Intro:
Many people have heard of the chickenpox. It is included in the standard vaccination schedule the Center of Disease Control and Prevention recommends for children today. Most of you probably got this vaccine yourself. Have you heard of any other poxviruses? Monkeypox, Cowpox, Smallpox?
Thesis:
Tragically, smallpox was the deadliest disease ever, killing millions of people over 3,000 years. But, it triumphantly gave birth to the development of vaccinations that have helped prevent deaths all over the world.
Tragedy
Causes:
Scientists do not know how Smallpox originated. It is highly contagious, a contact and airborne disease. It can be spread by coughing, sneezing or contact with other bodily fluids. Sharing clothing or bedding can also spread the virus. Overcrowding and unsanitary conditions increase the spreading of the disease.
Symptoms:
Once someone comes in contact with the virus, it can take seven to 14 days for symptoms to show. First, they start to develop a rash, starting in the mouth, and a fever, a temperature of 103 or higher. It also causes vomiting, severe headaches and body pains that last for several days. This is when a person is most contagious. After three to four days, fluid filled sores begin to grow on the body, especially on the face and limbs. These are called pustules. The pustules start to scab over after about 5 days. When they have completely dried up they fall off, generally leaving a scar. At this point, they are no longer contagious.
Types:
There were two common and two rare forms of smallpox. The two common forms are variola minor and variola major. Variola minor was a less fatal type of smallpox. The Centers for Disease Control and Prevention (CDC) estimates that only 1 percent of those infected died. It was less common than variola major. 30% of people who caught this died.
The Spread of Smallpox:
Scientists believe that smallpox was first incubated 10,000 years ago in Northern Africa. When the mummy of Ramses V who died in 1156 B.C. was discovered in 1898, pustules, the scars left from smallpox, were found on his head.
Records show epidemics began to pop up 100 years later during the 4th century BCE (Before Common Era) in China and continued to spread throughout Asia and as trade with Japan increased. Smallpox reached Europe by 700 A.D. (8th Century). The Crusades helped spread it. No one was safe, it even killed Queen Mary II of England, Holy Roman Emperor Joseph I, French King Louis XV and Tsar Peter II of Russia. The disease continued to devastate new lands by European explorers during the 11th and 12th centuries. The Aztec and Inca Indians were almost completely wiped out by the virus introduced to them by Spanish conquistadors during the 1520s. Smallpox made its way to North America when the permanent settlement at Jamestown began in 1607.
The disease spread so much that the government raided houses and forced vaccinations. They quarantined those who had Smallpox. Families were torn apart. In April 1, 1854 a Smallpox hospital opened Blackwell Island, now known as Roosevelt Island. It was the first major U.S. hospital dedicated to the care of victims of smallpox. It was managed by New York City and could house 100 patients at a time. A large quarantine hospital opened in the 1880s on North Brother Island. It was used until the 1940s.
By the beginning of the 18th century, 400,000 Europeans were dying each year from the contagious disease. The World Health Organization (WHO) estimates that 300-500 million lives were lost due to smallpox.
Triumph
Inoculation:
The terms inoculation, variolation and vaccination are often used interchangeably when talking about Smallpox, but they are not the same. Inoculation is introducing or placing something which will reproduce onto something else. It is used to increase immunity towards a specific disease by getting the body to build up antibodies to the disease. Because smallpox is caused by the virus variola, performing inoculation with the smallpox virus was called variolation. The term vaccination wasn’t invented until the early 1800s.
Variolation, was done by exposing an individual to small amounts of the variola virus by grinding up the dried-up scabs and rubbing them on people or inhaling the powder to help prevent them from getting the disease. This was used in Africa, India and China in the 1500s. In Turkey during the early 1700s (18th Century), lancets or needles became a popular way to introduce the smallpox material to people. The wife of the British ambassador to Turkey who had been disfigured by smallpox witnessed the Turkish custom, they called it ingrafting. Lady Mary Wortley Montague brought the practice to England in 1718.
In 1721, Cotton Maher, a Harvard medicine graduate was told by one of his slaves about the inoculation treatment used in Africa. Boston physician Zabiel Boylston began experiments on June 26, 1721. In his 1726 book “An Historical Account of the Small-Pox Inoculated in New England”, he wrote that his 6-year-old son Thomas was the first person to be inoculated in the New World. His notes were the first tabular form of clinical statistics in America.
When George Washington was nineteen, he was infected with smallpox. In 1777, after seeing the tole the disease was taking on his troop, the commander-in-chief of the Continental Army ordered mandatory inoculation for any soldier who had not already survived a smallpox infection. Variolation, previously outlawed by the Continental Congress, became legal after they saw the great results of this first mass inoculation in military history.
Edward Jenner, a British country doctor was doing experiments on cowpox, a non-contagious and less lethal member of the poxvirus family. He had noted that dairymaids didn’t contract Smallpox if they had already been infected with Cowpox. Jenner injected an 8-year-old boy James Phipps with a cowpox lesion that he got from Sarah Melmes, a milkmaid. It worked! The boy did not get sick with Smallpox. This was the first vaccination, an inoculation using the virus that causes Cowpox. Latin vacca means cow. By 1796 he had begun performing the treatment on more people including his own eleven-month-old son. He submitted his results to the Royal Society and published his book “An Inquiry into the Causes and Effects of the Variolae Vaccinae”. Although it was rejected by the Royal Society, this was the birth of the science of preventative medicine and the vaccine became widely known.
