(1946) Smallpox epidemic still haunts doctors

Seattle Times ^ | Wednesday, March 05, 2003 | By Warren King, Seattle Times medical reporter

[Paleo Conservative]

In 1946, a smallpox outbreak shook Seattle. Citizens lined up at businesses, schools and even churches for the vaccine. Today, the doctors who helped quell the outbreak want everyone vaccinated in case of a terrorist attack.

As a combat medic in the Philippine jungles during World War II, David Hurlbut saw his share of horror in broken, bullet-riddled bodies. None of it was worse than the face of smallpox, which he saw on a troop ship coming home to Seattle.

[Paleo Conservative]

This is an excelllent article. The doctors interviewed are strongly in favor of vaccinating as many people as possible before an outbreak occurs. There is none of the PC anti-vaccination hysteria that has been prevalent for the last few weeks.

"If you're worried about smallpox, you need to vaccinate your population ahead of time," said Dr. Fillmore Buckner, whose pre-med class observed smallpox patients in 1946. Now a medical-legal writer, Buckner used public health records and newspaper accounts to write a history of the epidemic for the King County Medical Society Bulletin.

[Paleo Conservative]

Ping!

[Terridan]

So what are we waiting for? We should be able to get it irregardless of it being used as bio-warfare... hence, no worries! I wish with all of my heart that my kids were protected... best wishes and thanks for the post!

[tallhappy]

Thanks for this post.

We live in an age where nothing is real to people.

Being contrary to vaccination plans or not going along is, among other things, meant to be a snub at Bush.

People play politics with it like this because they don't believe it's real. Not the threat itself but the disease. It's been so long that we've been disease free that too many can't concieve of it. It is abstraction to them, just more TV.

[happygrl]

I wish everyone on FR would read this article.

I would get re-vaccinated in a New York minute if they made it available.

[not_apathetic_anymore]

I just read A Demon in the Freezer. It's a very sobering book. Before I started the book I thought I'd be in line for a vaccination, but ironically, after finishing it I'm more undecided. If I were in charge of a bio-weapons lab I would certainly try to cultivate a super-strain of the bug that made the vaccine ineffective. Apparently that is not too difficult. Thus I came away with the impression that the vaccine may in fact be an exercise where many get serious and unpleasant side effects for no protection.

[LadyDoc]

Thanks for the "heads up".

The PC types who don't want vaccination are three types: Those who hate Bush and would oppose anything, those who are naive and figure we can cure anything, and those who have HIV and are worried.

The first type are typical liberals, but alas are high in Medical societies just like in church socieites.

The second are the main problem.

The third have a point, since HIV positive people and people on dialysis and chemotherapy could die. That's why there are so many guidelines.

As for smallpox, I never saw a case. There is a real worry that we would miss such a case.

Luckily, in our area there are two older docs who say they have treated smallpox, and would still recognize the "smell" of an early case: One is my husband who saw cases in the Philippines, the other an ancient psychiatrist who still practices part time and saw cases in North Dakota.

If there were cases here, I suspect they'd trot out the old retired docs and Foreign medical graduates to identify cases early, and then implement the mass vaccinations.

It's a gamble: vaccinate, you could lose hundreds or thousands, maybe unnecessary. Don't vaccinate, you could lose tens of thousands....and there is no guarantee that Saddam doesn't have monkeypox, which will not be stopped by vaccinations...or anthrax or ebola or plague or tularemia etc etc.

[AppyPappy]

4th type: Those who want voluntary vaccinations only. Darwin will win out in the end

[Vic3O3]

ping!

[Mamzelle]

If the docs themselves are not anxious to be vaccinated, it could be that they are conservative rather than merely obstructive. These same "antibushers" pushed to get large supplies of the vaccine stored in every major metropolitan area. They have studied the path of the disease, and it works from a target area out. Smallpox is not antrax, and this is not 1946. In 1946 my mother had no antibiotics for her rheumatic fever.

Introducing a live, deadly microbe to a mass population (in the form of a vaccine) is not something to be done without great thought and caution.

[Free the USA]

http://www.freerepublic.com/perl/bump-list

[tallhappy]

Smallpox is not antrax, and this is not 1946. In 1946 my mother had no antibiotics for her rheumatic fever.

This is rambling. Are you trying to make a point?

Introducing a live, deadly microbe to a mass population (in the form of a vaccine) is not something to be done without great thought and caution.

Smallpox vaccination is by far the most common non-innate experience of all mankind. It has been given for centuries and for decades was given multiple times to every person on Earth.

