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And Now, the Good News about Smallpox
Slate ^ | October 26, 2001 | Jon Cohen

Posted on 10/27/2001 10:21:30 AM PDT by ignatz_q

And Now, the Good News About Smallpox - In the event of a terrorist attack, we're not all toast. By JonCohen
By JonCohen
Updated Friday, October 26, 2001, at 10:38 PM PT

If you received a smallpox vaccine in infancy, as most everyone did in the United Statesbefore routine immunizations stopped in 1972, your immunity to this disfiguring and often lethal disease certainly has waned. Indeed, authoritative sources would have you believe that you have no immunity whatsoever. But if you dig out original scientific studies about the smallpox vaccine, a much different-and a much more optimistic-picture emerges.
According to U.S. Census Bureau data, about 40 percent of the U.S. population is 29 or younger, and having never received a smallpox immunization, up to 30 percent of that cohort would die if infected with the virus during a bioterrorist attack. But what of the remainder of the population, the 60 percent that got the vaccine at one point or another? What is their vulnerability?

The Centers for Disease Control and Prevention Web site offers this depressing answer in a smallpox FAQ: "Most estimates suggest immunity from vaccination lasts 3 to 5 years." In 1999, leading experts offered similar estimates in a "consensus statement" on smallpox as a biological weapon that they published in the Journal of the American Medical Association. "Because comparatively few persons today have been successfully vaccinated on more than 1 occasion, it must be assumed that the population at large is highly susceptible to infection," they concluded. "Dark Winter," a war game conducted in June at Andrews Air Force Base in which a smallpox "attack" was launched, proposed that 80 percent of the U.S. population is susceptible to the disease.


But data from a 1902-1903 smallpox outbreak in Liverpool, England, strongly suggests otherwise. A study analyzed the impact of the disease on 1,163 Liverpudlians, 943 who received the vaccine during infancy, and 220 who were never vaccinated. The study further separated people by age and by the severity of their disease. In the oldest age group, 50 and above, 93 percent of the vaccinated people escaped severe disease and death. In contrast, 50 percent of the unvaccinated in that age bracket died, and another 25 percent had severe disease. To put it plainly, the vaccine offered remarkable protection after 50 years.

Frank Fenner, a virologist at Australia's John Curtin School of Medicine who co-authored Smallpox and Its Eradication-a 1,400-page book that is the field's bible-says the Liverpool study remains the best evidence that vaccine immunity lasts for decades. The Liverpool study, paradoxically, also helped create the common wisdom that vaccine immunity rapidly wanes. In the Liverpool study, Fenner notes, vaccinated kids who were 14 and younger had zero cases of severe disease or death. So out of "conservatism," he explains, many smallpox experts began to advocate that anyone in an area where smallpox exists should be revaccinated every decade (Australia went one step further and said every five years). An added benefit of this aggressive vaccination policy was that it also slowed the spread of smallpox, because recently vaccinated people were less likely to transmit the virus than those who had received their immunizations decades before.

More recent data supports the Liverpool experience. In a 1996 study published in the Journal of Virology, a group led by Francis Ennis at the University of Massachusetts Medical Center pulled immune cells out of people who had received the smallpox vaccine decades before. When they tickled these cells to see whether they remembered the lesson the vaccine had taught them, they found that "immunity can persist for up to 50 years after immunization against smallpox."

James Leduc, the CDC's resident smallpox authority, concedes that the conventional wisdom posted on the CDC's Web site might not tell the whole story. "The issues that you are raising are absolutely accurate and well founded," he says. "What you see on the Web site is a first attempt to get a consistent message out," he says, explaining that the public health quandaries-such as the need to produce more vaccine-sometimes overshadow the scientific ones.

