Skip to comments.And Now, the Good News about Smallpox
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
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.
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.
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 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.
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.
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.
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.
Brings a whole new meaning to the phrase, "It's for the children.".
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.
What did C.S. Lewis say about men without chests?
I'm glad you posted this.
Great news! Its just the children at risk. All of the children.
I'm not worried about me, just my son.
Check your pediatric records. Virtually beveryone born in the 1960s was vaccinated for smallpox.
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.
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.
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.
Most smallpox scars are there, but some people were vaccinated in other places. Check your records. Smallpox vaccines were virtually universal during the 60s.
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.
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?
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.
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.
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.
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.
Again, great article. Thanks for posting.
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