excerpt from The Vaccine Guide
Smallpox (or variola) has an infamous history as a dreaded contagious disease, and a deadly weapon of war. Unfortunately, the smallpox vaccine has a similar history. Smallpox arose from a relatively harmless rodent virus that became deadly when it jumped the species barrier to humans thousands of years ago. The oldest reference to the disease is in Egyptian records of 3700 B.C. Since that time, smallpox has killed hundreds of millions of people. The disease is especially devastating to cultures that have not been previously exposed. The native populations of North and South America were decimated by smallpox and war, reducing their numbers from 72 million when Columbus landed in 1492 to 600,000 by 1800 (Thornton, 1987).
Modern medicine has no effective treatment for this deadly virus. The fatality rate is about 30 percent in epidemics. The death rate is highest among those never vaccinated. In one review of 680 smallpox cases in Europe during the period 1950-1971, vaccination over 20 years prior to exposure reduced the death rate to 11 percent compared to about 50 percent in the unvaccinated (Mack, 1972). Smallpox was declared officially eliminated from the planet in 1980. Subsequently, the virus was maintained in government storage facilities, and developed as a weapon of war.
The only possible causes of smallpox disease now would be laboratory accidents, a mass release during wartime, or through terrorist acts. No one knows what a modern epidemic would be like, but experts fear the worst, partially because today’s weapons-grade smallpox virus is designed to be lethal, and because the United States stopped routine smallpox vaccination in 1971.
Another similar pox virus does cause disease and deaths, termed human monkeypox when it was discovered in 1970 because the virus resembled a pox virus found in captive monkeys in 1958 (Mukinda et al., 1996). Monkeypox exists in rainforest villages of central and western Africa, where it is transferred through person-to-person contact. It causes the same symptoms as smallpox, and differs from smallpox virus only in its nucleotide sequences. Several outbreaks have occurred. In 1996, 71 cases were reported Katako-Kombe area in Zaire with four deaths. In one small village of 346 inhabitants, 42 cases were reported, including three deaths (WHO, 1996). By December of 1997 more than 500 cases of monkeypox were reported in Zaire. It is possible that smallpox has already made a comeback in this remote part of the world.
Twelve days after exposure, smallpox begins with fever, tiredness, vomiting, and severe back pain. Within three days a rash develops on the face, then spreads to the trunk, arms, and legs. The victim is potentially contagious from the onset of symptoms until all eruptions have healed. The hardy virus is spread through droplets from the nose or mouth, which can even travel through ventilation systems to infect others. The skin lesions themselves are also contagious. Once the rash appears, the flat red eruptions develop into hardened pustules over the course of a week. These lesions can be felt as lumps under the skin. Thousands of these pustules may occur over the body, with swelling and generalized redness of the skin, and severe, fiery itching. The swollen face is often completely covered with lesions. On the eighth day of the eruption a dark spot appears on the pustule and then it opens, discharging pus, forming a scab, and then leaving a depressed scar, which is often permanent. Complete recovery usually occurs within three weeks.
However, in severe cases of the disease, fever begins again on day 11 with a rampant worsening of symptoms. Infections of the eye can cause blindness, fluids collect in the airways resulting in suffocation, sores and abscesses develop, and the body bloats and swells. An especially vicious form of smallpox results in bleeding from the skin lesions and internal organs, and frequently these patients die. It is during the second week that most deaths from smallpox occur.
Smallpox is a potent weapon of war. The British purposefully inflicted smallpox on Native Americans during the French and Indian War in Canada (1754-1767), and on the Continental army during the American Revolution. A Confederate doctor deliberately sold clothes contaminated with smallpox to Union soldiers during the American Civil War, and Japanese doctors exposed Chinese prisoners of war to aerosolized virus in germ warfare experiments during World War II (Tucker, 2001).
