Smallpox Vaccine Scar: Who Has One and Why?

Why Edward Jenner Infected His Gardener's Son With Smallpox

images.Wellcome.Ac.Uk, Public Domain, https://commons.Wikimedia.Org/w/index.Php?Curid=8776638"... [+] align="" width="940"] The coxpox-infected pus came from the hand of a milkmaid named either Lucy or Sarah Nelmes.

Friday marks the 270th birthday of Edward Jenner, the doctor who developed the world's first vaccine.

Born on May 17, 1749, Edward Jenner grew up in Berkeley, in southwest England, and after medical school, he returned to Berkeley to set up a practice. Living and working in a town surrounded by dairy farms, it would have been hard for Jenner to miss noticing that milkmaids almost never caught smallpox, a disfiguring and often deadly disease that plagued much of the world until the 20th century. It starts with a fever, and then a rash and pus-filled blisters spread across the patient's body. Those who live often bear pockmarked scars from the dried-up pustules for the rest of their lives -- but about 15% to 30% of people who caught smallpox died from it.

18th-century milkmaids were lucky to dodge all that, but their work often exposed them to cowpox, a version of pox virus which evolved to infect cattle (several animal species have their own species of pox virus). Humans can also catch it, but it's much milder than smallpox. People who had caught cowpox seemed immune to smallpox, which was certainly a point in favor of working as a milkmaid.

When Edward Jenner was eight years old, some responsible adult figure in his life cut his arm and rubbed pus from a freshly-burst smallpox pustule into it. Based on field observations of eight-year-old boys, young Jenner probably thought this was either utterly horrifying or extremely cool, but history doesn't record which.

Today, we know that once you've been exposed to a virus or other pathogen, your immune system learns to recognize the intruder and generates molecules called antibodies to help fight it off. Assuming you survive your first encounter with a pathogen, the exposure helps you resist catching it again. In the late 1700s, people only knew that once you'd been exposed to smallpox, you weren't likely to catch it again, so "variolation" had become a common childhood rite of passage in Europe (after some initial controversy and a few firebombings). It was a much older practice in other parts of the world, such as China, India, Turkey, and west Africa.

Young Jenner faced about a 2% chance of dying of smallpox thanks to his variolation. That's pretty horrifying compared with the safety standards of modern vaccines, but it offered better odds than the 15% to 30% chance of death he'd face if he caught the virus. And life in 18th century Europe made that a very real risk.

Years later, Edward Jenner the village physician and man of science had the idea that there might be a less risky way to protect people against smallpox, based on the milkmaids' seeming immunity. So he did what any reasonable scientist would do when faced with a compelling hypothesis and a need to test it: he infected his gardener's eight-year-old son with cowpox and took notes. "Informed consent" wasn't really a big thing in the 18th century, especially if you were poor and your father worked for the scientist in question.

James Phipps had a rough few days after that; Jenner's notes describe nine days of fever and aches, much milder than smallpox but clearly no picnic. If you're already reeling in horror at the ethics of experimenting on the nearest available small child, hold on to your smelling salts: six weeks later, Jenner infected Phipps with actual smallpox. Fortunately for Phipps, and perhaps for Jenner, nothing happened. It turns out that cowpox is similiar enough to smallpox that the same antibodies protect against both. Modern vaccines are made with dead or weakened viruses and, mercifully, no actual pus.

History doesn't record what young Phipps or his father thought about all this, but later in life, Jenner gave Phipps and his family a cottage in Berkeley, and Phipps attended Jenner's funeral in 1823. They're now both buried in the same church where Phipps was baptized as a child (about four years before the smallpox experiment).

Incidentally, Jenner was also the first scientist to decribe the cuckoo's morbid habit of leaving its eggs in other birds nests, where the cuckoo young hatch and promptly shove their hosts eggs and hatchlings over the edge to their deaths.

Is Smallpox Still A Threat?

