Notes on an epidemic of smallpox in New York City - 1947 and the ensuing mass vaccination

In late March 1947, a man (Mr E. LaBar), infected in Mexico, developed hemorrhagic smallpox shortly after arriving in New York City. He was not diagnosed immediately, but was hospitalized at a hospital for infectious diseases in New York City. His disease was NOT recognized as smallpox until 2 new typical cases of smallpox occurred in 2 individuals in the hospital where he was treated.

April 5, 1947
Commissioner Weinstein reports on 3 cases, 1 death in 1st NYC incidence since 1939; says disease, brought from Mexico by 1st victim,was contracted by 2 others in hospital where he died. Health department joins US Public Health Service in search for other contacts; vaccinates staff of Bellevue and Willard Parker Hospitals; urges New Yorkers to use free vaccination service.

April 6, 1947
Weinstein reports NYC vaccination progress; 2 cases recovering; NYC and NY State Health Departments and USPHS tracing 1st victims' contacts; [officials] ask hospitals to maintain 24-hr vaccination service.

April 8, 1947
2 new suspected cases in Willard Parker Hospital; Comr Weinstein distributes free vaccine to NYC doctors and hospitals.

April 11,1947
NYC health authorities check with officials at towns where E La Bar stopped on way from Mexico. Vaccinations continue.

April 13, 1947
2 new cases reported at Cardinal Hayes Convalescent Home for Children, Milbrook, N.Y.

April 15, 1947
8th case discovered in New York City.Weinstein reports all known and suspected cases isolated. NYC gets extra units from Army & Navy; buys 2 million more. Swedish authorities report vaccinating travelers from US. Westchester County Health commissioner reports vain efforts to secure vaccine; claims NYC cornered supply.

April 16,1947
Vaccine shortage interrupts NYC drive. Mayor and Commissioner report no health hazard. Federal government allows drug manufacturers to package vaccine in 50-dose tubes to speed aid.

April 17,1947
NYC police charge S. C. Steinberg with illegal medical practice for posing as nurse to vaccinate 500 persons with water; seek to contact her victims.

April 18, 1947
500,000 vaccinated in 1 day; Commissioner estimates total immunized at 2 million. Smallpox death reported in Camden, NJ. S.C. Steinberg sent to Bellevue Hospital for observation.

April 21, 1947
President Truman vaccinated on eve of NYC visit. Medical teams start vacination drive in NYC high schools, plan to continue drive in elementary schools.

April 22, 1947
Diagnosis of Staten Island death changed from smallpox to other causes; false rumor causes vaccinationn rush on SI.

April 24, 1947
Westchester County Health Commissioner scores lack of cooperation among doctors in certain area of county. NYC vacination drive reach 4 1/2 million.

April 26, 1947
Commissoner Weinstein reports threatened epidemic effectively curbed; compares total of 12 cases, 2 deaths in Milbrook and NYC to probable incidence without vaccination drive.States that without prompt vaccination drive, "the hospitals would have been filled to overflowing."

May 3, 1947
Weinstein reports outbreak finished; free vaccination ended; estimates 6,350,000 NYC residents immunized.

Harry K's comments

This is an interesting site that gives a nice summary, from archived New York Times articles, of what happened in the last major outbreak of small pox in the US. As a physician, I'd like to make several observations.

1) Small pox vaccine has efficacy even after a person has been exposed to small pox

2) The outbreak was contained to only two deaths, even though it wasn't recognized as small pox till after the death of the first case.

3) The outbreak was contained in the most major metropolitan area, by mass vaccination-- 6 million vaccinated in <1 month.

4) Though it is not in the article, it is a fact that death from small pox occurs from bacterial superinfection in the affected tissue, and eventually, the bloodstream. In epidemics of the past, the were no good treatments for the bacterial infections--today, there are. There is every reason to believe that death rates would be lower today with broad-spectrum antibiotics.

5) I'm not saying we don't need to worry about small pox. We do. We need more vaccine. But the evidence is that an actual outbreak would not be the nightmare scenario (40 million dead) that is often described.

Yes, very informative! There are limits, even in dense cities, to the spread of virulent diseases. We may face a greater challenge due to a coordinated and planned effort to spread disease, but I think we will be able to respond quickly enough to avert a cataclysm. Still, I think I shall make sure I have supplies to last my family through perhaps 2 or more weeks until a vaccine program ramps up.

