An Army soldier at Fort Benning, Ga. ,wearing nuclear,
biological and chemical protection gear. The Bush
administration on Friday ordered smallpox vaccination of
military personnel and emergency medical workers.
Smallpox response might include quarantine
State and federal authorities could take extraordinary
steps to contain an epidemic
Dec. 12 — If
terrorists using smallpox as a weapon started an epidemic in an
American city, public health officials might need to consider
imposing a quarantine to stop the spread of the fast-moving deadly
disease.
GUIDELINES ISSUED in
September by the federal Centers for Disease Control and Prevention
say that in some cases, the isolation of a small number of smallpox
patients may be sufficient to control an epidemic. But in other
situations, far-reaching quarantines might be required.
State governments recently submitted draft plans for
responding to a smallpox outbreak but, citing security concerns,
most states are saying very little about their plans.
Professor Lawrence Gostin, director of the Center for Law and
the Public’s Health at Georgetown University Law School, said “there
are huge logistical problems” with a quarantine, “not to mention the
civil liberties implications of taking away people’s liberties en
masse.”
Smallpox
lesions are shown in this 1973 photograph from an outbreak in
Bangladesh.
Forty
years ago, quarantines were not seen as critical to stemming the
spread of smallpox. During the international campaign against the
virus that culminated in 1977 when the disease was eradicated,
health officials used a “surveillance-containment” strategy to
combat the disease, isolating infected people and watching them
closely for the fever and skin rash that characterize smallpox.
People who had been in contact with those infected were
immediately vaccinated because inoculation within four days of
exposure provided some protection against smallpox and prevented
people from dying from the disease.
TRACING VS.
VACCINATING
But a recent study led by Professor Edward Kaplan at Yale
University’s Department of Epidemiology and Public Health concluded
that a “race to trace” everyone who had been in contact with an
infected person might not stem an epidemic today.
Smallpox's
rise and fall
Time line of a scourge
10000 B.C.
Smallpox appears in settlements in northeast Africa.
1350 B.C.
The first recorded smallpox epidemic occurs during the
Egyptian-Hittite war when Egyptian prisoners unwittingly
spread the virus among the Hittite population.
1000 B.C.
Variolation, an early form of smallpox inoculation, is
developed in China and India. The process involved taking
the pus from the pocks of someone suffering from the virus
and inoculating healthy people with it. A mild case of
smallpox developed, but the process granted lifelong
immunity afterwards. The practice would eventually spread
to Europe and the New World by the 18th century.
180
The Roman Empire is devastated by the Plague of Antonine
which kills millions. The dead include Marcus Aurelius,
the reigning emperor.
570
Bishop Marius of Avenches names the virus, "variola", a
derivation of the Latin word for "stained." The popular
term for the virus, "smallpox", won't come into use in
England until the 15th century.
910
Rhazes. a Persian physician, writes the first medical
description of smallpox.
1520
Two years after Spanish conquistadors arrive in Mexico,
the Aztec emperor Ciutlahuac dies of smallpox. Over the
next century of Spanish occupation, Mexico’s population
diminishes from an estimated high of 15 to 20 million in
1518 to 1.6 million by 1620. The decimation is repeated
throughout the New World as Europeans unknowingly
introduce smallpox.
18th century
Smallpox kills four reigning European monarchs including
Tsar Peter II of Russia and King Louis XV of France. Other
notable victims include the king of Ethiopia and a
Japanese emperor. By the last decades of the 18th century
an estimated 400,000 Europeans die of smallpox each year.
1754-1767
Smallpox is used as a weapon when British forces
distribute blankets used by smallpox patients to Native
American tribes during the French-Indian war.
1774
Benjamin Jesty, a farmer from the town of Dorset in the
United Kingdom, inoculates his family with material taken
from the udders of cows that had cowpox, a virus similar
to smallpox. Medical reports begin to appear linking
smallpox immunity in those individuals with a previous
case of cowpox.
1796
Edward Jenner, a British surgeon, injects the fluid
extracted from a postule of a cowpox victim into a healthy
child. Eventually, the word "vaccine", derived from the
medical name of cowpox, "variolae vaccinae", falls into
common usage. Jenner does not invent vaccination, but he
does confer scientific status. By 1800, Jenner’s efforts
to popularize vaccination results in vaccination campaigns
throughout Europe.
