Smallpox vaccine
Encyclopedia
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
to be developed. The process of vaccination was discovered by Edward Jenner
Edward Jenner
Edward Anthony Jenner was an English scientist who studied his natural surroundings in Berkeley, Gloucestershire...
in 1796, who acted upon his observation that milkmaids who caught the cowpox
Cowpox
Cowpox is a skin disease caused by a virus known as the Cowpox virus. The pox is related to the vaccinia virus and got its name from the distribution of the disease when dairymaids touched the udders of infected cows. The ailment manifests itself in the form of red blisters and is transmitted by...
virus did not catch smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
. Prior to widespread vaccination, mortality rates in individuals with smallpox were high—up to 35% in some cases.
Pre-vaccination history
Artificial induction of immunity
Artificial induction of immunity is the artificial induction of immunity to specific diseases - making people immune to disease by means other than waiting for them to catch the disease. The purpose is to reduce the risk of death and suffering....
was already known. A process called inoculation
Inoculation
Inoculation is the placement of something that will grow or reproduce, and is most commonly used in respect of the introduction of a serum, vaccine, or antigenic substance into the body of a human or animal, especially to produce or boost immunity to a specific disease...
, also known as insufflation or variolation was practiced in India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
as early as 1000 BC. This interpretation is disputed, however: other investigators contend the ancient Sanskrit
Sanskrit
Sanskrit , is a historical Indo-Aryan language and the primary liturgical language of Hinduism, Jainism and Buddhism.Buddhism: besides Pali, see Buddhist Hybrid Sanskrit Today, it is listed as one of the 22 scheduled languages of India and is an official language of the state of Uttarakhand...
medical texts of India do not describe these techniques. The first clear reference to smallpox inoculation was made by the Chinese
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...
author Wan Quan (1499–1582) in his Douzhen xinfa (痘疹心法) published in 1549. Inoculation for smallpox does not appear to have been widespread in China until the reign era of the Longqing Emperor
Longqing Emperor
The Longqing Emperor was the 12th emperor of the Ming dynasty in China between 1567-1572. His era name means "Great celebration". His name at birth was Zhu Zaihou and he was born during the reign of his father Emperor Jiajing, at the Forbidden City at the Ming Dynasty capital Beijing....
(r. 1567–1572) during the Ming Dynasty
Ming Dynasty
The Ming Dynasty, also Empire of the Great Ming, was the ruling dynasty of China from 1368 to 1644, following the collapse of the Mongol-led Yuan Dynasty. The Ming, "one of the greatest eras of orderly government and social stability in human history", was the last dynasty in China ruled by ethnic...
. In China powdered smallpox scabs were blown up the noses of the healthy. The patients would then develop a mild case of the disease and from then on were immune to it. The technique did have a 0.5-2% mortality rate, but that was considerably less than the 20-30% mortality rate of the disease itself.
Variolation was also practiced throughout the latter half of the 17th century by physicians in Turkey
Turkey
Turkey , known officially as the Republic of Turkey , is a Eurasian country located in Western Asia and in East Thrace in Southeastern Europe...
, Persia, and Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
. In 1714 and 1716 two reports of the Turkish method of inoculation were made to the Royal Society
Royal Society
The Royal Society of London for Improving Natural Knowledge, known simply as the Royal Society, is a learned society for science, and is possibly the oldest such society in existence. Founded in November 1660, it was granted a Royal Charter by King Charles II as the "Royal Society of London"...
in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
, by Emmanuel Timoni, a doctor affiliated with the British Embassy in Constantinople
Istanbul
Istanbul , historically known as Byzantium and Constantinople , is the largest city of Turkey. Istanbul metropolitan province had 13.26 million people living in it as of December, 2010, which is 18% of Turkey's population and the 3rd largest metropolitan area in Europe after London and...
, and Giacomo Pylarini
Giacomo Pylarini
Giacomo Pylarini was a Venetian physician and consul for the republic of Venice in Smyrna who in 1701 on the children of the English ambassador to Constantinople, gave the first smallpox inoculation outside of Turkey...