Fenner, like several other smallpox experts queried, has no idea how much protective immunity exists now in the United States. "Oh, gosh, it is a guess," he says. But as Bernard Moss, a researcher who works with the smallpox vaccine at the National Institute of Allergy and Infectious Diseases, stresses, a vaccine simply gives the immune system a head start in the race against a bug. In the case of smallpox, the bug is fairly slow to cause disease-symptoms typically don't surface for a few weeks-and an infection in a vaccinated person can act like a booster shot, revving up an already primed immune system. "Everyone would agree that if you had a vaccination in your life," says Moss, "you're much better off than if you hadn't."

None of this good news argues against rebuilding the nation's smallpox vaccine stockpile, which has dwindled to a mere 15.4 million doses. (The federal government has committed more than $500 million to produce 300 million doses.) Regardless of our country's precise immune status against smallpox, widespread use of the vaccine during outbreaks repeatedly has worked: New York City dramatically aborted an epidemic in 1947 with a rapid and aggressive vaccination (and, importantly, isolation of victims) campaign that limited the spread to 12 cases and two deaths. And surely we have become more vulnerable to smallpox since routine immunizations stopped.

But the good news inspires the sort of confidence the country needs right now: The entire population isn't at extreme risk in the event of a smallpox attack. As the CDC's Leduc says, "This is not going to be a wildfire that overtakes the world."

Related in Slate

For the good news on anthrax, see this previous Slate piece by Jon Cohen.



Jon Cohen, the author ofShots in the Dark, writes for Science magazine. You can e-mail him at joncohen45@hotmail.com.


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I've been making essentially this same argument for weeks. While the CDC has to cover their bases, the immunization protocol used before the erradication of smallpox means that the worst case scenarios of immunity lasting only a few years simply can't be true for most recipients.
1 posted on 10/27/2001 10:21:30 AM PDT by ignatz_q
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To: ignatz_q
Thanks for the post, ignatz_q. The thing that struck me about this information is that a smallpox attack against our country is an attempt to wipe out our future by attacking our children and our young people. Anyone who thinks otherwise is ignorant or a fool.

The gravity of this is almost too much to process. I had my vaccine back in 1956. My husband had his in 1955 or 1956. Our son, who is 22, was not vaccinated. I am totally enraged at the mere thought.

2 posted on 10/27/2001 10:43:48 AM PDT by alethia
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To: ignatz_q
True, but if 30% of our children die, life will not be worth living for many people.
3 posted on 10/27/2001 10:45:20 AM PDT by arkfreepdom
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To: ignatz_q; CheneyChick; vikingchick; WIMom; one_particular_harbour; kmiller1k; Victoria Delsoul...
data from a 1902-1903 smallpox outbreak in Liverpool, England, strongly suggests otherwise. A study analyzed the impact of the disease on 1,163 Liverpudlians, 943 who received the vaccine during infancy, and 220 who were never vaccinated. The study further separated people by age and by the severity of their disease. In the oldest age group, 50 and above, 93 percent of the vaccinated people escaped severe disease and death. In contrast, 50 percent of the unvaccinated in that age bracket died, and another 25 percent had severe disease. To put it plainly, the vaccine offered remarkable protection after 50 years.
4 posted on 10/27/2001 10:48:49 AM PDT by Sabertooth
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To: ignatz_q
I wonder if the arabs are that stupid. If they release smallpox here, it will kill some of us but we will get it under control pretty quickly.

However, it is bound to spread to other parts of the world where they don't have money for prevention. It is bound to get back to the middle east, with international travel the way it is now. Far more of them will die.

5 posted on 10/27/2001 10:49:12 AM PDT by manx
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To: alethia
I am totally enraged at the mere thought.

I can understand that, but I'm not so angry about the situation. For one thing, there is still exactly zero evidence that any smallpox exists except for two tiny, secure amounts in disease research facilities in the U.S. and Russia. For another, the disease does seem to be erradicated as a natural pathogen.

