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The January 30, 2003 edition of the New England Journal of Medicine had a series of papers on the subject of smallpox.  This issue is also in the news as President Bush has been vaccinated, as our troops are immunized and as every state prepares to roll out a Federally mandated plan of voluntary vaccination for certain people.
   
Why the Concern About Smallpox
Rogue nations and possible terrorists may have the Variola virus that produces smallpox.  Thus there is the potential for those exposed to smallpox to contract it.  Unlike many viruses, this one not only disfigures the victim, it is universally lethal.  So there is very real fear associated with the possible introduction of this dreadful virus.  That is the bad news. 

The good news is that it is relatively difficult for the virus to be sustained in among a human population, especially a sophisticated one such as the United States.  The disease is contagious, but it takes physical contact with a victim at a relatively short period of time in the illness - and fortunately this time is well after the disease should have been detected.  In other words, someone with smallpox should be sequestered away from others so that contact does not occur in the general public.  This is easy to do because the victim usually is so ill and has a very bad rash that he does not want to venture out into public places, and is generally confined to bed. Obviously, those caring for patients with smallpox are at greatest risk of contracting the disease and this is precisely why first responders and healthcare workers are likely to be the only ones given the vaccine. 
   
Some Important Fact About Smallpox
If one does come into contact with an infectious patient or with the virus, it is possible to be vaccinated at that time with immunity a likely outcome.  There is enough vaccine in the country to vaccinate everyone, if it were necessary which is most unlikely.  There has not been a single case of smallpox in the U.S. since 1949, and none in the world since 1977.  It has been eradicated as a world health disease even though the virus is know to be still in test-tubes.  The elimination of the disease speaks to the difficulty of it being spread and the effectiveness of immunization world-wide.  One misconception is that once vaccinated and most Seabrookers were, there is no reason to believe that the immunity is still active in those of us vaccinated as children.  The last year of routine vaccination in this country was 1972 and immunity is thought to last no longer than about 20 years so all of us are susceptible - if we are exposed physically to the virus or an infectious patient.     
   
Why Not Vaccinate Everyone?
If there is ample vaccine why not recommend that everyone get the vaccine as I did in the October Seabrooker for the flu?  The reason is simple.  Unlike the flu vaccine, the Smallpox vaccine is a live virus vaccine.  It is made from the vaccinia virus that does cause a variety of symptoms and is thought to have a mortality of 1 to 3 per 100,000 people vaccinated with it.  In other words this prophylaxis is not risk free and when the chances of exposure are low the risk is not worth the benefit.  Older patients, those with cancer and those with compromised immune systems are particularly susceptible to this vaccine's toxicity.  The bottom line is that Seabrookers do not need smallpox vaccination.

MUSCHealth.com Online Health Library Related Links:

Other Online Resources:
Medline Plus Information on Smallpox
Centers for Disease Control Information on Smallpox 
Centers for Disease Control Information on Smallpox Vaccination 

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