Smallpox, a disease that killed an estimated 500 million people in the 20th century alone, is the only human disease to be eradicated. However, a new report, "Future State of Smallpox Medical Countermeasures," from the National Academies of Science, Engineering, and Medicine (NASEM) argues that the U.S. And the global community should prepare for smallpox to make a return.

Dr. Zhilong Yang, an associate professor in the Texas A&M School of Veterinary Medicine & Biomedical Sciences' Department of Veterinary Pathobiology, served on the committee that produced the report, which draws conclusions from the COVID-19 pandemic and mpox multi-country outbreak to assess the state of smallpox preparedness.

According to the report, smallpox could return through an accidental "leak," or even through an act of terrorism. It also states that preparing for the return of smallpox is key to preventing the spread of other diseases caused by viruses within the same family, like the mpox virus, which became a global outbreak in 2022 and continues to be a health concern.

"Smallpox vaccines and drugs also hold the promises and potentials to prevent and treat mpox and other viruses within the same family of smallpox virus, which is another important reason that we should continue to research poxviruses and develop smallpox medical countermeasures, including diagnostics, vaccines and therapeutics," Yang said.

Currently, only two laboratories—the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia, and the Laboratory for Applied Microbiology at Koltsovo in Russia—have official collections of the virus that causes smallpox, making the chance of an accidental "leak" low. However, there are enough publicly available genetic sequences of the smallpox virus to make it possible for the smallpox virus to be re-created, especially with the advance of synthetic biology and artificial intelligence .

"Even one case of smallpox outbreak would be a huge global issue, so we must stay vigilant," Yang said. "Scientists and medical professionals must also be aware that smallpox's symptoms are very similar to diseases like mpox that have been prevalent more recently. If there is a smallpox outbreak, we must be quick to recognize it."

Citation: Is smallpox still a threat? (2024, April 13) retrieved 21 April 2024 from https://medicalxpress.Com/news/2024-04-smallpox-threat.Html

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All Your Questions Answered On Smallpox

• Q: What is smallpox?

A: Smallpox is a severe, often fatal human disease caused by the variola. This comes in two strains: the less severe variola minor and the more deadly variola major. It is highly infectious and has an incubation period of seven to 17 days. The disease can be passed on through direct contact, infected body fluids and contaminated objects such as clothing. Only rarely has it spread through the air. It is not known to be transmitted by insects or animals.

• Q: What are the symptoms?

A: An infected person will suffer initial headaches and feverish, flu-like symptoms. After a few days, the disease progresses to vomiting, followed by the development of a rash which may cover the entire body with watery and pus-filled blisters. In severe cases, delirium and death will follow within a fortnight.

• Q: Does anyone get smallpox today?

A: No. Natural smallpox was eradicated after a global mass vaccination campaign. The last naturally occurring case was in Somalia in 1977 and in 1980 the disease was declared eradicated. In Britain, the last endemic case was in 1935. However, the virus still exists in laboratories in Russia and the US.

• Q: Does smallpox kill everyone who gets it?

A: No. Around two thirds of people who get smallpox will survive. But they may be scarred for life even after the blisters heal. Some victims are left blind.

• Q: Can you pass on the virus without knowing you have it?

• A: A person with smallpox can be contagious from the moment the fever begins, becoming most infectious with the onset of the rash.

• Q: Is there any treatment?

A: There is no specific cure, only prevention through vaccination but those known to have come into contact with the virus would receive immediate immunisation. As the vaccine takes effect faster than the disease can spread, it should prevent infection.

• Q: How much vaccine does Britain have?

A: The Government has admitted there is only enough vaccine for around 20 million - a third of the population. However, they claim that by diluting stocks, the vaccines would still be effective and could treat the whole population.

• Q: Have any public figures or military personnel been immunised in case of war?

A: Not officially, although the Ministry of Defence says a "cohort" of soldiers deemed to be most at risk of being targeted by a bio-weapon have been offered it.

• Q: How long does a smallpox vaccine last?

A: The dose offers protection for three to five years, with decreasing immunity thereafter.