I'm not trying to downplay the possibility that it could be used for an attack, but the odds are much, much Even if Iraq or a terrorist group has smallpox, it's very hard to handle safely, and even harder to deliver effectively. I want us to start stockpiling vaccine to be safe, but I'm just not sure that mass-innoculation is the answer at this point.

6 posted on 10/27/2001 10:49:20 AM PDT by ignatz_q
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To: alethia
Great. So I'll die, my brothers and sisters will die - but our parents and their contemporaries will be fine. Oh well; they've got enough time to have a couple more kids, then, and repopulate America. Of course, it'll really wreck the social security system!

Honestly, at the first sign of smallpox, I'm gonna go find some cows and vaccinate myself. Anyone have James Herriot's number, because I don't know what cowpox looks like.

7 posted on 10/27/2001 10:50:18 AM PDT by JenB
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To: ignatz_q
I believe that is the plan....stockpile 300 million. The vaccine is effective if giving early in the course.
8 posted on 10/27/2001 10:52:11 AM PDT by arkfreepdom
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To: arkfreepdom
No-- the really good news is that the vaccine we have can ALL reserved for our children, who were never vaccinated. The rest of us can just take our chances until we get the new vaccines on order for delievery next year or so. I think this is GREAT news-- particularly since other stuff indicates that those 15 million doses can be diluted at least 5 to 1 and still be equally effective (they date from when there was real dosage overkill). So, there's plenty for all the young people who never got vaccinated.
9 posted on 10/27/2001 10:52:53 AM PDT by walden
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To: arkfreepdom
giving=given...my bad.
10 posted on 10/27/2001 10:53:30 AM PDT by arkfreepdom
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To: ignatz_q
Now I get it: this whole friggin thing is a plot by the geriatric crowd to keep their social security. The lengths these people go to...
11 posted on 10/27/2001 10:53:59 AM PDT by Zviadist
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To: arkfreepdom
But if 60% of the population is relatively immune, it makes it harder for an epidemic to get out of control, and creates a firewall of high-immunity which would aid the effectiveness of a quarantine if there is an outbreak.

It also means that if the 15 million doses on hand can be effectively diluted to 75 million (the CDC's stated goal), the real target population for the vaccine is down to around 110 to 120 million.

We could make giant strides toward "herd immunity" in a hurry, in the event of an emergency.

12 posted on 10/27/2001 10:54:26 AM PDT by Sabertooth
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To: arkfreepdom
If, if ... if they kill 30% of our children, several countries in the Middle Eastern region ahd better cease to exist. Sadly, we the people have condoned the serial killing of more than 40 million of our children since 1973. When will such foolishness stop?
13 posted on 10/27/2001 10:56:05 AM PDT by MHGinTN
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To: manx
I wonder if the arabs are that stupid.

Why?

They're goading us into a war that will go worse for them than us, whatever happens. But they're still spoiling for a fight.

14 posted on 10/27/2001 10:56:40 AM PDT by Sabertooth
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To: arkfreepdom
We can thank the UN and the WHO for recommending the end of vaccinations. Those who objected back then for the exact reasons we see now were ignored and called names.

Brings a whole new meaning to the phrase, "It's for the children.".

15 posted on 10/27/2001 10:56:50 AM PDT by martian_22
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To: Zviadist
And, if all those under 30+ are gone, just how will there be any money FOR SOCIAL SECURITY??????? You think there's a trust fund somewhere?
16 posted on 10/27/2001 10:56:50 AM PDT by goodnesswins
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To: JenB
See post #12.
17 posted on 10/27/2001 10:57:29 AM PDT by Sabertooth
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To: Sabertooth
Thanks for the "good" news. They stopped vaccinating by the time I came out of the chute.
18 posted on 10/27/2001 10:59:45 AM PDT by Senator Pardek
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To: arkfreepdom
Hopefully, since breastfeeding has come back in vogue in the past 30 years or so, many children may have gotten some sort of protection from their mothers who were vaccinated. It may help them a little bit; it may make the difference between life and death.