It was the Soviets, however, who developed secret stocks of lethal smallpox for use in war. The Soviets established their first smallpox bioweapons laboratory in 1947 near Moscow. By the 1970s they maintained an annual stockpile of twenty tons of virulent, weapons-grade smallpox (Alibek, 1999). This was enough to blanket 4,000 square miles of enemy territory. The Soviets utilized gene-splicing techniques, adding toxins to the virus that could induce systemic hemorrhage, neurologic disease, and brain damage. The smallpox designer weapon also resulted in a shortened incubation period of a few days rather than the usual two-week period of the natural disease. Several countries, including Iraq and North Korea, also possess smallpox virus for use as a biowarfare weapon. The question remains whether Russian or Iraqi scientists would supply smallpox vaccine to terrorists knowing the devastating consequences to their own populations of a worldwide epidemic.
Unlike anthrax, dispersing smallpox through a terrorist act is relatively simple. Spray the infectious live virus in a public place and a widespread epidemic is nearly guaranteed. The terrorists themselves would face no risk of disease if they were previously vaccinated; however, the ensuing worldwide epidemic would certainly return to affect their own families and comrades.
People who contract smallpox through their skin are much less likely to die of the disease. This discovery led to the practice in India (around 1000 B.C.) of making incisions in the skin of healthy people and inoculating them with pus from a smallpox lesion. The fatality rate was thereby reduced from 30 percent to one percent. The practice spread to Tibet and to China by 1000 A.D., but it did not reach Europe until 1718, when the first western child was inoculated through the skin, a process that came to be known as variolation.
The practice of variolation spread to America and throughout Europe during the eighteenth century, accompanied by severe opposition. Although variolation did result in immunity to smallpox, the non-sterile technique also served to spread other diseases, such as syphilis and tetanus. The discovery that milkmaids who contracted cowpox from the udders of cows were rendered immune to human smallpox led to the development of a vaccine (from the Latin vacca for cow). By the early 1800s, vaccination with cowpox replaced variolation with smallpox.
The vaccination procedure involves piercing the skin and inserting the live cowpox virus into the lesion. Eventually the cowpox virus in the vaccine became altered through many years of culture and was assigned a new name, vaccinia virus. Otherwise smallpox vaccination has remained relatively unchanged over the past 200 years.
Over 95 percent of those receiving smallpox vaccine for the first time will develop antibodies at a titer of 1:10 or greater; however, the level of antibody that protects against smallpox infection is not known (CDC, 1991d).
Smallpox vaccination is certainly not a guarantee against contracting the disease. During an epidemic in India (in 1953) 80 percent of people with smallpox had a history of at least one vaccination and 50 percent had been vaccinated two or three times (Kempe, 1960). As a result of that experience the author recommended yearly smallpox vaccinations during periods of epidemics.
During the nineteenth and early twentieth centuries, when smallpox epidemics ran rampant, vaccination had a terrible reputation, and seemed quite ineffective in preventing disease. A disastrous smallpox epidemic occurred in England during the period 1871-1873 at a time when a compulsory smallpox vaccination law had resulted in nearly universal coverage. A Royal Commission was appointed in 1889 to investigate the history of vaccination in the United Kingdom. Evidence mounted that smallpox epidemics increased dramatically after 1854, the year the compulsory vaccination law went into effect. In the London epidemic of 1857-1859, there were more than 14,000 deaths; in the 1863-1865 outbreak 20,000 deaths; and from 1871 to 1873 all of Europe was swept by the worst smallpox epidemic in recorded history. In England and Wales alone, 45,000 people died of smallpox at a time when, according to official estimates, 97 percent of the population had been vaccinated. Their investigation led to the repeal of England’s compulsory smallpox vaccination law.
When Japan started compulsory vaccination against smallpox in 1872 the disease steadily increased each year. In 1892 more than 165,000 cases occurred with 30,000 deaths in a completely vaccinated population. During the same time period Australia had no compulsory vaccination laws, and only three deaths occurred from smallpox over a 15-year period.
In the Philippines between 1917 and 1919, the US government staged a compulsory vaccination campaign, which brought on the worst epidemic of smallpox in the country’s history with over 160,000 cases and over 70,000 deaths in a completely vaccinated population. The entire population of the Philippines at the time was only 11 million.
