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.
This is where political correctness breaks down......let someone try describing them as 'different'.........
There is evil in the world, and it's a very real thing.
Smallpox
Author/s: Rosalyn S. Carson-DeWitt
Definition
Smallpox is an infection caused by the virus called variola, a member of the poxvirus family. Throughout all of history, smallpox has been a greatly feared disease, responsible for huge epidemics worldwide, and the cause of great suffering and massive numbers of deaths. In 1980, the World Health Organization (WHO) announced that an extensive program of vaccination against the disease had resulted in the complete eradication of the virus, with the exception of samples of stored virus in two laboratories.
Description
Smallpox was strictly an infection of human beings. Animals and insects could neither be infected by smallpox, nor carry the virus in any form. Most infections were caused by contact with a person who had already developed the characteristic skin lesions (pox) of the disease, although a person who had a less severe infection (not symptomatic or diagnosable in the usual way) could unwittingly spreading the virus.
Causes & symptoms
Smallpox was a relatively contagious disease, which accounts for its ability to cause massive epidemics. The variola virus was acquired from direct contact with individuals sick with the disease, from contaminated air droplets, and even from objects used by another smallpox victim (books, blankets, utensils, etc.). The respiratory tract was the usual entry point for the variola virus into a human being.
After the virus entered the body, there was a 12-14 day incubation period during which the virus multiplied, although no symptoms were recognizable. After the incubation period, symptoms appeared abruptly and included fever and chills, muscle aches, and a flat, reddish purple rash on the chest, abdomen, and back. These symptoms lasted about three days, after which the rash faded and the fever dropped. A day or two later, fever would return, along with a bumpy rash starting on the feet, hands, and face. The rash would progress, ultimately reaching the chest, abdomen, and back. The individual bumps (papules) would fill with clear fluid, and eventually become pus-filled over the course of 10-12 days. These pox would eventually scab over, each leaving a permanently scarred pock or pit when the scab dropped off.
Death from smallpox usually followed complications such as bacterial infection of the open skin lesions, pneumonia, or bone infections. A very severe and quickly fatal form of smallpox was called "sledgehammer smallpox," and resulted in massive, uncontrollable bleeding (hemorrhage) from the skin lesions, as well as from the mouth, nose, and other areas of the body.
Fear of smallpox came from both the epidemic nature of the disease, as well as from the fact that no therapies were ever discovered to either treat the symptoms of smallpox, or shorten the course of the disease.
My son just turned 18, but in the smallpox vaccination reality that we happen to live in right now, he is completely unprotected. To me, he is still my child.
The Hitlery generation has made 'the children' a bad thing. Just one more of Her Corruptness' legacies.
Thanks for the caveats. But I can't help myself.
I can't help feeling more hopeful about our chances against smallpox. It seemed so hopeless before. Everyone sick. Everyone dying.
If vaccinations MIGHT last 50 years, and some of us had vaccinations only 40 years ago, there just MIGHT be some hope. Considering the tentative findings of this study, and the advances in medicine, and the thought that some vaccine might be available to help those who are not immune...things look better.
Is there a chance that, somehow, the smallpox immunity factor in the bodies of the over-40 year-olds could be transferred to their family members who are not immune?
You appear to be a genius at "missing the point"- which is why I gave up on this pointless discussion and got some work done. CathyRyan's "point" was perfectly obvious the FIRST time she made it- to everyone but you. Have you ever had your reading comprehension checked? Maybe you should.
By the way, I strongly suspect that you are a either a politician or an academic in some non-rigorous field (English? Ethnic Studies?), because you seem to have little ability to reason. And I mean that in the NICEST POSSIBLE WAY!
They should start with the under 20s and the military. A lot of the 20- to 30-year-old group will be in the work force with older people not likely to spread the disease. Maybe this group could be treated on a case-by-case basis.
How do you go about doing your own vaccination?
I believe the esteemed Mr. Harriot is no longer living.
It looks as though someone burned you on the upper arm with a small car cigarette lighter; roughly circular and with pin pricks where the vaccine needle was dipped and jabbed repeatedly in the epidermal layer of flesh at the apex of the outer shoulder muscle.
Since our current medical practitioners have no experience with diagnosing smallpox, I hope that CDC is supporting them with the necessary information, photos, etc. As potential first-line diagnosticians, school nurses should also be alerted to symptoms and isolation procedures. Given what's happened with Anthrax, I suspect this is too much to expect of CDC.
Apart from preparing our family for potential isolation and keeping alert, I feel too, too helpless on this threat.
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