. Lady Mary Wortley Montagu, wife of the British ambassador to Ottoman Constantinople, is widely credited with introducing the process to Great Britain in 1721. Source material tells us on Montagu; "When Lady Mary was in the Ottoman Empire, she discovered the local practice of inoculation against smallpox called variolation." The procedure had been performed on her son and daughter, aged 5 and 4 respectively. They both recovered quickly. In 1721, an epidemic of smallpox hit London and left the British Royal Family
British Royal Family
The British Royal Family is the group of close relatives of the monarch of the United Kingdom. The term is also commonly applied to the same group of people as the relations of the monarch in her or his role as sovereign of any of the other Commonwealth realms, thus sometimes at variance with...
in fear. Reading of Lady Wortley Montagu’s efforts, they wanted to use inoculation on themselves. Doctors told them that it was a dangerous procedure, so they decided to try it on other people first. The test subjects they used were condemned prisoners. The doctors inoculated the prisoners and all of them recovered in a couple of weeks. So assured, the British royal family inoculated themselves and reassured the English people that it was safe.
Stimulated by a severe epidemic, variolation was first employed in North America in 1721. The practice had been known in Boston since 1706, when Cotton Mather
Cotton Mather
Cotton Mather, FRS was a socially and politically influential New England Puritan minister, prolific author and pamphleteer; he is often remembered for his role in the Salem witch trials...
(of Salem witch trial fame) discovered that his slave, Onesimus had been inoculated while still in Africa and that many slaves imported to Boston had also received inoculations. The practice was, at first, widely criticized. However a limited trial showed that 6 deaths occurred out of 244 who were vaccinated (2.5%) while 844 out of 5980 died of natural disease, and the process was widely adopted throughout the colonies. By 1777 George Washington
George Washington
George Washington was the dominant military and political leader of the new United States of America from 1775 to 1799. He led the American victory over Great Britain in the American Revolutionary War as commander-in-chief of the Continental Army from 1775 to 1783, and presided over the writing of...
, who initially hesitated to have his Revolutionary War
American Revolutionary War
The American Revolutionary War , the American War of Independence, or simply the Revolutionary War, began as a war between the Kingdom of Great Britain and thirteen British colonies in North America, and ended in a global war between several European great powers.The war was the result of the...
troops inoculated during a smallpox outbreak writing, “should We inoculate generally, the Enemy, knowing it, will certainly take Advantage of our Situation;”, eventually ordered mandatory inoculation of all troops and recruits who had not had the disease.
This technique was documented as having a mortality rate of only one in a thousand. Two years after Kennedy's description appeared, March 1718, Dr. Charles Maitland successfully inoculated the five-year-old son of the British ambassador to the Turkish court under orders from the ambassador's wife Lady Mary Wortley Montagu
Lady Mary Wortley Montagu
The Lady Mary Wortley Montagu was an English aristocrat and writer. Montagu is today chiefly remembered for her letters, particularly her letters from Turkey, as wife to the British ambassador, which have been described by Billie Melman as “the very first example of a secular work by a woman about...
, who four years later introduced the practice to England.
An account from letter by Lady Mary Wortley Montagu to Sarah Chiswell, dated 1 April 1717, from the Turkish Embassy describes this treatment:
The small-pox so fatal and so general amongst us is here entirely harmless by the invention of ingrafting (which is the term they give it). There is a set of old women who make it their business to perform the operation. Every autumn in the month of September, when the great heat is abated, people send to one another to know if any of their family has a mind to have the small-pox. They make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nutshell full of the matter of the best sort of small-pox and asks what veins you please to have opened. She immediately rips open that you offer to her with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much venom as can lye upon the head of her needle, and after binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins. . . . The children or young patients play together all the rest of the day and are in perfect health till the eighth. Then the fever begins to seize them and they keep their beds two days, very seldom three. They have very rarely above twenty or thirty in their faces, which never mark, and in eight days time they are as well as before the illness. . . . There is no example of any one that has died in it, and you may believe I am very well satisfied of the safety of the experiment since I intend to try it on my dear little son. I am patriot enough to take pains to bring this useful invention into fashion in England, and I should not fail to write to some of our doctors very particularly about it if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue for the good of mankind, but that distemper is too beneficial to them not to expose to all their resentment the hardy wight that should undertake to put an end to it. Perhaps if I live to return I may, however, have courage to war with them.
Early vaccination
During the earlier days of empirical experimentation in 1758, American Jonathan Edwards died from a smallpox inoculation.
