Sarah Bennett
Smallpox is a serious, infectious disease caused by the variola virus, with gruesome symptoms including high fever, vomiting, mouth sores, and fluid-filled lesions across the body. The disease has a high mortality rate, killing around 30% of those infected within two weeks. Fortunately, vaccination has led to the eradication of smallpox, with the last case reported in 1977. The smallpox vaccine was first introduced in the United States in 1799, and mandatory vaccination policies were implemented in the 1840s and 1850s. However, routine vaccination against smallpox was discontinued in 1972 due to the disease's eradication. Currently, smallpox vaccines are not recommended for the general public, including children, as the virus no longer exists in nature.
| Characteristics | Values |
|---|---|
| Is smallpox vaccination necessary for children in the US? | No, smallpox vaccination of the general population was stopped in the US in 1972. |
| Are there any smallpox vaccines available in the US? | Yes, there are two licensed smallpox vaccines in the US and one investigational vaccine that may be used in a smallpox emergency. |
| What are the side effects of smallpox vaccination? | Mild side effects include fever, swelling of the lymph node in the armpit near the site of inoculation, itching, sore arm, headache, body aches, mild rash, and tiredness. |
| Who should not get the smallpox vaccine? | People who have skin conditions, weakened immune systems, pregnant women, and anyone allergic to the vaccine or its components. |
| What is the method of administering the smallpox vaccine? | The vaccine is administered by multiple punctures of the skin with a bifurcated needle that holds the vaccine solution in the fork. |
| What is the difference between smallpox and chickenpox? | Smallpox is different from chickenpox in terms of how it is spread. Chickenpox can be spread before the rash occurs, while smallpox is only spread after the rash has occurred. |
| What is the history of smallpox vaccination? | The practice of smallpox vaccination, or variolation, has been known for hundreds of years in India, Turkey, Persia, and Africa. In the 1840s and 1850s, mandatory smallpox vaccination was implemented in Britain and parts of the US. |
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What You'll Learn
Smallpox vaccine history in the US
Smallpox is a serious infectious disease caused by the variola virus. It was first described in the year 910, and a vaccine was not developed until almost 800 years later. Smallpox was the first human infection to be successfully eradicated through vaccination and public health procedures to track and contain the disease.
In 1714 and 1716, two reports of the Ottoman Empire Turkish method of inoculation were made to the Royal Society in England. Lady Mary Wortley Montagu, who had witnessed the practice of inoculation against smallpox during her time in the Ottoman Empire, had her five-year-old son inoculated in 1718. He recovered quickly, and she went on to have her daughter inoculated in 1721. This encouraged the British Royal Family to take an interest, and a trial of inoculation was carried out on prisoners in Newgate Prison. This was successful, and in 1722, Princess Caroline of Wales had her children inoculated.
In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against smallpox. He noticed that during smallpox outbreaks, women who milked cows were spared infection and theorised that they were protected by their contact with blisters on cows' udders. He tested his theory by taking fluid from a cowpox sore on a milkmaid's hand and injecting it into an eight-year-old boy, James Phipps, who suffered a reaction but soon recovered. He then inoculated Phipps with matter from a human smallpox sore, and the boy remained healthy. Jenner published his findings in 1798, and the first smallpox vaccine in the United States was administered that same year by Dr. Benjamin Waterhouse, who gave the vaccine to his son and other family members. Massachusetts became the first state to require that children be vaccinated before going to school.
Routine smallpox vaccination of the general population in the US ended in 1972, and smallpox was declared eradicated worldwide in 1980. The last case of smallpox was seen in 1977. Today, smallpox vaccines are not available to the general public, but they are still being produced for research and to guard against bioterrorism and biological warfare. There is enough vaccine to vaccinate every person in the US in the event of an outbreak.
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The vaccination process
Smallpox vaccination for the general public was stopped in the US in 1972, so most people in the country younger than 50 have never been vaccinated against smallpox. However, in the event of a smallpox outbreak, health officials would use smallpox vaccines to control it. There is enough smallpox vaccine to vaccinate every person in the United States if an outbreak were to occur.
The smallpox vaccine is administered by multiple punctures of the skin (scarification) with a bifurcated needle that holds the vaccine solution in the fork. The skin should be cleaned with water rather than alcohol, as alcohol could inactivate the vaccinia virus. If alcohol is used, it must be allowed to evaporate completely before the vaccine is administered. Vaccination results in a skin lesion that fills with pus and eventually crusts over. This manifestation of localized vaccinia infection is known as a vaccine "take" and demonstrates immunity to smallpox. After 2–3 weeks, the scab will fall off and leave behind a vaccine scar.
The smallpox vaccine contains a live vaccinia virus, not a killed or weakened virus like many other vaccines. For this reason, people who are vaccinated must take precautions when caring for the place on their arm where they were vaccinated, so they can prevent the vaccinia virus from spreading. The vaccinia virus is a poxvirus similar to smallpox but less harmful. The smallpox vaccine does not contain the smallpox virus and cannot give you smallpox.
The vaccination often causes a residual, lifelong scar. Mild side effects from the vaccine include fever, swelling of the lymph node in the armpit near the site of inoculation, itching, sore arm, headache, body aches, mild rash, or tiredness. People who have, or even once had, skin conditions (especially eczema or atopic dermatitis) and people with weakened immune systems, such as those who have received a transplant, are HIV positive, or are receiving treatment for cancer, are more likely to experience side effects. Anyone who falls within these categories, or lives with someone who falls into one of these categories, should not get the smallpox vaccine unless they are exposed to the disease. Pregnant women should not get the vaccine because of the risk it poses to the fetus. Anyone who is allergic to the vaccine or any of its components should not get the vaccine. Vaccination of persons less than 18 years of age is not recommended in non-emergency circumstances.
