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.
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.
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.
There is a huge difference between anthrax and smallpox. Anthrax bacteria is endemic to large portions of the world, people who work with wool and leather come into contact with spores constantly, so occasional infections are nothing new. However, if even ONE case of smallpox shows up, after being declared "eradicated" in 1980, it will be obvious.
Have you ever been in a big city ER?
Please explain ow this would happen, since you are sick for 2 or 3 days BEFORE YOU ARE CONTAGIOUS?
I am sure that middle+ class parents are very good about getting their kids to the MD promptly when they become sick. For poor single parent households where the parent might be holding down two jobs to pay the rent and keep food on the table, I wouldn't be so quick to assume that they are going to take off work every time a kid gets sick, especially if they have no health insurance and have been told by their boss that if they are absent from work one more time, they're fired. The realitiy is that some poor kids need a lot more wrong with them than just a fever, a cough, and a rash before they are taken in for medical care. Your assumption that every single kid who contracts smallpox is immediately going to receive medical attention, and thus be promptly diagnosed, is unrealistic for large segments of our population
. You are trying to scare people. Fortunately, you aren't doing a very good job of it.
No, I'm trying to work with other people on FR to come up with a realistic threat assessment. The realistic threat assessment that our government has come up with is classified, and they won't tell us its contents. That means it is up to us to try to discern the actual situation as best as we can.
Nobody should be scared into panic or dispair. Another post above by a nurse outlined a reasonable and effective contingency plan that people can take to protect themselves and their loved ones. However, a realistic threat assessment and contingency plan must take account of the probability that it may not be wise to wait until the public authorities issue an absolutely definitive and final diagnosis and make an official public announcement. Rather, one is going to have to monitor the media and stay plugged into the grapevine, and ready to implement the contingency plan immediately upon the FIRST credible report.
Sorry, but until those 300 million doses of vaccine are available and administered, this is the best that parents can do for their children. And I am far more concerned about them than I am about whether or not YOU approve, Tom!
However, if this country would suffer this kind of a disaster, it would demand a nuclear retaliation. But then again, Berkely, CA would probably demand we remain calm.
When I was six, "the scar" was a source of great pride. You were "grown up."
Have you ever been in a big city ER?
TomB apparently thinks that if any kid is infected with smallpox, then the second the rash starts to appear the parent (who of course is a stay-at-home mom, staying by the kid's bedside every second, because everyone knows that only dads need to work) will realize "Oh my, it's smallpox", call the ambulance, and they will don protective gear and rush the kid directly into an isolation ward. Oh, yes, and of course we will have however thousand or millions of isolation units we might need, no upper limit to that capacity.
I sure do wish I could live in TomB's world!
The realitiy is that some poor kids need a lot more wrong with them than just a fever, a cough, and a rash before they are taken in for medical care.
is ridiculous, because once it is announced that smallpox is occurring in a given area, anytime a person gets sick they will assume is the diesase, as anyone paying attention to what is going on with anthrax right now can plainly see. You also continue to ignore the fact that the disease is not contagious for 2-3 days after the person gets sick.
Have you ever been in a hospital after a state of emergency has been declared?
Do you REALLY think that once smallpox has been identified, they're going to go about things normally?
Really shows the depth of the depravity exhibited by our enemy.
My cousin, a physician, dropped dead of a heart attack in the middle of the cardiac intensive care section of the hospital he worked in. Sometimes, when people have a heart attack, there's nothing that can be done. But I'm not sure what that has to do with smallpox.
You do realize that when an epidemic occurs, that certain procedures are put in place?
Do you inderstand how contagious smallpox is?
My plan is (hopefully never to be used) following the first announcement of ONE CASE on your local news, it's time for lockdown quarantine. You stay home, use whatever you have at home to eat and drink (the water supply should be OK but I'll still use bottled or stored water) and listen to your local radio and local TV station for instructions. The health department will set up mass vaccinations and at that time you leave your quarantined home and go for your first vaccination or your booster.
This should give you 100% protection from the virus UNLESS someone in your household had already been infected. If someone in your family had already been infected and should become ill, that person would have to be separated from the rest of the family and one of the previously vaccinated persons would go with that person to another part of the house and stay there until the vaccinations become available.
It's doable, folks. Just remember: Isolation, isolation, isolation! No co-mingling. Forget the job, school, everything, until you get your vaccination and you'll be OK.
Remember, smallpox is not contagious before the rash breaks out and the patient is feeling very sick before the rash appears so you should be able to isolate him before he or she infects the rest of the family.
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