It is not a "deadly microbe".

[Calamari]

"that Saddam doesn't have monkeypox, which will not be stopped by vaccinations..."

This indicates that vaccination is protective against monkey pox.

Occupational Health - Zoonotic Disease Fact Sheet #31

http://www.ksu.edu/research/animal/occhs/fact31.htm

MONKEY POX

SPECIES: Nonhuman primates, primarily macaques

AGENT: Orthopoxvirus Disease in humans is indistinguishable from smallpox, (Variola) i.e., serologic & clinical syndrome.

RESERVOIR AND INCIDENCE: Animals: Nine reported outbreaks in captive NHP's, primarily rhesus and cynomolgus. Has also been reported in languors, baboons, chimpanzees, orangutans, marmosets, gorillas, gibbons, and squirrel monkeys. The virus has been isolated from a wild squirrel. Man: The first human case of Monkey Pox was reported in 1970. Between 1970 and 1986, over 400 cases had been reported from tropical rain forested areas of West and Central Africa.

TRANSMISSION: Transmission can be via direct contact, aerosol, ingestion, or parenteral administration. Person to person transmission can occur.

DISEASE IN NONHUMAN PRIMATES: Usually exhibit a high morbidity and low mortality. Clinical signs may be inapparent or an animal may exhibit fever, lymphadenopathy, and cutaneous eruptions of the extremities, trunk, lips, or face. Cynomologus monkeys seem to be most severely affected. Death is uncommon except in infant monkeys.

DISEASE IN MAN: Signs in man include fever, sore throat, headache, and a vesiculopustular rash of peripheral distribution which clears up in 5 to 25 days. Severe complications include bronchopneumonia, vomiting, and diarrhea. Case fatality rate 10-15%. Although the disease is not common in man it is important from the standpoint of differentiating it from smallpox.

DIAGNOSIS: based on progression of lesions, histopathology and virus isolation. On histological examination epidermal cells contain eosinophilic cytoplasmic and intranuclear inclusions. ELISA

TREATMENT: Symptomatic.

PREVENTION/CONTROL: Sanitation, isolation. Vaccination with vaccinia virus is protective in both man and nonhuman primates.

BIOSAFETY LEVEL: BL-1

University Research Compliance Office: (532-3224), comply@ksu.edu

[SarahW]

The vaccine contains no smallpox virus.

[nmh]

Don't be so quick to vaccinate. Most vaccinations are not necessary and often lead to problems. If in doubt, check this MD out. He is not a quack . He is aq legitimate doctor who is able to articulate what is wrong with the over vaccination mentality. He also devles into some court cases where vaccinations appear to be the root cause of the medical problem. Can you say autism?

Here's his website:

http://www.mercola.com

[nmh]

It is not "pc" to be against some vaccinations. Other medical doctors also see the danger. I did a search for you and this link will give you the results. In the results you will see FACTS about what happens with many of these vaccinations healthwise and with the legal ramifications.

http://www.google.com/custom?cof=AH%3Acenter%3BAWFID%3A5cdb2968a482194d%3B&domains=www.mercola.com&sitesearch=www.mercola.com&q=vaccinations&sa2=Search+Mercola.com

[Gritty]

(This is a good article and IMHO needs to be archived on FR)

In 1946, a smallpox outbreak shook Seattle. Citizens lined up at businesses, schools and even churches for the vaccine. Today, the doctors who helped quell the outbreak want everyone vaccinated in case of a terrorist attack.

As a combat medic in the Philippine jungles during World War II, David Hurlbut saw his share of horror in broken, bullet-riddled bodies. None of it was worse than the face of smallpox, which he saw on a troop ship coming home to Seattle.

"He was covered with a mass of pus pockets," Hurlbut recalled of a desperately ill GI who broke out with the disease on the ship.

"He was sort of in a daze, and I felt so sorry for him. ... It was so different from combat; it was a natural phenomenon."

The year was 1946, and the infected soldier returning with Japan occupation forces would start the last recorded outbreak of smallpox in the Seattle area. The disease spread mostly from Harborview Medical Center, then called King County Hospital, out into the community.

By the time the four-month siege was over, 65 people would suffer from smallpox, including 20 who would die. Some 350,000 in King County alone received emergency vaccinations.

The experience still haunts those who witnessed the suffering. And several physicians who were there say Americans now should not hesitate to get inoculated if the government makes the vaccine available to the public. Only conditions that could cause vaccine complications should stop them, they say. Protection against bioterrorism should be a high priority, they argue.