Some of the earliest statistical
Statistics
Statistics is the study of the collection, organization, analysis, and interpretation of data. It deals with all aspects of this, including the planning of data collection in terms of the design of surveys and experiments....
and epidemiological
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
studies were performed by James Jurin
James Jurin
James Jurin FRS MA FRCP MD was an English scientist and physician, particularly remembered for his early work in capillary action and in the epidemiology of smallpox vaccination...
in 1727 and Daniel Bernoulli
Daniel Bernoulli
Daniel Bernoulli was a Dutch-Swiss mathematician and was one of the many prominent mathematicians in the Bernoulli family. He is particularly remembered for his applications of mathematics to mechanics, especially fluid mechanics, and for his pioneering work in probability and statistics...
in 1766. Another early account was Dr Fewster's 1765 paper in the London Medical Society, entitled "Cow pox and its ability to prevent smallpox". He reported that variolation induced no reaction in persons who had had cowpox. Dr. Rolph, another Gloucestershire physician, stated that all experienced physicians of the time were aware of this.
At the age of thirteen, Jenner was apprenticed to Dr. Ludlow in Sodbury. He observed that people who caught cowpox while working with cows were known not to catch smallpox. He assumed a causal connection. The idea was not taken up by Dr. Ludlow at that time. After Jenner returned from medical school in London, a smallpox epidemic struck his home town of Berkeley
Berkeley, Gloucestershire
Berkeley is a town and civil parish in Gloucestershire, England. It lies in the Vale of Berkeley between the east bank of the River Severn and the M5 motorway within the Stroud administrative district. The town is noted for Berkeley Castle where the imprisoned Edward II was murdered.- Geography...
, England. He advised the local cow workers to be inoculated. The farmers told him that cowpox prevented smallpox. This confirmed his childhood suspicion, and he studied cowpox further, presenting a paper on it to his local medical society.
Perhaps there was already an informal public understanding of some connection between disease resistance and working with cows. The “beautiful milkmaid
Milkmaid
A milkmaid is a girl or woman employed to milk dairy cows. She also used the milk to prepare dairy products such as cream, butter, and cheese...
” seems to have been a frequent image in the art and literature of this period. But we know for a fact: In the years following 1770 there were at least six people in England and Germany (Sevel, Jensen, Jesty
Benjamin Jesty
Benjamin Jesty was a farmer at Yetminster in Dorset, England, notable for his early experiment in inducing immunity against smallpox using cowpox....
1774, Rendall, Plett 1791), who tested successfully the possibility of using the cowpox vaccine as an immunization for smallpox in humans. In 1796 Sarah Nelmes, a local milkmaid, contracted cowpox and went to Jenner for treatment. Jenner took the opportunity to test his theory. He inoculated James Phipps, the eight-year-old son of his gardener, not with smallpox but with cowpox. After an extremely weak bout of cowpox, James recovered. Jenner then tried to infect James with smallpox but nothing happened—the boy was immune to smallpox.
Jenner reported his observations to the Royal Society. Further work was suggested, and Jenner published a series of 23 cases, including his son Edward, where none suffered severely from smallpox. Two years later a society to oppose vaccination had been established in Boston, Massachusetts — an indication of rapid spread and deep interest. By 1800 Jenner’s work had been published in all of the major European languages. The process was performed all over Europe and the United States. The death rate was close to zero with the process, which became known as vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
and was continued to around 1974 in the UK. A typical death rate at that time was roughly one per million, making vaccination against smallpox with vaccinia
Vaccinia
Vaccinia virus is a large, complex, enveloped virus belonging to the poxvirus family. It has a linear, double-stranded DNA genome approximately 190 kbp in length, and which encodes for approximately 250 genes. The dimensions of the virion are roughly 360 × 270 × 250 nm, with a mass of...
the most dangerous immunisation widely provided in modern times. Thanks to the development of the smallpox vaccine
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
, the disease was officially eradicated
Eradication of infectious diseases
Eradication is the reduction of an infectious disease's prevalence in the global host population to zero. It is sometimes confused with elimination, which describes either the reduction of an infectious disease's prevalence in a regional population to zero, or the reduction of the global prevalence...
in 1979.
Balmis Expedition
The Balmis Expedition was a three year mission to the Americas led by Dr Francisco Javier de Balmis with the aim of giving thousands the smallpox vaccine. He set off from La Coruña on 30 November 1803...
