical School, which was the source of the outbreak]]

In 1978, a smallpox outbreak in the United Kingdom led to the death of Janet Parker, a British medical photographer. She was the last person recorded to have died from this disease. Parker's illness and death were linked to two additional fatalities, prompting the government to establish the Shooter Inquiry. This official investigation, conducted by a panel of experts headed by microbiologist R.A. Shooter, led to significant reforms in the study of dangerous pathogens in the UK.

The Shooter Inquiry found that Parker was accidentally exposed to a strain of smallpox virus that had been grown in a research laboratory on the floor below her workplace at the University of Birmingham Medical School. Shooter concluded that the mode of transmission was most likely airborne through a poorly maintained service duct between the two floors. However, this assertion has been subsequently challenged, including when the University of Birmingham was acquitted following a prosecution for breach of Health and Safety legislation connected with Parker's death. Several internationally recognised experts produced evidence during the prosecution to show that it was unlikely that Parker was infected by airborne transmission in this way. Although there is general agreement that the source of Parker's infection was the smallpox virus grown at the Medical School laboratory, how Parker contracted the disease remains unknown.

Background

Smallpox research at the Birmingham Medical School

Smallpox is an infectious disease unique to humans, caused by either of two virus variants named Variola major and Variola minor, with the latter typically producing a milder disease. The World Health Organization (WHO) had established a smallpox eradication programme and, by 1978, was close to declaring that the disease had been eradicated globally.

At the time of the 1978 outbreak, a laboratory at University of Birmingham Medical School had been conducting research on variants of smallpox virus known as "whitepox viruses", which were considered to be a threat to the success of the WHO's eradication programme. The laboratory was part of the Microbiology Department, the head of which was virologist Henry Bedson, son of Sir Samuel Phillips Bedson.

A smallpox outbreak in the area had occurred in 1966, when Tony McLennan, a medical photographer working at the medical school, contracted the disease. He had a mild form of the disease, which was not diagnosed for eight weeks. There are no records of any formal enquiries on the source of this outbreak despite concerns expressed by the then head of the laboratory, Peter Wildy.

Janet Parker

Parker was born in March 1938, and was the only daughter of Frederick and Hilda Witcomb (née Linscott).

thumb|The exterior of Wards 32 and 33 at East Birmingham Hospital during the 1978 smallpox outbreak

Parker's illness and death

On 11 August 1978, Parker (who had been vaccinated against smallpox in 1966, but not since On 20 August at 3pm, she was admitted to East Birmingham Hospital and a clinical diagnosis of Variola major, the most serious type of smallpox, was made by consultant Alasdair Geddes.

By this time the rash had spread and covered all Parker's body, including the palms of her hands and soles of her feet, and it was confluent (i.e. the lesions had merged) on her face. Parker died of smallpox at Catherine-de-Barnes on 11 September 1978. She was the last recorded person to die from smallpox.

Concerns over the survival of infectious virus in Parker's body were well-founded, and at the inquest the coroner, who signed Parker's cremation certificate, disallowed an autopsy for safety reasons. Other than Parker's mother, no further cases occurred. The other close contacts, which included two biomedical scientists from the Regional Virus Laboratory, were released from quarantine in Catherine-de-Barnes on 10 October 1978.

On 5 September 1978, Parker's 71-year-old father, Frederick Witcomb, of Myrtle Avenue, Kings Heath, died while in quarantine at Catherine-de-Barnes Hospital. No post-mortem was carried out on his body because of the risk of smallpox infection. In Bedson's Munk's Roll biography published by the Royal College of Physicians, virologist Peter Wildy and Sir Gordon Wolstenholme wrote:

Subsequent investigations and reactions

The Shooter inquiry

thumb|Plan of the Birmingham smallpox laboratory in 1978, based on one in the Shooter Report. and comprising [[Christopher Booth, Sir David Evans, J.R. McDonald, David Tyrrell and Sir Robert Williams, with observers from the World Health Organization (WHO), the Health and Safety Executive and the Trades Union Congress.]]

The inquiry's report noted that Bedson had failed to inform the authorities of changes in his research that could have affected safety. Shooter's enquiry discovered that the Dangerous Pathogens Advisory Group had inspected the laboratory on two occasions and each time recommended that the smallpox research be continued there, even though the facilities at the laboratory fell far short of those required by law. Several of the staff at the laboratory had received no special training. Inspectors from the WHO had told Bedson that the physical facilities at the laboratory did not meet WHO standards, but had nonetheless recommended only a few changes in laboratory procedures. Bedson misled the WHO about the volume of work handled by the laboratory, telling them that it had progressively declined since 1973, when in fact it had risen substantially as Bedson tried to finish his work before the laboratory closed. Shooter also found that while Parker had been vaccinated, it had not been done recently enough to protect her against smallpox. Nicolas Hawkes wrote, in 1979, that: Allan Watt Downie and Keith R. Dumbell, showed that airborne transmission from the laboratory to the telephone room where Parker was supposedly infected was highly improbable.) and it would take 20,000 years for one particle to travel to the telephone room at the rate the fluid was aspirated. but the inquiry's conclusions on the transmission of the virus have not been generally accepted. Professor Mark Pallen, who wrote a book about the case,

In light of this incident, all known stocks of smallpox were destroyed or transferred to one of two WHO reference laboratories which had BSL-4 facilities: the Centers for Disease Control and Prevention (CDC) in the United States and the State Research Center of Virology and Biotechnology VECTOR in Koltsovo, Russia.

At the time of the outbreak, the WHO had been about to certify that smallpox had been eradicated globally.