News traveled to New England and Thomas Jefferson helped provide physicians across the country with access to it. A Harvard Medical School professor Benjamin Waterhouse got some of the dried vaccine from Jenner. On July 8, 1800, Waterhouse vaccinated his 5-year-old son. This was America’s first vaccinated person.
In America, the Vaccination Act of 1853 mandated smallpox vaccination for infants. State legislation sanctioned the vaccination of schoolchildren and the exclusion of unvaccinated students from public schools in 1893. While there were successes there were still fatalities using smallpox virus as an inoculation so many citizens fought against the use of vaccinations. The Anti-Vaccination Society of America was formed and L.H. Piehn became president. Piehn was a German-born Nora Springs, Iowa, banker whose daughter was reported to have died from the effects of smallpox vaccination in 1894.
The court gave New York City officials the right to continue to exclude unvaccinated kids from public schools but ruled in unconstitutional to quarantine unvaccinated citizens who had not contracted smallpox and that “to vaccinate a person against his will, without legal authority to do so, would be an assault.” In 1898, a ‘conscience clause’ was included in that year’s Vaccination Act that allowed parents to obtain exemption certificates for their children. The Anti-Vaccination League encouraged the public to obtain smallpox vaccination exemptions.
In 1905, a long-awaited Supreme Court decision arrived. In the verdict of Jacobson v. Massachusetts, the city found support for its raids and island quarantines when the courts affirmed “the right of the majority to override individual liberties when the health of the community requires it.” By 1922, many United States schools required smallpox vaccination before children could attend.
In the 1950s, more advancement came with production of a heat-stable, freeze-dried vaccine. The vaccine could now be stored for long periods without being refrigerated.
The bifurcated needle invented in the 1960s by Benjamin Rubin, MD, of Wyeth Laboratories. The Smallpox vaccine was not administered as a “shot” where one needle injected through several layers of skin and the muscle like we see today. The bifurcated (two prongs) needle is dipped into the vaccine solution and made multiple punctures to the top layers of skin. The vaccine was usually is given in the upper arm. The virus starts to multiple and a papule forms. It develops into a vesicle and then the blistered area scabs over. Instead of pox it is a pock. When the scabs fall off they are no longer contagious. It often leaves scars.
The World Health Organization launched the Intensified Smallpox Eradication Program in 1967.
In the 1970s, Wyeth Laboratories developed Dryvax, It was prepared from calf lymph using a strain of vaccinia. Because it uses a live virus, recipients must be careful not to expose others to the injection spot, especially young, elderly or immunocompromised individuals. People with burns, psoriasis and severe acne, people with incompetent immune systems like HIV/AIDS, leukemia or lymphoma, people in radiation treatment or chemotherapy, infants less than one year of age and pregnant women should not receive the vaccine.
In 1975, Rahima Banu from Bangladeshi suffered the last wild human case of variola major (smallpox of the severe kind). Thanks to the success of vaccination no cases of naturally occurring smallpox have happened since 1977.
Because in 1972 smallpox vaccines stopped being part of routine vaccinations in the US except for a few healthcare workers and response teams and the World Health Organization declared smallpox completely eradicated in 1980, production of Dryvax vaccine was discontinued in 1982.
In 2008, the U.S. military stopped using the freeze-dried Dryvax and began using Acambis’s ACAM2000 vaccine. It also uses a vaccinia virus, but it is grown in a lab culture instead of the flanks of calves.
Vaccines can help prevent people from contracting the Smallpox disease but what about people who have contracted it. Is there treatment? disease is caused by a virus. Drugs that fight diseases caused by viruses are called antiviral drugs. While there is no proven treatment for smallpox, there are three antivirals, tecovirimat, cidofovir, and brincidofovir that can prevent it from getting worse. These have shown to be effective in animals but have not been tested on humans but their use may be considered if there ever is an outbreak of smallpox.
On the Brightside, if catch it and survive you won’t catch it again. The CDC created the Division of High-Consequence Pathogens and Pathology Poxvirus and Rabies Branch. They do disease surveillance and investigations of the poxviruses. They also help with research and development of vaccines and train health departments all over the world.
Long-term research continues to help to develop a safer vaccine. The government is funding two companies to develop and test new vaccinia vaccines. Clinical trials are underway but have only been tested on animals, not humans. Data suggests vaccine recipients are protected for 5 years with one dose. The vaccine can also reduce the severity of illness if given within a few days following exposure to smallpox.
Conclusion:
Despite the shortcomings of the initial inoculation practices and the road blocks presented by the highly lethal and contagious nature of the disease as well as the anti-vaccination organizations, the world’s medical professionals have not only developed vaccines which have eradicated smallpox but have used the things learned from Smallpox vaccinations to create more vaccines.