"If you're worried about smallpox, you need to vaccinate your population ahead of time," said Dr. Fillmore Buckner, whose pre-med class observed smallpox patients in 1946. Now a medical-legal writer, Buckner used public health records and newspaper accounts to write a history of the epidemic for the King County Medical Society Bulletin.

"If you couldn't control an outbreak from one case in 1946, what are you going to do if a self-infected terrorist gets on an airplane and starts flying from city to city?"

Many experts say an outbreak could be controlled by vaccinating people who have close contact with those who are diagnosed with the disease — a tactic called "ring vaccinations."

The federal government's current smallpox-vaccination plan appears stalled, according to some disease experts. Health workers likely to see the first cases are being offered the vaccine, but many are turning it down, saying the possibility of serious vaccine side effects, though small, outweighs the unknown risk of a terrorist smallpox attack.

	TOM REESE / THE SEATTLE TIMES Dr. David Hurlbut, now 80, returned to Seattle from World War II with a soldier who was suffering from smallpox. Five weeks after their ship docked, the city was in the throes of an epidemic.

State health officials now estimate a maximum of only about 2,000 of the workers will receive the vaccine, compared to an estimate of 7,000 two months ago. At least 12 hospitals have said they will not participate in the program for now. Under the federal program, emergency workers, then the general public, eventually will be offered the vaccinations, though federal health officials do not recommend them to the public prior to an outbreak.

In 1946, it seemed possible to stop an outbreak early on.

Hurlbut, now 80, took blood and urine samples from the shipboard patient who was exposed to the disease in Japan. He volunteered for the task, he laughs now, to avoid standing in the long cafeteria lines aboard the troop ship.

The huge ship, the USS Hermitage, was only a few days out of Nagoya, Japan, when the young soldier broke out with the dreaded pox. Records show he was vaccinated after his exposure, but the inoculation didn't take. Hurlbut has a theory about why.

"Some of the guys were proud of the fact that they had scrubbed the heck out of the vaccination site with alcohol and had not gotten the itchy, sometimes very red and sore reaction," he wrote in his own account for the Medical Society Bulletin. Perhaps the soldier did the same and killed the vaccine's live virus in the process, Hurlbut said.

Soon after the soldier's diagnosis, the ship's doctors decided everyone aboard should be inoculated as an extra precaution — even though all had received the vaccine when they joined the military. The Hermitage was diverted to Hawaii to pick up vaccine. Then it made a slower-than-usual passage to Seattle to allow the vaccinations to take effect.

On arrival in Seattle on Feb. 3, the infected soldier was isolated in Fort Lawton's hospital in the Magnolia neighborhood. But infection-control measures soon were broken: An orderly caring for the soldier had contact with a recovering diphtheria patient on the isolation ward.

Everyone in the ward was vaccinated within 24 hours of the soldier's arrival, including the woman with diphtheria. So doctors weren't worried about smallpox when the patient broke out in pustules at home about two weeks after her exposure.

At Harborview, she was diagnosed as having generalized vaccinia, a reaction to the live virus carried in the vaccine.

But the several doctors who conferred on the case were wrong. She had smallpox.

The woman's vaccination wound showed that it "took" — or stimulated an immune reaction. But she may have been exposed to the disease before the vaccination or before full immunity developed. No one knows precisely what happened, doctors say now.

"It was very hard to really believe we had smallpox on hand and not something else," said Dr. Jim Haviland, who had been appointed the hospital's infectious-diseases chief fresh out of his residency and just two weeks before the outbreak.

"We hadn't had smallpox in the community in 20 years. Essentially, no one had seen it or had any experience with it, and there was no medical school here at the time."

The misdiagnosis set up the hospital for spread of the disease. Doctors, nurses and orderlies were in and out of the patient's room, walking through other wards, caring for other patients.

After five days, with the woman getting worse, she was diagnosed correctly. Less than two weeks later, four more hospital patients had symptoms, but the doctors still were reluctant to diagnose smallpox.

"We decided to handle it as smallpox when we saw how very sick they became," said Haviland, now 91. "We lost a couple of the patients in the beginning (of their symptoms), and that convinced us."

On March 11, just five weeks after the USS Hermitage had returned, Harborview was closed to all but emergency admissions and the hospital's several hundred patients were vaccinated. Infectious-disease staff members worked night and day. But the outbreak was up and running: By March 25, 17 cases had been diagnosed, three patients had died and people had been exposed outside the hospital.

Local and state health officials declared a public-health emergency that day, and mass immunizations began March 29.