My mother vaccinated me herself at a time when it was becoming less common to give smallpox vaccines (she was a nurse). My doctor had not ordered one for me. Since all this talk about smallpox, I have been thinking that it has to count for something, even thirty or so years after the fact. Maybe it will make the difference between life and death, or the difference between a mild case and a severe one. My mother has also been thinking about this, and she's glad she vaccinated me.

19 posted on 10/27/2001 11:01:16 AM PDT by wimpycat
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To: Sabertooth
I'm just so tired of all the new things we're supposed to fear; airplanes, bombs, anthrax, smallpox, nuclear suitcases.... if you stay home it'll come in your mail, go to the mall on Halloween and you die... We need to collectively grow some backbone, so defiance to the terrorist b*st*rds who've done this.

What did C.S. Lewis say about men without chests?

20 posted on 10/27/2001 11:01:28 AM PDT by JenB
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To: ignatz_q
Can someone tell me hat the Small pox vaccine scar looks like? I have heard differing ideas. I thought the large scar was a polio vaccine...but perhaps I am wrong. D
21 posted on 10/27/2001 11:04:02 AM PDT by Deborah63
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To: Sabertooth
We will need more than 60% of the population to be immune for herd immunity to stop an epidemic....although I do agree with your point. Even with significant immunization for diphtheria, we still have occasional outbreaks. No epidemics though.
22 posted on 10/27/2001 11:04:50 AM PDT by arkfreepdom
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To: Deborah63
The scar is from the smallpox vaccination, and is located on your upper arm.
23 posted on 10/27/2001 11:06:17 AM PDT by arkfreepdom
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To: ignatz_q
This IS good news. Far better than what we thought. At least we'll have the older folks around to nurse the younger ones back to health, until vaccinations are given out.

I'm glad you posted this.

24 posted on 10/27/2001 11:06:46 AM PDT by syriacus
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To: arkfreepdom
Well looks like that vaccine was stopped in this area for people born after 1962....oh well! Debbie
25 posted on 10/27/2001 11:08:27 AM PDT by Deborah63
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To: JenB
Sad to say, I think James Herriott is no longer among the living. He was wonderful! I read all his books!

g

26 posted on 10/27/2001 11:09:59 AM PDT by Geezerette
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To: ignatz_q
The entire population isn't at extreme risk in the event of a smallpox attack.

Great news! Its just the children at risk. All of the children.

I'm not worried about me, just my son.

27 posted on 10/27/2001 11:10:00 AM PDT by abner
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To: Deborah63
Well looks like that vaccine was stopped in this area for people born after 1962

Check your pediatric records. Virtually beveryone born in the 1960s was vaccinated for smallpox.

28 posted on 10/27/2001 11:10:51 AM PDT by Sabertooth
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To: arkfreepdom
Last week I took a small position in Bioreliance [BREL] - the company that makes smallpox vaccine, he.he.hey.
29 posted on 10/27/2001 11:11:45 AM PDT by snopercod
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To: Sabertooth
WEll that is why I am questioning the scar. If it is the large scar on the upper arm..then I definitely don't have it...but if it is a different scar it is possible. No one in our area born after 1962 has the large scar. Are we sure that wasn't a polio vaccine?
30 posted on 10/27/2001 11:12:11 AM PDT by Deborah63
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To: manx
However, it is bound to spread to other parts of the world where they don't have money for prevention. It is bound to get back to the middle east, with international travel the way it is now. Far more of them will die.

I agree. People can think of ways to argue that point, but powerful people in the Islamic countries know this disease can not be contained in the target country like Anthrax can. Unless we start seeing mass inoculation for smallpox in Islamic countries and China, there is little reason for worry on this. Anyone contemplating such a thing would be put out of his misery by the powers that be in China, Russia, etc.

