Mankind has not been very successful in totally eradicating disease from planet Earth, with one exception – smallpox. Imagine such a disease – totally eliminated in 1977 – causing worldwide concern (if not fear) a quarter of a century later.
But the use of smallpox as a weapon is not new to civilization. The British forces at Fort Pitt (Pittsburgh, Pa.) purposefully gave smallpox-contaminated blankets and goods to Native Americans during the French and Indian Wars in an attempt to weaken them.
The epidemic that followed carried a mortality rate of 50
percent among native tribes. Smallpox or variola at one time carried a mortality rate of 30
percent in unvaccinated persons.
During the smallpox epidemic of 1899, two Sisters of Mercy – Sister Mary Veronica Fitzpatrick of St. Louis and Sister Mary Xavier Kinsella of Springfield – cared for Ozarks smallpox victims in the quarantined “pest camp” outside the city limit of Springfield.
By doing so, they too were not permitted within the city limit of Springfield until the epidemic had run its course. Many patients survived due to the medical care and supportive spirit of the two women.
Vaccination of the general population in the United States was halted after 1980. However, military vaccination resumed in 2002, when more than 500,000 troops were vaccinated in response to the significant likelihood of a
terrorist attack.
The simplicity of smallpox production and delivery (aerosolization) is well known. Indeed, only 10-100 virus particles are needed for infection. In addition, given the highly infective nature of the virus, researchers estimate that one infected patient can infect 20 new contacts during the infectious stage of the illness. Scientists estimate that those previously vaccinated for the disease will retain their immunity for about 10 years, although this is only an estimate.
Forty-two percent of the U.S. population is younger than 30 and have not received the smallpox vaccine.
The vaccine, which contains small amounts of another pox-type virus called vaccinia, is available only through the Centers for Disease Control and Prevention and state and federal health agencies.
There are 15 million to 50 million doses of the vaccine in the United States. This stock was diluted in 2002, and the current stock is approximately 150
million doses.
The executive branch of the federal government ultimately decides who is vaccinated for smallpox. The state health departments have possession of the vaccine and as of this year, can use the doses for vaccination of essential personnel and in case of an outbreak.
As of this writing (March 2003), the federal government had begun Phase II of the smallpox vaccination program. The goal of Phase II is the vaccination of 500,000 essential medical
personnel.
The third phase, if and when it starts, will offer immunization to the general public.
Of course, problems encountered during the early phases may suspend general vaccination.

ONE READER ASKS:

What is St. John’s policy regarding smallpox vaccination?

Vaccinated health care workers must be kept away from patient care for three weeks because of the risk of transmission of the virus to immuno-comprised patients, such as those who have diabetes, HIV/AIDS and some cancers.
Because a Springfield company began offering the smallpox vaccine as part of a research protocol in January,
St. John’s has advised employees not to participate in these trials and has posted signs at its facilities asking members of the public who have recently received the smallpox vaccination not to visit patients because of the risk of transmission. Staff at St. John’s physicians’ offices are asking patients if they have recently received the vaccination and if so, will isolate those patients in exam rooms to reduce the risk of transmission of the vaccinia virus to other clinic patients.

Have a question for Dr. Clark? Alan Clark, M.D., is available to answer questions concerning general medical topics. Ask Dr. Clark is for the purpose of disseminating health-related information and is not intended for the purpose of diagnosing or prescribing. Please consult your physician before undertaking or adopting any form of medical treatment, exercise program or dietary plan.