Replies

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.

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??

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.