The deadly lessons of smallpox


Prevention: As the United States weighs spending $500 million on vaccine in case of possible bioterror, scientists disagree on the merits of mass inoculation.

October 21, 2001|By Tom Pelton | Tom Pelton,SUN STAFF

In March 1947, a businessman traveled by bus from Mexico to New York City carrying a virus that had killed more people than the Black Plague and World War II combined but that many thought had been eradicated from the civilized world.

Near hysteria broke out in the city after people learned that the man was in a hospital with the disfiguring facial pustules that signify smallpox. To combat panic over the highly contagious airborne disease, authorities ordered the vaccination of more than 6 million people in less than a month.

The swift action may have prevented an epidemic. But the use of the vaccine turned out to be more deadly than the smallpox itself, with the virus killing two people - including the businessman - and the vaccine killing six.

As the United States considers spending $500 million to create enough smallpox vaccine for every person in the country as protection against bioterrorism, public health experts warn against mass vaccination because side-effects of the vaccine include death, facial scarring and brain damage. Some experts argue that more efficient, targeted methods could be used to protect Americans.

One conservative option, says Nicole Coffin, a spokeswoman for the U.S. Centers for Disease Control and Prevention, would be isolating victims and vaccinating only people who had face-to-face contact with the infected.

The CDC is drafting a plan that would steer away from mass vaccinations unless absolutely necessary, trying to monitor possible outbreaks and contain them, according to news reports.

Such a method, sometimes called ring vaccination, seeks to create circles of immunized people around the virus. This requires fewer vaccinations and thus fewer negative side-effects. Such was the strategy often employed by the World Health Organization as it hunted down the last cases of the deadly disease during the 1960s and 1970s, said Jonathan B. Tucker, author of the recent book Scourge: The Once and Future Threat of Smallpox.

This strategy might work best with the limited amount of vaccine available in the United States today - between 7.5 million and 15 million viable doses, though 300 million more doses may become available late next year.

Encirclement was used in Bangladesh in 1975, during the final phase of a worldwide campaign by WHO to eliminate the most deadly disease in human history.

When a 2-year-old girl on Bhola Island was reported to have a pockmarked face, 200 epidemiologists from around the globe swarmed into her village. They quarantined the girl and her family, vaccinated 18,000 people who lived within 1.5 miles and searched every home within five miles for anyone with rashes on the face.

It worked. The virus, which cannot exist outside the human body, was effectively imprisoned. It did not spread, and the next year, smallpox became the first disease to be declared wiped off the face of the globe, although frozen samples of the virus remain in the United States, Russia, and perhaps in North Korea and Iraq.

Some experts worry about terrorists getting their hands on these samples, possibly from Iraq, and unleashing them as weapons of mass destruction. And there are fears that the conservative, encirclement method might fall dangerously short in the unlikely event that terrorist "biomartyrs" deliberately infected themselves with smallpox and spread the disease to people in different parts of the United States.

Unlike the anthrax bacterium that terrorists have recently mailed to Florida, New York and the District of Columbia, smallpox is contagious and can spread easily from person to person.

Terrorism experts speculate that a "biomartyr" infected with smallpox - who has open sores in his mouth shedding millions of viruses - could cough or sneeze in a crowded place like an airplane and quickly spread the disease.

Civil unrest might erupt if the government tried to restrict the vaccine to limited circles of people during a widespread outbreak, says Tucker. "It's a difficult equation," says Tucker, an expert on biological weapons at the Monterey Institute of International Studies in California. "We have to weigh the risk of exposure to smallpox with the risk of very significant complications of the vaccine, which include death and brain damage."

Health officials pondering the best use of 300 million doses of smallpox vaccine - the amount requested last week by Health Secretary Tommy G. Thompson - are faced with a complex set of variables. First of all, the likelihood that a terrorist could obtain a sample of the smallpox virus is extremely remote, says Dr. Stuart Isaacs, an expert on pox viruses at the University of Pennsylvania School of Medicine.

The last known case of smallpox was in Somalia in 1976. It's possible scientists from the former Soviet Union could have taken the virus to Iraq, says Isaacs, but the devastating consequences of unleashing it could be expected to deter even terrorists.

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