1801
President Thomas Jefferson creates the National Vaccine
Institute.
1803
Spain begins the first overseas vaccination program when
it sends the vaccine to North and South America.
1967
World Health Organization launches global vaccination
campaign against smallpox.
1972
Routine smallpox vaccination among the American public
ends.
1977
Last naturally occurring case of smallpox reported in
Somalia.
1980
The World Health Organization recommendeds that all
countries cease vaccination and that all laboratories
destroy their stocks of smallpox or transfer them to the
Institute of Virus Preparations in Moscow, Russia, or the
Centers for Disease Control and Prevention (CDC) in
Atlanta, Ga. All countries report compliance. Soviets
begin to develop smallpox as a bioweapon.
1982
Vaccine production is discontinued in the United States.
1990
U.S. military discontinues routine vaccinations.
Today
Smallpox vaccinations are generally limited to selected
lab workers and military personnel.
Tracing people in
isolated villages could be effective, but in a teeming city with
millions of residents and visitors this approach could be all but
impossible, the study said.
Kaplan’s study recommends mass vaccination of the local
population in the face of a smallpox outbreak.
In an interview with MSNBC.com, he said that unlike the
relatively small isolated outbreaks of 40 years ago, a terrorist
attack using smallpox might be widespread and coordinated.
“At the time the attack is detected you don’t know if it is
big or small,” he said. Instead of a couple of infections in any one
place there might be a couple of thousand.
Kaplan also raised what he calls “a nightmare scenario.”
“What would happen if it were determined that the smallpox
vaccinations weren’t working right — if you had been attacked with a
strain of smallpox engineered to defeat the vaccine? Then a
quarantine becomes of tremendous importance,” Kaplan said, as the
only way to contain the disease and let it run its course in those
infected, while not allowing it to spread to others.
The Bush administration is soon expected to announce its
policy on smallpox vaccinations, in light of concerns that
terrorists might seek to trigger a smallpox epidemic in the
United States. At first, only police, emergency medical
workers and members of the military are likely to be
vaccinated. Here are some questions and answers about
smallpox and the vaccine.
What is
smallpox?
Smallpox is a contagious and sometimes fatal disease caused
by a virus and marked by fever and a distinctive progressive
skin rash. It is thought to have killed more people
throughout history than any other epidemic disease. In 1980,
the World Health Organization declared the disease
eradicated following vaccination programs, but the Soviet
Union maintained an active smallpox weapons development
program and other countries such as Iraq may have similar
programs.
How is
smallpox spread?
Smallpox spreads from contact with infected persons.
Generally, direct and fairly prolonged face-to-face contact
is required to spread smallpox. It also can be spread
through contact with infected bodily fluids or contaminated
objects such as bedding.
When do
symptoms appear?
After exposure, it takes between seven and 17 days for
symptoms to appear. During this time, the infected person
feels fine and is not contagious.
Why not
vaccinate everyone right now?
The smallpox vaccine is very effective, so the Bush
administration is planning to offer it widely. But many are
urging caution because the vaccine itself, made with a live
virus called vaccinia, carries rare but serious risks.
Can the
vaccine hurt anyone?
Based on studies from the 1960s, experts estimate that 15
out of every million people vaccinated for the first time
will face life-threatening complications, and one or two
will die.
Who is at
risk of vaccine side effects?
According to the Centers for Disease Control, those who have
any of the following conditions, or live with someone who
does, should not get the smallpox vaccine unless they have
been exposed to the smallpox virus.
The conditions are:
Eczema or atopic dermatitis.
Skin conditions such as burns, chickenpox, shingles,
impetigo, herpes, severe acne, or psoriasis.
Weakened immune system.
Pregnancy or plans to become pregnant within one month
of vaccination.
Can vaccine
help someone exposed to smallpox?
Vaccination within three days of exposure will completely
prevent or significantly modify smallpox in the vast
majority of persons. Vaccination four to seven days after
exposure likely offers some protection from disease or may
modify the severity of disease.
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Are there
other treatments?
Cidofovir, a drug currently used for treatment of
opportunistic infections in AIDS patients may be an
effective treatment against smallpox, European researchers
recently reported.
Sources: Centers for Disease
Control, The Associated Press, American Society for Microbiology
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"
The number of cases and the number of people exposed.
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