David Hurlbut, who had traveled around the West visiting relatives after being discharged from the Army, suddenly found himself dealing with smallpox again. He had accepted a job in tuberculosis control with the state health department but soon after, in early April, was loaned to the Seattle City Health Department to help with the vaccinations.

"I had already been through a ship being afraid of smallpox, and now Seattle was afraid of smallpox," said Hurlbut.

The vaccinating went on night and day in clinics, schools, fire stations, businesses, even churches. In less than two weeks, 350,000 of King County's 475,000 residents were vaccinated.

"I was vaccinating on the sidewalk outside the (Health Department) building," said Hurlbut. "They'd line up, somebody else would swab their arms, and we'd hit 'em."

The efficient vaccination campaign quelled the outbreak after several more weeks. It was a good thing, as Hurlbut, Haviland and Buckner say they were astonished at how easily the disease spread.

A Port Angeles man who was picking up his son, a tuberculosis patient, from Harborview contracted the virus after coincidentally being in the admitting room with a smallpox patient. He died of the disease after spreading it to five others, including his son, who also died.

Haviland recalls an unvaccinated Harborview employee who simply stuck his head inside the smallpox ward out of curiosity and was infected.

Investigators never even determined the source of nine patients' infections. The rest of the 56 patients were all linked to Harborview — through either direct or secondary exposure, according to the State Department of Health's Annual Report for 1946.

Records show that the outbreak peaked during March and April, then tapered off. The last case in Seattle was diagnosed May 7, and the last death came May 18. Haviland believes that both the soldier and the female patient survived the disease.

Vaccinations clearly were important in preventing infections. State investigators learned that of 65 patients, 59 either said they had never been vaccinated, were vaccinated after exposure or were vaccinated more than four years before exposure. One was vaccinated less than four years before exposure. Vaccination histories for five patients could not be determined.

Haviland, Hurlbut and Buckner still marvel at the speed of the 1946 outbreak. They shudder to think of it happening again.

If it does, they say, any patient with the disease must be isolated immediately and completely. And with the threat of terrorism, they stress, the public should be offered vaccinations and accept the offer.

"If I hadn't seen smallpox, maybe I would have a different attitude," said Buckner, a retired obstetrician-gynecologist who saw the smallpox patients as a University of Washington student. "But I have no open mind on this. ... I am very strongly in favor of mass vaccinations."

Warren King: 206-464-2247 or wking@seattletimes.com

[Gritty]

State investigators learned that of 65 patients, 59 either said they had never been vaccinated, were vaccinated after exposure or were vaccinated more than four years before exposure. One was vaccinated less than four years before exposure. Vaccination histories for five patients could not be determined.

... In less than two weeks, 350,000 of King County's 475,000 residents were vaccinated.

Some vaccinations either did not "take" or "take" in time.

Also, even with a crash program of vaccination, they apparently weren't able to vaccinate everybody, even though they had assembly lines set up on the street and no other societal problems.

I wish the government would release the vaccine for public use. I would be first in line, even though I have gotten this vaccination many times before.

[Mamzelle]

No live virus at all, not even cowpox? Then it's different than the old vaccine. That doesn't mean it's without risk, especially for mass vaccinations. Hesitation, considering that there's no outbreak as yet, is not unreasonable. The vaccines are ready and in place. They have not been in common use for a long, long, time, if they are even the same vaccine.

Frankly, there are better and easier means of biowarfare than smallpox. I am dubious of small pox as a threat compared to other threats.

[Mamzelle]

You are free to seek it out and inject yourself with this newest vaccine. That doctors don't see the wisdom of haste is not unpatriotic, but an indication of skepticism. Infection scenarios are discussed in every hospital in the country, and what is known of possible infection outbreaks does not indicate immediate wide infection, but would likely have some warning. It would be like a bulls-eye, with infection spreading from the central infected outward. That a hospital would have quick access to a stockpile of vaccinations is a good thing, to use them now may well not be.

Rambling? I was attempting to demonstrate that our medicine is not the medicine of almost sixty years ago--communications are much better, treatments are better, and knowledge of side effects better. Smallpox wouldn't be spread by a squirt gun like anthrax and does not kill so quickly as anthrax. Yes, I was trying to make a point, only with fewer words and allusions rather than with lots of words, directly. I hope I've managed to finally make my point.

A possible smallpox terrorist incident would also likely be in a large metro area. Should all rural areas also be vaccinated? These are matters of public health policy debate as well as safety. It's a cheap shot to accuse someone unconvinced of the science of smallpox vaccinations as somehow antiAmerican.