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.
I'm not making light of smallpox, but I do want to say that it does not always leave a person terribly disfigured. I am struck, when reading biographies or histories, with just how many famous people were infected by smallpox, and the wide range of responses these famous victims displayed. Charles II had smallpox, and he apparently was left unscarred , and that's true of other famous smallpox sufferers-some were left entirely unscathed. Fanny Kemble, the famous 19th century actress, was left unscarred and smoothskinned, but her complexion was robbed of its translucence and left with the sallow, muddy, 'thickened' look associated with an older woman who'd had children.( She was still a teen, and had no children.) Other victims were left with only a few scars to hide, and that's how the 18th century fad for black velvet patches started. And some, like Mirabeau, the Duke of Anjou , and one of Marie Antoinette's sisters, were left terribly disfigured. It's not a given that every single infected person will get the absolute worst end result. I do not know what link there might be between those who got off light, and any exposure they might have had to cowpox, but I thought cowpox exposure would have left them totally immune.(???)
That said, I hope steps are being taken to get the vaccine available. And given that smallpox was not eradicated from the third world, and given post 1965 emigration policies, I do not understand why the post 1971 babies were left vulnerable.
Exactly, not everyone has a scar. I was vaccinated in the 50's but don't have a scar.
And then if you lived outside the US, you may have a scar from a different kind of a vaccination. For instance, we were living outside the US when my 13 year old son started school, and he had to have a BCG vaccine (for TB) because it was required by the country we were in. This leaves a scar very similar to the smallpox scar.
Again, great article. Thanks for posting.
I'm thinking that these terrorists certainly understand the target audience of such an attack. If this happens, you'll see MANY Baby Boomers seriously "go to war" in many ways. And many, many mothers.
Your link just goes back to the Smallpox article. Hopefully, here's the correct link to the Anthrax piece.
I'm with you on this one, arkfreepdom (love the handle!!).
Think about this for a minute -- all young persons in our country from birth to the age of 29 -- we could lose 30% of two American generations. Children and grandchildren.
The decision to end immunizations for smallpox after eradication was the only logical choice considering there is a (very) small chance of sickness or death from the vaccination. While the risks were worth it compared to the mortality rate of the disease, it is not worth it to continue it just for piece of mind.
As far as the disease itself, the most important thing to remember is that it is NOT contagious in its initial stages. Only after the appearance of the telltale rash, usually after 10 or 12 days, does the disease become contagious. However, once the rash does appear, the patient becomes very weak and is likely to be bedridden by that time. This means that containing the disease is much easier that you've been led to believe.
Also, as we are seeing with anthrax, the mortality rate is going to be much lower than expected because of newer treatments.
On the whole, smallpox, while potentially dangerous, is very controllable.
Well take comfort the distribution will be done right. It will be distributed ethnically, just to be fair, starting with the largest groups of minorities, then illegal alien's kids. If there's any left, maybe your kids will get some.
Ah, you say, but Iraq (for example) could simply immunize all of it's people.
No, they couldn't. The mere possession of enough smallpox vaccine to do the job would be an admission of guilt, and it's use could not be hidden for long- even from our bumbling CIA.
The result would be the total annihilation of that country by the U.S. (especially when our children start dying by the tens of thousands).
There are suicide bombers, but I am not aware of any "suicide nations".
No and no.
Chicken Pox is in the Herpes family of viruses, and is not a true pox.
Smallpox and cowpox are true poxes, and are of the variola family.
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