And Now, the Good News about Smallpox

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."

"On the whole, smallpox, while potentially dangerous, is very controllable"

Pretty optimistic assumptions in your post- I think TOO optimistic. Read a journal called "EMERGING INFECTIOUS DISEASES" (available on the web- type that into GOOGLE).

My optimism derives from the fact that I cannot see any head of State authorizing such an attack, and I don't think freelancing terrorist groups can pull this off.

If they did use this as a weapon, and spread it widely right at the start, I would be surprised to escape with less than 25-30% fatalities.

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.

But, but, all the anti-vaccinationists tell us that this is simply due to better sanitation. Could it be that being vaccinated actually causes people to move to areas of better sanitation and so escape the disease or at least contract weaker strains that, presumably, exist in areas of better sanitation? Ha ha ha ha.

we could lose 30% of two American generations. Children and grandchildren.

Depending on age and physical condition, we might see more than 30% dead. The Liverpool study at the start of this thread had 75% of unvaccinated becoming seriously ill, with 2/3 of those who became ill dying. A 50% mortality rate

Realisticly speaking, if we get a serious epidemic, the ones who will get the vacines first will be doctors, nurses and other medical personnel, police and other emergency personnel. Namely the people who cannot function without coming into contact with sick people.

(The families of the rich and connected will also get vacinated first, but that's another issue)

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.

You sure about that?

I've read that smallpox is contagious during incubation, prior to the manifestation of symptoms. There were also several smallpox threads on the subject last week, with comments from doctors, and none suggested that the virus wasn't contagious prior to the development of pustules.

If they did use this as a weapon, and spread it widely right at the start, I would be surprised to escape with less than 25-30% fatalities.

That is your opinion, but the fact that the disease takes so long to become contagious, and the emergence of many anti viral meds in the past decade, make you scenario highly unlikely.

Another point, there was an outbreak of smallpox in New York City in 1947, in which a man arrived from Mexico sick with the diesase. The diagnosis of smallpox wasn't even made until two other infections had been identified. But despite the headstart, there were only 12 total cases.

We have the ability to keep a dangerous diesase like smallpox under control.

If this is the case, I shall have to thank my mother for breastfeeding me and my siblings.

Breastfeeding provides a newborn a lot of antibody protection for several months after birth which is important to protect them until their own immune systems kick in. But the antibodies in the breast milk don't last for more than a few months, you have no protection at all against smallpox unless you were immunized. I don't believe it's really going to take months to get the immunizations, the virus used to make the vaccine can replicate much faster than that, but even if it does, it's not really that hard for people to do their own if they had to.

If there's an outbreak in my area, she won't leave the house until the CDC has vaccinations on the ground, which will probably be within 48 hours of a confirmed case.

You are absolutely right! The only defense against smallpox, other than vaccination, is isolation. Think: Quarantine.

But, remember, you have to isolate EVERYONE in your household until the vaccinations are made available. The previously vaccinated members of the family could still bring the virus home on their clothing, etc. and infect your daughter. No work, no visitors, no mail, no new supplies (food, water). Nothing comes in from outside the home. No contact with the outside world whatsoever.

It would only be for a few days at most and the only sure way to keep your daughter safe.

I'm a nurse, with an unvaccinated son, and this is exactly what I intend to do if a smallpox outbreak occurs in my area.

As the CDC's Leduc says, "This is not going to be a wildfire that overtakes the world."

Seems to me that it could take over the world without necessarily affecting us badly. Census figures show that Third World countries have much younger (and therefore unvaccinated) populations than the aging democracies of the West. Half of Pakistan is supposed to be less than 24 years old, for example.

Add this to the squalid, overcrowded living conditions and weak public health authorities of the Third World, and it seems to me that smallpox could spread like wildfire there, while sparing us from significant harm-- if we let it. We would not do this because we are a good and kind people with immense resources.

If there should be even a single case anywhere in the world, we can be sure the CDC would be at the front lines helping to vaccinate and quarantine the outbreak. Count on us to do our best to bring peace and health and prosperity to the world.

We have made some mistakes along the way, but let us dwell instead on the good things that Western civilization and in particular the US have given the world, and be of good cheer. Vaccinations, food aid, the Green Revolution, the GPS system, the US Navy guarding free passage on the high seas, the Internet, intercontinental air transport, and the list goes on. What have the savage dark parts of the world contributed to human happiness? Practically nothing since someone invented Arabic (really Indian or Chinese) numerals a millenium ago.

No wonder they hate us so much. They are so inferior to us in every way. At the root of Islamic rage is nothing more than a festering envy and abject sense of impotence.

-ccm

"Not everyone got a scar from the smallpox vacination."

Technically, I've had 3 smallpox vaccinations in my life (and I'm in my late 40's). The first one didn't "take", or cause the lesion that shows the vaccine has worked, so I had to be redone. I got a nice, visible scar from the 2nd one. I had a booster in the 7th (I think) grade, that also reacted, leaving its own smaller scar. That scar is no longer visible.

I would hope the government gets on the stick and vaccinates the younger people in this country, so we seriously reduce the attraction of using smallpox as a terrorist weapon.

You sure about that?

I'm positive.

From this article in JAMA, which, BTW, took all of 30 seconds to find using Google:

Historically, the rapidity of smallpox transmission throughout the population was generally slower than for such diseases as measles or chickenpox. Patients spread smallpox primarily to household members and friends; large outbreaks in schools, for example, were uncommon. This finding was accounted for in part by the fact that transmission of smallpox virus did not occur until onset of rash. By then, many patients had been confined to bed because of the high fever and malaise of the prodromal illness. Secondary cases were thus usually restricted to those who came into contact with patients, usually in the household or hospital.

There is a lot of scare mongering going on around here lately. Anything you read (including this) should be taken with a grain of salt. Although information like this is very easy to confirm.

Have you heard the joke? A guy goes for a company physical. The doctor tells him to undress. As he takes his shoes and socks off, the doctor exclaims over the condition of his feet. "What happened to your feet?" he asked. "Oh, I had a bad case of tolio." "Don't you mean 'polio'?" "No, it was tolio and it left my feet this way." When the guy takes off his trousers, the doctor asked, "Good G-d, man! What happened to your knees?" "Oh, when I was a child I had a really bad case of kneesles." The doctor just shrugged and told him to continue disrobing. When the guy took off his shorts, the doctor said, "Wait, don't tell me. A bad case of small cocks?" (Alternate reading: chicken cocks)

"That is your opinion, but the fact that the disease takes so long to become contagious, and the emergence of many anti viral meds in the past decade, make you scenario highly unlikely."

Well, yes, that IS my opinion, but if you read my original post in reply to your somewhat optimistic scenario, you would note tha my basic opinion is that this will not happen- because this weapon will not be used.

I submit that you have no better idea of what the total casualties would be than I do, and further, that no-one can possibly know this unless and until the attack happens. There are an awful lot of variables not even mentioned on this thread, many of which are unknowable.

If it makes you feel better to believe that smallpox, the ancient scourge of mankind, really isn't all THAT dangerous, then do so.

This CDC flak seems to be saying that his agency's policy is to just make stuff up to advance their agenda. The Carl Sagan approach to science.

By the way, I wonder what you and the author of the SLATE article would consider an "acceptable" casualty rate? What if only 10% of Americans died? How about only 5%- would that be OK? At what projected case fatality rate should everyone just relax? (A 1% rate would mean the deaths of almost three MILLION Americans...)

No- if this is ever used, it's pretty much certain that some countries are going to disappear rather suddenly. I don't think that rationality and SLATE articles will have much of a chance.

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