• Q: Would I have been vaccinated in childhood?

A: If you are older than about 35, then probably yes. Routine vaccination in the UK ceased in the early 1970s. Those who did receive the dose may have some residual immunity, though it is not clear how effective this would prove in an outbreak.

• Q: Can I be vaccinated today?

A: No. Unless there is an outbreak, the smallpox vaccine will not be made available to the public. The Department of Health says that vaccines would be "rapidly deployed" in the event of an outbreak.

• Q: What form does the vaccination take?

A: A shallow injection, using a double- pronged needle dipped in a suspension of the live "vaccinia" virus which is closely related to smallpox. The injection site must be kept clean and covered to prevent the virus from spreading.

• Q: What are the sideeffects of being vaccinated?

A: Most people experience mild reactions that include fever and body aches. However, others may experience more serious reactions ranging from a severe allergic reaction at the site of the vaccination to heavy fever. As a result, about one in a thousand people will require medical treatment after being vaccinated. A study in the US suggested that if 60 million people under the age of 30 were vaccinated, the likely number of deaths would approach 150.

• Q: Who should not be vaccinated?

A: Pregnant women should not be vaccinated because of the risk to the foetus. Those with weakened immune systems, such as those undergoing transplant surgery, should not be given the vaccine. Unless there is an emergency, it is not recommended that those aged under 18 routinely be vaccinated. In addition, those with certain skin conditions, such as dermatitis, may be advised to consult their specialist before having the injection.

• Q: How many people need to get smallpox before it is considered an outbreak?

A: One confirmed case of smallpox would be considered a public health emergency.

• Q: If there is an outbreak, who will get the vaccination?

A: Health workers, such as doctors and nurses, will be the offered the vaccine first. Key military personnel will follow. It is likely that only the population in the area immediately surrounding an attack would be immunised to begin with.

• Q: Does the vaccine offer 100 per cent protection?

A: Around 95 per cent of those vaccinated would have immunity to the disease. Controversially, some experts in the US have suggested that a vaccine against the Lister strain, such as the one ordered by the British government, might not be the best option against "battlefield strains" of the disease.

• Q: What is the US doing?

A: By 2004, the US Centre for Disease Control and Prevention-CDC) estimates that America-should have enough doses to protect the entire population. President Bush has decided to make the vaccine available to all US citizens, beginning with the military and health workers.

• Q: Has smallpox ever been used as a weapon?

A: Yes. British soldiers gave infected blankets, which had been used by smallpox patients, to American Indians during the French and Indian War of 1754-67. As a result, many tribes contracted the disease, with some losing up to half their populations.

• Q: What makes smallpox a powerful weapon today?

A: The smallpox virus is incredibly hardy. It can survive in aerosol form for four days. It can survive in closed space for up to three months. It is also highly contagious and easily sprayed into the air.

• Q: Could terrorists have supplies of smallpox?

A: Smallpox is much harder to get hold of than the germs that cause anthrax or plague and special skills are required to grow the virus in large quantities and make it into weapons. It is also highly dangerous for those working with the virus. But because it is so dangerous, smallpox may still appeal to ambitious terrorists.

• Q: Which countries have smallpox stockpiles?

A: Officially, smallpox remains in only two places in the world the Centre for Disease Control in Atlanta, Georgia, and a laboratory in Russia. In 1971, the Soviet Union tested a smallpox bio-weapon near the Aral Sea. It killed three people and had to be contained by an extensive vaccination campaign. Recent reports indicate that in the early 1980s, Russia grew large quantities of smallpox and successfully adapted it for use in bombs and missiles.

• Q: Are the Russian smallpox stockpiles safe?

A: The fear is that underpaid or unemployed Russian scientists might sell, or have sold, bio-weapons expertise or equipment to terrorists or rogue states.

• Q: Does Iraq have smallpox?

A: Although Iraq has admitted having other biological agents, such as anthrax and botulism toxin, there is no hard evidence it has obtained smallpox.

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