The thing is, they had a plentiful supply of vaccine on hand, because vaccinations were being given to the general population on a regular basis, so they could deal with the problem right away before an epidemic could take hold.

I don't believe that is true today. Vaccine supplies are minimal, if news reports are true, and it will take a certain amount of time to build up adequate stockpiles. In other words, there is a window of vulnerability which, I trust, is being dealt with as quickly as possible.

I disagree that bacterial infection of lesions is a major cause of death. From:Smallpox as a Bioweapon

Secondary bacterial infection is not common, and death, which usually occurs during the second week of illness, most likely results from the toxemia associated with circulating immune complexes and soluble variola antigens. Encephalitis sometimes ensues that is indistinguishable from the acute perivascular demyelination observed as a complication of infection due to vaccinia, measles, or varicella.

My girlfriend and her family are all from Mexico. I have noticed that they each have a scar on their shoulder, from, I assume, the Smallpox vaccination. Even my girlfriend's niece, aged 4 years old, has this identical scar. The scars seem to be the same ones that my parents have, but I do not have, due to the fact that I was born when they decided to stop vacinating.

Since I am a believer in prevention, I am wondering about going to Mexico and getting immunized against Smallpox.

My question to any M.D.'s is whether this is advisable or not? Also, are their vaccinations of the same level as those of the United State's?

All of this came up after calling my local Dallas County immunization clinic and finding out that they do not have the vaccinations available and that only the CDC does.

I, for one, do not want my family, friends, or myself taking a chance on getting smallpox and, if, Heaven forbid, we were to contract it, hoping that our new medicine's can treat and eliminate the disease.

In my opinion, this is like changing the oil on my car. I do it because I know what could possibly happen if I don't, being the engine would lock up and die.

I may be heading for Mexico to get that shot! Roadtrip anyone??

"My girlfriend and her family are all from Mexico. I have noticed that they each have a scar on their shoulder, from, I assume, the Smallpox vaccination."

Anybody born much before 1970 anywhere in the world has that smallpolx vaccine scar, usually on their upper left arm. I read that the scar has something to do with a reaction from the booster shots.

I would caution anybody from deriving TOO much comfort from this successful containment. There is a fundamental difference between that outbreak and a potential terrorist act. The difference is that the former was accidental. A terrorist act would be deliberate.

Compare the damage done when good-sized airplane crashes from an accident (typically 50 to 250 deaths), to the damage done when that same airplane is smashed into the WTC. (Estimate 1/2 of the approx. 5500 assumed dead = 2750 deaths).

Ten terrorists infected with smallpox could make it their one last goal in life to wander among crowds, coughing, sneezing, spreading mucus on doorknobs, and so forth. That would INITIALLY infect far more than the one 'index' case cited in the article. And some of those so-called 'first-wave' cases will board trains and planes, spreading smallpox from coast to coast, BEFORE THE FIRST CONFIRMED CASE IS EVEN IDENTIFIED.

We must compare apples to apples. Terrorist incidents are not 'unfortunate'. They are not 'tragic'. They are evil, and deliberate.

Perhaps you'd like to share your perspective on vaccine stockpiling and precautionary vaccination. Do you agree with Secretary Thompson on his policy of increasing stockpiles of vaccine but withholding vaccinations until we actually have a real outbreak?

Having read his comments and his thinking on this, I tend to agree that he has the right idea. I would, however, like to see medical and military vaccinated at the first opportunity. Certainly, it would not have the same vaccination risks that have been associated with the military's anthrax vaccination.

Thanks for your comments. I'd enjoy reading more on the public health/epidemiological perspective.

I'm a little reticent to admit that I agree with Tommy Thompson. I think he has come off looking like a clown so far. However, the gov't is catching up to this. I agree that we need a larger stockpile (>100 million doses) so simultaneous outbreaks in multiple large cities can be dealt with. The argument against vaccinating everyone ASAP is as follows: there is an 1 in 1 million incidence of serious morbidity, even death with smallpox vaccination, due to inflammation of the brain. While 1 in a million is rare, it would be 280 cases of death or serious neurologic damage in this country. If there is an outbreak, absolutely the risk is worth it. If, at this point we're not even 100% sure that the virus exists outside of US and Russian stockpiles, than we probably should hold off on mass vaccination.

Perhaps the deployed military should receive it.

Harry K.

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