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.
Yes.
I've been saying this here for a while now, as have others.
I think that your title for this SLATE article("THE GOOD NEWS ABOUT SMALLPOX") just bothered me. There really IS no good news, and if it were to be used as a weapon, the consequences (I believe) would be about as horrible for us and for the rest of the world as anyone could possibly imagine. Yet you are peddling false reassurance, and a sort of "move on, folks, nothing to see here" attitude that I associate with the senior management of the Post Office, or the Reno Justice Department.
You have consistently missed the point of my posts, and answered arguments that I have not made. This leads me to believe that you have some agenda- although it is hard to guess what it is.
In any case, I do have other things to do. Salud!
You know, every time I made an assertion, I backed it up with a link. You, however, continue to make general statements that are just not true.
You have consistently missed the point of my posts, and answered arguments that I have not made.
Then why don't you restate your points, and I will address them?
Since smallpox has not been an active infection in human populations since the mid 1970s, if terrorists were to start a new epidemic with some of the stored samples, we might presume the virus to be unchanged from what was active earlier. Thus, those immune systems that had been vacinated back when that same virus was active should be just as capable now of producing antibodies as they were back then.
This would tend to suggest that this article is right: those of us who were vaccinated when we were younger might indeed still carry in our immune systems the ability to make antibodies should we become infected. Because the immune system is old and rusty, it cannot be guaranteed that wouldn't become sick at all. But it should be good enough to give our systems a little bit of a head start against a smallpox infection. A little bit of a head start in antibody production is all we need to assure that smallpox for us would be only a minor illness.
However, if the smallpox sample is subjected to ANY genetic engineeering, no matter how minor, then all bets are off.
Sorry, but no. The antibodies passed from mother to child only help while the child is breast feeding. What is then needed is the ability of the immune system to make its own antibodies. That can only happen if the immune system is exposed to the virus so that it can use it as a template to make an antibody, and then to store the design code for the antibody.
If you realized that the guards at that Russian site were going unpaid for months at a time and could be bribed for a few bottles of Vodka, you might be a great deal less sanguine about the likelihood of a smallpox attack.
The World Health Organization has issued an alert to all governments to be prepared for a possible smallpox outbreak. My guess is that they weren't just sitting around and decided: "Gosh, we've nothing better to do, let's release this smallpox alert just for fun!"
Soviet defector Ken Alibek claims that some 20 tons of weaponized anthrax was manufactured...
Yes, but that "bedridden" child is not going to be kept in bed waiting for the MD to visit. They'll be taken to a clinic or the emergency room, and the MD will examine them THERE -- after they have sat in a crowded waiting room for an hour or so, like usual.
A patient won't be known to have smallpox until an MD has examined them and diagnosed them as having smallpox. And in this day and age, that isn't going to happen in their bed at home, but in an examining room, after the patient has passed through a waiting room.
And of course, a single parent who is working and trying to support a family may not exactly be the perfect "Dr. Mom" when it comes to practicing proper isolation procedures, getting the patient to medical attention promptly, and making sure that they don't wear infected clothes to work, etc.
If the current anthrax situation is the precedent, then I simply can't share your confidence that the public authorities are going to be able to instantaneously diagnosis a disease that nobody has seen in 30 years, instaneously determine the full extent of the outbreak, and then instaneously notify the public.
The appearance of even ONE case of pneumatory anthrax in Florida should have let us know that there was an anthrax bioterrorism attack underway. However, even government authorities, as well as MOST of the people on FR, were in denial about this for almost two weeks. Not a precedent to inspire much confidence, I'm afraid.
If there is a smallpox epidemic, there will be provisions made for isolating people in the hospital. You simply don't let contagious people sit around the general population. In the initial stages of the diesase, only a few days, there will be a chance for some infections like that, but once the first diagnosis of smallpox is made, quarantines can start.
Somalia. It gives me the creeps thinking about the Somalia/OBL connection when I think about smallpox... I know its irrational... but if you do a google search on "smallpox" and read about the excruciating pain and horrible disfigurement it causes while it slowly kills a child... it's enough to cause nightmares.
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