31 posted on 10/27/2001 11:13:05 AM PDT by OK
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To: Zviadist
I hope you're just kidding! We geezers would go back to work should something like that happen!!

g

32 posted on 10/27/2001 11:13:55 AM PDT by Geezerette
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To: abner
Great news! Its just the children at risk. All of the children.

I'm not worried about me, just my son.

Hey, I've got a 14 year-old daughter, and I'm not unconcerned. But this also makes it less likely that we would transmit smallpox to our kids if we're exposed. If there's an outbreak in my area, she won't leave the house until the CDC has vaccinations on the ground, which will probably be within 48 hours of a confirmed case. That's what the 75 million doses will be held in reserve for, to target infected communities. They plan to come in like a SWAT team with the vaccinations.

This isn't perfect news, but it's very good news.

33 posted on 10/27/2001 11:16:13 AM PDT by Sabertooth
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To: arkfreepdom
True, but if 30% of our children die, life will not be worth living for many people.

Forget "The Children" for a minute.

What about whole families: young kids and their under 29 parents?

I had no idea *40%* of America is 29 and under. You wouldn't know it with the way the Boomer's act. I hope when they start the vaccinations up again they start with the unvaccinated and don't decide to treat this on an outbreak-by-outbreak basis.

34 posted on 10/27/2001 11:18:53 AM PDT by newzjunkey
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To: Deborah63
Smallpox is the one that makes the scar, not polio. Mine is much less visible now than it once was, but I can feel it. It's low on side of the left shoulder, right in the middle.

Most smallpox scars are there, but some people were vaccinated in other places. Check your records. Smallpox vaccines were virtually universal during the 60s.

35 posted on 10/27/2001 11:19:24 AM PDT by Sabertooth
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To: wimpycat
Hopefully, since breastfeeding has come back in vogue in the past 30 years or so, many children may have gotten some sort of protection from their mothers who were vaccinated. It may help them a little bit; it may make the difference between life and death.

Can any doctor or other knowledgable person report what the likelihood that immunity would pass on is? I know it works for some things, but is smallpox one of them? In that case a great many younger children would indeed have a good chance of being immune, as I know breastfeeding has exploded in the past ten years especially.

If this is the case, I shall have to thank my mother for breastfeeding me and my siblings.

36 posted on 10/27/2001 11:20:01 AM PDT by JenB
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To: Deborah63
Not everyone got a scar from the smallpox vacination. I remember getting a small pox booster shot as a child (I got my first smallpox shot as an infant). My mother, who is still living, recently confirmed it. I have no vacination scar and neither does my older sister. My older brother has a scar. (I'm in my 40s).
37 posted on 10/27/2001 11:20:26 AM PDT by Bubba_Leroy
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To: abner
I am *not* the children.
My friends are *not* the children.
Their wives are *not* the children.
Their boyfriend are *not* the children.
Their girlfriends are *not* the children.
Their employees are *not* the children.
Their co-workers are *not* the children.
Their grocery clerks are *not* the children.
Their nurses are *not* the children.
Their chefs are *not* the children.
Their teachers are *not* the children.

Their kids, however, *are* the children.

All are unvaccinated against smallpox.

Enough with The Children already. It's downright offensive and smacks of age-ism and generational arrogance.

Were you part of the generation that decided we could go without the mandatory vaccinations because you had vanquished it?

38 posted on 10/27/2001 11:26:53 AM PDT by newzjunkey
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To: ignatz_q
...and even harder to deliver effectively.

These are people have clearly and undeniably demonstrated a eager willingness to die. They won't care about being infected with smallpox if that's what it takes to deliver death to our door.