(1803) carried the vaccine to Spanish America, the Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...
and China under commission of the Spanish Crown.
Some years before Dr. Jenner, Benjamin Jesty
Benjamin Jesty
Benjamin Jesty was a farmer at Yetminster in Dorset, England, notable for his early experiment in inducing immunity against smallpox using cowpox....
, a farmer
Farmer
A farmer is a person engaged in agriculture, who raises living organisms for food or raw materials, generally including livestock husbandry and growing crops, such as produce and grain...
at Yetminster
Yetminster
Yetminster is a village in the English county of Dorset. It lies within the West Dorset administrative district of the county, about five miles south-west of the town of Sherborne. It is sited on the River Wriggle, a tributary of the River Yeo, and is built almost entirely of honey-coloured...
in Dorset
Dorset
Dorset , is a county in South West England on the English Channel coast. The county town is Dorchester which is situated in the south. The Hampshire towns of Bournemouth and Christchurch joined the county with the reorganisation of local government in 1974...
(he later moved to and is buried at Worth Matravers
Worth Matravers
Worth Matravers is a village and civil parish in the English county of Dorset. The village is situated on the cliffs west of Swanage. It comprises limestone cottages and farm houses and is built around a pond, which is a regular feature on postcards of the Isle of Purbeck.The civil parish stretches...
) is recorded as observing the two milkmaids living with his family to have been immune to smallpox and then inoculating his family with cowpox to protect them from smallpox. This was done in 1774 and can be found with Crookshank's History and Pathology of Vaccination, London 1889, vol. 1, p. 110ff. But the question of who first initiated smallpox inoculation/vaccination can not be answered properly, as there is in the sources the exact date and time only for the predecessor Plett (1791), but not for Sevel, Jensen and Rendall.
Louis T. Wright, an African-American and Harvard medical school graduate (1915), introduced intradermal vaccination for smallpox for the soldiers while serving in the Army during World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
.
Leslie Collier
Leslie Collier
Leslie Harold Collier was a scientist responsible for developing a freeze-drying method to produce a more heat stable smallpox vaccine in the late 1940s....
developed a freeze-drying method to produce a more heat stable smallpox vaccine in the late 1940s.
Collier added a key component, peptone, a soluble protein, to the process. This protected the virus, enabling the production of a heat-stable vaccine in powdered form. Previously, smallpox vaccines would become ineffective after 1–2 days at ambient temperature.
The development of his vaccine production method played a large role in enabling the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
to initiate its global smallpox eradication campaign in 1967.
Eradication
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
. This was accomplished through a massive, worldwide outbreak search and vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
program. However, the variola
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
virus that led to the death of 300 million in the 20th century alone was not completely exterminated with the disease it caused. Three known repositories of the virus were left, one in Birmingham, England which was later destroyed after an accidental escape from containment caused the death of Janet Parker
Janet Parker
Janet Parker was the last known person to die from smallpox. She was a medical photographer and worked in the Anatomy Department of the University of Birmingham Medical School. Parker died after being accidentally exposed to a strain of smallpox virus that was grown in a research laboratory, on...
, and two still remaining at the Centers for Disease Control in Atlanta, Georgia
Atlanta, Georgia
Atlanta is the capital and most populous city in the U.S. state of Georgia. According to the 2010 census, Atlanta's population is 420,003. Atlanta is the cultural and economic center of the Atlanta metropolitan area, which is home to 5,268,860 people and is the ninth largest metropolitan area in...
and the State Research Center of Virology and Biotechnology
State Research Center of Virology and Biotechnology
The State Research Center of Virology and Biotechnology VECTOR, also known as the Vector Institute, is a highly sophisticated biological research center in Koltsovo, Novosibirsk Oblast, Russia. It is roughly analogous to both the Centers for Disease Control and Prevention and the US Army Chemical...
(VECTOR) in Koltsovo, Russia
Koltsovo, Novosibirsk Oblast
Koltsovo is an urban locality in Novosibirsky District of Novosibirsk Oblast, Russia, located from Novosibirsk. Population: Municipally, Koltsovo is incorporated as Koltsovo Urban Okrug...
. Each of those States reports that the repositories are retained for possible anti-bio-weaponry
Biological warfare
Biological warfare is the use of biological toxins or infectious agents such as bacteria, viruses, and fungi with intent to kill or incapacitate humans, animals or plants as an act of war...
research and against the possibility that some obscure reservoir of natural smallpox may be discovered in the future.