Current smallpox vaccination differs very little from the vaccine used in the nineteenth century, and no one knows whether the vaccine will be similarly ineffective if a modern epidemic
were to occur. Most important, however, is the complete uncertainty whether the current vaccine would have any protective effect against a weaponized smallpox virus used in a terrorist attack.
Two different strategies exist to contain an outbreak of smallpox through vaccination. One is to vaccinate the entire population. This is expensive, in financial terms, and in human life, because the vaccine would undoubtedly cause significant damage and deaths. A universal vaccination campaign such as this might be instituted in an uncontrolled and widespread epidemic. The second strategy is to isolate and contain the outbreak. Locate every person who had face-to-face contact with the victim, and vaccinate them. Then find everyone who came into contact with those people and vaccinate them too. That creates a ring of safety around the index case. This method works for smallpox because the vaccine will have some protective effect if given within four days of exposure. The method is not foolproof, vaccination is not always protective, and vaccine given within four days of exposure still results in a 10-40 percent incidence of smallpox (Kempe, 1960).
The US government retained only 15 million doses of smallpox vaccine after the disease was declared eliminated in 1980. In response to the terrorist attack on September 11, 2001 and the use of anthrax as a bioweapon in the following months, the United States arranged to purchase 300 million doses of live smallpox vaccine from Acambis, a British vaccine manufacturer, for a total of $850 million. Subsequent to the placement of this order, a French vaccine manufacturer, Aventis Pasteur, discovered a previously unknown stockpile of 85 million doses of smallpox vaccine in a freezer. The vaccine maker donated this supply of 40-year-old vaccine to the United States. Additionally, a study published in April 2002 showed that the vaccine supply could probably be greatly extended. Patients in that study received a vaccination with either the full strength smallpox vaccine or a 1:5 or 1:10 dilution of the vaccine. No significant difference was noted in the response to the vaccine in any of the three groups (Frey, et al., 2002). This suggests that the supply of vaccine could potentially be multiplied by a factor of ten. Once these supplies are made available, individual citizens may have the ability to receive the vaccine on a voluntary basis. Calls have also gone out from Congress for development of a safer, killed vaccine.
The simple practice of vaccination applied on a worldwide scale eventually eliminated smallpox disease from the planet, but not without a price.
The usual response to vaccination in an individual is the development of a half-inch pustule and inflammation at the site that persists for two to three weeks then crusts over, leaving a scar. Mild fever and illness with a rash and swollen lymph nodes often occur, but severe adverse reactions are not uncommon. The death rate from smallpox vaccine is at least one to two deaths per million vaccinations, making smallpox the most toxic vaccine ever invented. Vaccinating the entire US population would result in at least 300 to 600 deaths.
Other adverse effects of vaccination are more common. A severe form of eczema with inflamed skin, high temperature, and swollen lymph nodes occurs in as many as one in 26,000 vaccinations (Lane, 1970). The result is sometimes fatal. Encephalitis, or inflammation of the brain, is the other severe adverse reaction. It occurs in as many as one in 80,000 people vaccinated. Symptoms include fever, convulsions, partial paralysis, and death in approximately 25 percent of people with this reaction. Those who recover usually suffer some permanent mental impairment and paralysis.+ Statistics on the rate of complications vary depending on the type of survey. They are lower for voluntary reports and higher when physicians are polled for their experience. No controlled studies have ever been published. Rates are probably much higher than reported.
Infants and children under twelve months have a significantly higher risk of serious adverse reactions compared to older children and adults. The rate of brain inflammation is as high as one in 24,000 vaccinations in children under twelve months (Lane, 1970).
It is possible to spread the vaccinia virus from an inoculation to other sites on the body or to other people within the period 2-5 days following vaccination. This form of transmission will cause eczema vaccinatum in 30 percent of those contacts affected, a condition which may be fatal.
Because of the significant risk of adverse reactions, no one with a history of eczema or those with household contacts with a history of eczema should receive the smallpox vaccine. Pregnant women should never receive the vaccine because of the risk of fetal infection, which results in stillbirth or death of the infant after delivery. Individuals with immune deficiency disease, immunosuppression, and HIV infection should not be vaccinated (CDC, 1991d).
