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Smallpox: Smallpox Vaccination
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Smallpox is a virus which is a member of a genus of closely related viruses, known as Orthopoxes. The Orthopox genus, besides Smallpox (sp. variola)... contains other species, including Monkeypox, Cowpox, Mousepox, Camelpox, and several others, including a species which seems to have only emerged subsequent to large-scale vaccination, dubbed Vaccinia. Edward Jenner discovered, first by deduction and then by experimentation, that cowpox exposure will protect you against smallpox. He observed that milkmaids, women employed to milk cows, rarely seemed to get smallpox, a disease which otherwise ravaged the general population, infecting nearly all and killing one in three. Cowpox, although named for cows, is actually thought to be a disease of rodents, with cows secondarily infected due to poor sanitation.
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Smallpox is a highly contagious and sometimes deadly disease that is caused by infection with the variola virus. It has been around for thousands of years and has been associated with many deadly epidemics. Widespread vaccination between 1940 and 1970 has led to the global eradication of the virus and in 1980 the World Health Organization (WHO) officially declared smallpox eradicated. The last naturally occurring case of smallpox was in Somalia in 1977. The only remaining known variola virus isolates are stored at the Centers for Disease Control and Prevention (CDC) in the US and at the Vektor Institute in Russia. Renewed interest in smallpox is taking place, as there is concern that the variola virus may be used as an agent of bioterrorism.
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Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention.
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Smallpox was once worldwide in scope, and before vaccination was practiced, almost everyone eventually contracted the disease. There were 2 principal forms of the disease, variola major and a much milder form, variola minor (or alastrim). Before eradication took place, these forms could be differentiated clinically only when occurring in outbreaks; virological differentiation is now possible. Through the end of the 19th century, variola major predominated throughout the world. However, at the turn of the century, variola minor was first detected in South Africa and later in Florida, from whence it spread across the United States and into Latin America and Europe. Typical variola major epidemics such as those that occurred in Asia resulted in case-fatality rates of 30% or higher among the unvaccinated, whereas variola minor case-fatality rates were customarily 1% or less.
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Smallpox spreads most readily during the cool, dry winter months but can be transmitted in any climate and in any part of the world. The only weapons against the disease are vaccination and patient isolation. Vaccination before exposure or within 2 to 3 days after exposure affords almost complete protection against disease. Vaccination as late as 4 to 5 days after exposure may protect against death. Because smallpox can only be transmitted from the time of the earliest appearance of rash, early detection of cases and prompt vaccination of all contacts is critical.
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Smallpox is spread from one person to another by infected saliva droplets that expose a susceptible person having face-to-face contact with the ill person. Persons with smallpox are most infectious during the first week of illness, because that is when the largest amount of virus is present in saliva. However, some risk of transmission lasts until all scabs have fallen off. Routine vaccination against smallpox ended in 1972. The level of immunity, if any, among persons who were vaccinated before 1972 is uncertain; therefore, these persons are assumed to be susceptible.
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Smallpox Vaccination