It is important from the perspective of bioterrorism to note that some countries, including North Korea, did not participate in the WHO eradication program, choosing instead to mount their own program. There is no information to suggest that these countries did or did not retain samples of the virus.
Post-eradication vaccination
Cowpox
Cowpox is a skin disease caused by a virus known as the Cowpox virus. The pox is related to the vaccinia virus and got its name from the distribution of the disease when dairymaids touched the udders of infected cows. The ailment manifests itself in the form of red blisters and is transmitted by...
disease; this virus is appropriately named vaccinia
Vaccinia
Vaccinia virus is a large, complex, enveloped virus belonging to the poxvirus family. It has a linear, double-stranded DNA genome approximately 190 kbp in length, and which encodes for approximately 250 genes. The dimensions of the virion are roughly 360 × 270 × 250 nm, with a mass of...
, from the Latin vacca which means cow. This vaccine has functional viruses in it which improves its effectiveness but, unfortunately, causes serious complications for people with impaired immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
s (for example chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
and AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
patients, and people with eczema
Eczema
Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...
) and is not yet considered safe for pregnant women. A woman planning on conceiving within one month should not receive the smallpox immunization until after the pregnancy. In the event of an outbreak the woman should delay pregnancy if possible. A small, yet significant, percentage of healthy individuals also suffer adverse side-effects which, in rare cases, include permanent neurological damage. Vaccines that only contain attenuated vaccinia viruses (an attenuated virus is one in which the pathogenicity has been decreased through serial passage
Serial passage
Serial passage is a virus attenuation technique developed originally by Louis Pasteur in the 1880s. It is similar to selective breeding, and can be used to create an attenuated strain of a virus to develop vaccines, or to increase the virulence of a viral strain in order to create epidemics.The...
) have been proposed but some researchers have questioned the possible effectiveness of such a vaccine. According to the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
(CDC), "vaccination within 3 days of exposure will prevent or significantly lessen the severity of smallpox symptoms in the vast majority of people. Vaccination 4 to 7 days after exposure likely offers some protection from disease or may modify the severity of disease." This, along with vaccinations of so-called first-responders, is the current plan of action being devised by the United States Department of Homeland Security
United States Department of Homeland Security
The United States Department of Homeland Security is a cabinet department of the United States federal government, created in response to the September 11 attacks, and with the primary responsibilities of protecting the territory of the United States and protectorates from and responding to...
(including Federal Emergency Management Agency
Federal Emergency Management Agency
The Federal Emergency Management Agency is an agency of the United States Department of Homeland Security, initially created by Presidential Reorganization Plan No. 1 of 1978 and implemented by two Executive Orders...
(FEMA), now part of DHS) in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
.
The vaccine can cause complications for those around those who are vaccinated. People who get the vaccine will shed virus particles through vesicles on their skin and possibly through their respiratory tract. Infections in close and not-so-close contacts can ensue. The current plan to vaccinate first responders has the potential to cause infection in the most vulnerable section of the population, the hospitalized ill. Family contacts are also susceptible, although they are less vulnerable because their immune systems are presumably intact. Secondary infection can cause skin disease, pulmonary disease and rarely, neurologic disease.
As of June 21, 2003, a scientific advisory panel had issued a recommendation against further vaccination of first responders because a significant number of those vaccinated suffered heart problems, notably pericarditis
Pericarditis
Pericarditis is an inflammation of the pericardium . A characteristic chest pain is often present.The causes of pericarditis are varied, including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the precardium Pericarditis is an inflammation of...
and myocarditis
Myocarditis
Myocarditis is inflammation of heart muscle . It resembles a heart attack but coronary arteries are not blocked.Myocarditis is most often due to infection by common viruses, such as parvovirus B19, less commonly non-viral pathogens such as Borrelia burgdorferi or Trypanosoma cruzi, or as a...
.
In May 2007, the Vaccines and Related Biological Products Advisory Committee of the U.S. Food and Drug Administration (FDA) voted unanimously that a new live virus vaccine produced by Acambis, ACAM2000
ACAM2000
ACAM2000 is a smallpox vaccine developed by . It was approved for use in the United States by the U.S. Food and Drug Administration on 31 August 2007. It contains live vaccinia virus, cloned from the same strain used in an earlier vaccine, Dryvax...