39 posted on 10/27/2001 11:29:05 AM PDT by newzjunkey
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To: manx
However, it is bound to spread to other parts of the world where they don't have money for prevention. It is bound to get back to the middle east, with international travel the way it is now. Far more of them will die.
Good point. Many in all parts of the Third World could die from this, not just in the Muslim areas.

patent  +AMDG

40 posted on 10/27/2001 11:30:12 AM PDT by patent
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To: ignatz_q
PErsonally, I've been wondering if they could just bioengineer a strain of cowpox to be airborne contagious (and, of course, make double-damn-sure its' "safe",) then spread it out among the populace deliberately.
41 posted on 10/27/2001 11:30:58 AM PDT by Anotherpundit
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To: Sabertooth
That is good news.
42 posted on 10/27/2001 11:31:38 AM PDT by vikingchick
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To: Deborah63
On another FR thread, several people mentioned they were given the smallpox vaccination on the thigh or buttock, rather than on the arm..."less disfiguring". This was especially likely for girls.

I'm not making light of smallpox, but I do want to say that it does not always leave a person terribly disfigured. I am struck, when reading biographies or histories, with just how many famous people were infected by smallpox, and the wide range of responses these famous victims displayed. Charles II had smallpox, and he apparently was left unscarred , and that's true of other famous smallpox sufferers-some were left entirely unscathed. Fanny Kemble, the famous 19th century actress, was left unscarred and smoothskinned, but her complexion was robbed of its translucence and left with the sallow, muddy, 'thickened' look associated with an older woman who'd had children.( She was still a teen, and had no children.) Other victims were left with only a few scars to hide, and that's how the 18th century fad for black velvet patches started. And some, like Mirabeau, the Duke of Anjou , and one of Marie Antoinette's sisters, were left terribly disfigured. It's not a given that every single infected person will get the absolute worst end result. I do not know what link there might be between those who got off light, and any exposure they might have had to cowpox, but I thought cowpox exposure would have left them totally immune.(???)

That said, I hope steps are being taken to get the vaccine available. And given that smallpox was not eradicated from the third world, and given post 1965 emigration policies, I do not understand why the post 1971 babies were left vulnerable.

43 posted on 10/27/2001 11:31:59 AM PDT by kaylar
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To: Bubba_Leroy
Not everyone got a scar from the smallpox vacination

Exactly, not everyone has a scar. I was vaccinated in the 50's but don't have a scar.

And then if you lived outside the US, you may have a scar from a different kind of a vaccination. For instance, we were living outside the US when my 13 year old son started school, and he had to have a BCG vaccine (for TB) because it was required by the country we were in. This leaves a scar very similar to the smallpox scar.

44 posted on 10/27/2001 11:34:38 AM PDT by dawn53
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To: ignatz_q
Well, this is from Slate...but in any case, MAYBE we are not as bad off as we had thought. I would not bet.....even a dollar on it though.
45 posted on 10/27/2001 11:36:23 AM PDT by rwfromkansas
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To: syriacus
Keep in mind the article is only proposing some studies indicate this. It doesn't make it true. Also, that one study indicated it MAY last up to 50 years in some cases....not everyone will even in that study.
46 posted on 10/27/2001 11:37:59 AM PDT by rwfromkansas
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To: ignatz_q
My response suggested that if we see outbreaks of smallpox -- particularly since it is quite rare, there would be no mistaking the intent. The intent is what enrages me. If I could trade places with my son, I would. Mother's focus speaking -- and not just for my own, but for all of our children.

Again, great article. Thanks for posting.

47 posted on 10/27/2001 11:43:43 AM PDT by alethia
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To: Deborah63
I wouldn't call it a large scar. My smallpox vaccination scar is about the size of the tip of my finger. It should be on your upper arm.
48 posted on 10/27/2001 11:45:35 AM PDT by alnick
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To: ignatz_q
Isn't Herpes in the pox family?...and might that offer some immunity?
49 posted on 10/27/2001 11:45:43 AM PDT by blam
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To: JenB
I would think that breastfeeding would offer protection for any antibodies that the mother produces. Maybe not total protection, but some. Also we have better supportive treatment today than was available in the past.
50 posted on 10/27/2001 11:46:45 AM PDT by muggs
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