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Side effects
Smallpox vaccinations are not currently available to the general public in the United States because smallpox has been eradicated, and the virus no longer exists in nature. However, the vaccine is still administered to selected healthcare workers and the military, and it may be offered to all citizens in the future.
The smallpox vaccine is generally safe and effective, with most people experiencing mild side effects. However, some individuals may encounter more severe reactions, and the vaccine is known to have certain risks and side effects, ranging from mild and self-limiting to severe and life-threatening.
Mild side effects from the smallpox vaccine include fever, swelling of the lymph nodes in the armpit near the vaccination site, itching, sore arm, headache, body aches, mild rash, and tiredness. These reactions are typically mild and indicate that the vaccine is beginning to work. However, about one-third of first-time vaccine recipients experience more significant side effects, such as difficulty sleeping or missing work or school.
More severe side effects associated with the smallpox vaccine include progressive vaccinia, which presents as a non-healing sore at the vaccination site, and postvaccinal encephalitis, or inflammation of the brain. Additionally, a few people have developed heart inflammation (myocarditis) or inflammation of the lining of the heart (pericarditis) after receiving the smallpox vaccine. It is estimated that one to two people out of every million vaccinated could die as a result of life-threatening reactions to the vaccine.
People with certain medical conditions are more likely to experience severe side effects and should exercise caution when considering the smallpox vaccine. These conditions include a weakened immune system, active skin conditions such as eczema or dermatitis, and active breaks in the skin, such as poison ivy or acne. Additionally, those with a history of stroke may be at an increased risk of serious side effects. It is important for individuals to consult with their healthcare provider to assess their unique risks and benefits before receiving the smallpox vaccine.
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Who shouldn't get the vaccine
Since 1972, smallpox vaccinations have not been routinely administered to the general public in the United States, as the disease was eradicated. However, in the event of a smallpox outbreak, health officials would use smallpox vaccines to control it. Currently, there is a stockpile of 85 million doses of the vaccine, with plans to produce an additional 210 million doses.
Given the potential risks of vaccine complications, careful screening of potential vaccine recipients is essential. The following groups should not get the smallpox vaccine unless they are exposed to the disease:
- Pregnant women, as the vaccine poses a risk to the fetus.
- Women who are breastfeeding.
- People with weakened immune systems, including those who have received an organ transplant, are HIV-positive, are receiving treatment for cancer, or have severe autoimmune diseases such as systemic lupus erythematosus.
- Individuals taking immunosuppressive medications, such as steroids, high-dose corticosteroids, or methotrexate.
- People with heart conditions or those using steroid eye drops.
- Anyone under the age of 12 months, and children under the age of 18 in non-emergency circumstances.
- Individuals with a history of skin conditions, particularly eczema or atopic dermatitis.
- People with a history of severe reactions to the smallpox vaccine or its components (polymyxin B, streptomycin, chlortetracycline, or neomycin).
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The future of smallpox vaccination
Smallpox is a serious infectious disease caused by the variola virus. It has been a scourge against humanity for at least 1500 years, killing millions of people worldwide. The symptoms of smallpox are gruesome: high fever, vomiting, mouth sores, followed by fluid-filled lesions on the whole body. Death would come suddenly, often within 2 weeks, and survivors could be left with permanent harm such as blindness and infertility.
Smallpox vaccination was first demonstrated in 1796 by Dr. Edward Jenner, who noticed that milkmaids exposed to cowpox appeared to be immune to smallpox. He tested his hypothesis by inoculating an 8-year-old boy, James Phipps, with cowpox pus and subsequently challenging him with smallpox. The experiment was a success, and Jenner went on to prepare a paper describing this case along with 13 other individuals who had contracted either horsepox or cowpox before being exposed to smallpox.
Routine smallpox vaccination among the American public stopped in 1972 after the disease was eradicated in the United States. The last case of smallpox was seen in 1977. Currently, smallpox vaccines are not recommended for the general public because the virus no longer exists in nature. However, there are two licensed smallpox vaccines in the United States (ACAM2000 and APSV) and one investigational vaccine that may be used in an emergency.
In the event of a smallpox outbreak, health officials would use these vaccines to control it. There is enough smallpox vaccine to vaccinate every person in the United States if needed. The smallpox vaccine is made from a virus called vaccinia, which is similar to smallpox but less harmful. The vaccine contains a live vaccinia virus, which means that people who are vaccinated must take precautions to prevent the virus from spreading.
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Frequently asked questions
No, routine smallpox vaccination in the US was discontinued in 1972.
Smallpox has been eradicated, and the virus no longer exists in nature.
There is enough smallpox vaccine in the US to vaccinate every person in the country. Mass vaccination would be conducted as part of a national strategy.
People who have skin conditions, weakened immune systems, or are pregnant should not get the smallpox vaccine unless exposed to the disease. Vaccination is also not recommended for those under 18 in non-emergency circumstances.
Mild side effects include fever, swelling of the lymph node in the armpit, itching, sore arm, headache, body aches, mild rash, and tiredness.