, is both safe and effective for use in persons at high risk of exposure to smallpox virus. However, due to the high rate of serious adverse effects, the vaccine will only be made available to the CDC (a part of the United States Department of Health and Human Services
United States Department of Health and Human Services
The United States Department of Health and Human Services is a Cabinet department of the United States government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America"...
) for the Strategic National Stockpile
Strategic National Stockpile
The Strategic National Stockpile is the United States' national repository of antibiotics, vaccines, chemical antidotes, antitoxins and other critical medical equipment and supplies...
. http://www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4292B2-00-index.htm http://www.acambis.com/default.asp?id=1893
The main problem with developing a new, safer vaccine, is that, barring a bioterrorist attack on immunized individuals, its effectiveness cannot be tested on humans, and other animals do not naturally contract smallpox. Monkey
Monkey
A monkey is a primate, either an Old World monkey or a New World monkey. There are about 260 known living species of monkey. Many are arboreal, although there are species that live primarily on the ground, such as baboons. Monkeys are generally considered to be intelligent. Unlike apes, monkeys...
s at USAMRIID research facilities have been infected, but tests on animals that are artificially infected with a human disease may give false or misleading results. To demonstrate safety and effectiveness, human trials always have to confirm data obtained from animal testing.
In the United States the smallpox vaccine is the only FDA-approved treatment for smallpox and monkeypox
Monkeypox
Monkeypox also known as cockpox is an exotic infectious disease caused by the monkeypox virus. The disease was first identified in laboratory monkeys, hence its name, but in its natural state it seems to infect rodents more often than primates...
. As with smallpox, vaccination after infection is effective if the vaccine is given before symptoms develop.
Currently, the United States Air Force has made it mandatory that any Airman deploying to the Middle East must receive the smallpox vaccination before leaving stateside. The same is true of the U.S. Army, and any US Marine being deployed outside the contiguous United States (OCONUS), as well as any Marine or US Navy sailor being deployed ship side. It is also an option for all Department of Defense employees and contractors traveling to the United States Central Command's Area of Responsibility (CENTCOM AOR).
HIV protection
Recent studies suggest that the smallpox vaccine provides some level of defense against HIV. Both the smallpox vaccine and HIV exploit a receptor called CCR5CCR5
C-C chemokine receptor type 5, also known as CCR5, is a protein that in humans is encoded by the CCR5 gene. CCR5 is a member of the beta chemokine receptors family of integral membrane proteins...
, which is expressed on the surface of white blood cells. Researchers theorize that one factor in the sudden spread of HIV in the early 1980s was the result of eradication of smallpox in the late 1970s, and the subsequent and abrupt decline in smallpox vaccinations worldwide.
Vaccine stockpiles
In late 2001, the governments of the United States and the United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
considered stockpiling smallpox vaccines, even while assuring the public that there was no "specific or credible" threat of bioterrorism. Later, the director of State Research Center of Virology and Biotechnology VECTOR warned that terrorists could easily lure underpaid former Soviet researchers to turn over samples to be used as a weapon, saying "All you need is a sick fanatic to get to a populated place. The world health system is completely unprepared for this."
In the United Kingdom, controversy erupted over the company contracted to supply the vaccine due to the political connections of its owner, Paul Drayson, and questions over the choice of vaccine strain being different from that used in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. Plans for mass vaccinations in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
stalled as the necessity and undesirable side-effects came into question.
See also
- Kinepox
- John ClinchJohn ClinchRev. Dr. John Clinch was a clergyman-physician credited with being the first man to practise vaccination in North America....
, first doctor to test the smallpox vaccine in North America. - Benjamin WaterhouseBenjamin WaterhouseBenjamin Waterhouse was a physician and professor at Harvard Medical School...
, first doctor to test the smallpox vaccine in the United States. - Vaccination ActVaccination ActThe UK Vaccination Acts of 1840, 1853 and 1898 reflect the continuing argument over vaccination policy in the United Kingdom. Similar legislation was passed in the USA and other countries....
- Eczema vaccinatumEczema vaccinatumEczema vaccinatum is a rare severe adverse reaction to smallpox vaccination.It is characterized by serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by widespread infection of the skin in people with previous...