Treatment of the complications that occur after smallpox vaccination consists of vaccinia immune globulin (VIG). This is a sterile solution of the immune globulin from plasma of individuals previously vaccinated for smallpox. VIG has been effective in the treatment of eczema and vaccinia caused by the smallpox vaccine. It is not effective for post-vaccine encephalitis (CDC, 1991d).
In the late nineteenth century, a British homeopathic physician, Dr. J. Compton Burnett, published a treatise that asserted smallpox vaccination caused a chronic nervous system and skin disease. He named this chronic disease “vaccinosis,” distinguishing it from the immediate adverse reactions to vaccination. Symptoms were characterized by nerve pain and various skin ailments such as acne and psoriasis that began soon after a smallpox vaccination and persisted. Burnett discovered that a homeopathic medicine, Thuja occidentalis, cured the vaccinosis disease, and Thuja became the routine medicine prescribed in homeopathic practice for smallpox vaccine reactions (Burnett, 1892).
Opposition to smallpox vaccination has been vocal and vehement since the first Anti-Compulsory Vaccination League was formed in England in 1866. Newspapers during the early twentieth century were filled with accounts of disease and death following vaccination. The anti-compulsory associations doubted the safety of vaccination and often asserted that vaccination caused more brain damage and deaths than smallpox itself. They were especially opposed to forced vaccination. Accounts were circulated of vaccine squads who forcibly vaccinated citizens, literally holding them down while a health worker administered the inoculation. In 1907 Britain passed a law allowing conscientious objection to enforced vaccination. By contrast, in 1905 the US Supreme Court ruled that the state could pass laws requiring vaccination to protect the public in the case of a dangerous communicable disease.
It is conceivable that a safer vaccine than the current live-virus inoculation could be produced, and proposed manufacturing processes do exist for a killed vaccine, but several factors make development of a safe vaccine difficult (Rosenthal, 2001). First, there is no animal model to use in researching smallpox. Second, in the absence of naturally occurring smallpox disease, there is no way to establish whether a new vaccine would work. And third, research on a new vaccine takes five to ten years. In the meantime, we are stuck with the two-hundred-year-old vaccine and all its shortcomings.
· Smallpox disease was declared eradicated from the world in 1980. The only threat of infection is from a terrorist attack or biowarfare.
· The effectiveness of vaccination during historic epidemics is questionable.
· Antibody levels induced by vaccination begin to diminish after one year, although even more than 20 years later there is some reduction in incidence of death among those previously vaccinated.
· Vaccination administered within four days after exposure reduces the incidence of smallpox, the severity of disease, and the fatality rate.
· Smallpox is deadly, but so is the vaccine.
· The smallpox vaccine may not be effective against the genetically engineered virus designed as a bioweapon.
A Personal Strategy
If an outbreak of smallpox occurs, assess the likelihood of your exposure based on the location of index cases. For example, if you live in rural Oregon you are less likely to encounter the virus than in a large metropolitan area such as Chicago or Los Angeles. Remember that the vaccine reduces the severity of illness and risk of death when given within four days of exposure to someone with the disease. Individuals with a history of eczema should not be vaccinated because of the increased risk of skin reactions and death. If anyone in a household has eczema, then no one in the household should be vaccinated.
If you decide to receive the vaccination, make sure your doctor has access to vaccinia immune globulin (VIG) to treat adverse reactions, which has been in short supply. If you decide not to receive the vaccine, then consider discussing your situation with a homeopathic practitioner for alternative approaches. Homeopaths have been treating smallpox and epidemic diseases for two hundred years.
Tucker, Jonathan B. Scourge: The Once and Future Threat of Smallpox, Atlantic Monthly Press, New York, 2001.
www.whale.to/vaccines.html contains many historical articles about smallpox and the anti-compulsory vaccination campaign.
www.vaccines.org is a searchable database of scientific and CDC vaccine articles.