Um, isn't smallpox gone?

[Skeptic Ginger]

....

But my arguments with my wife got me to thinking; is smallpox like polio? Have we in the first world simply forgotten about the rest of the globe? I know I have no concerns that my son will contract polio. I also know that polio is still a fact of life for many on this planet. Is the reported eradication of smallpox simply another example of the first world's egocentric "it no longer affects Us, and is therefore no longer a world health issue" atitude?

This has been stated but let me add a tiny bit to the story.

The reason we were able to eradicate smallpox was because there are no animal or environmental reservoirs. Vector is the wrong word. It does mean something which carries and transmits disease. However, a reservoir is where a disease resides when out of circulation so to speak, but is still in existence. A vector more often refers to something which carries and transmits the disease. So a vector is always a reservoir but a reservoir is not always a vector.

The wild bird population is a reservoir for bird flu but it isn't referred to as a vector of disease though technically when poultry end up being direct sources of human infection they are then considered vectors. Ponds and lakes have been found to be reservoirs of influenza viruses. A lake is not a vector.

Anyway, back to the story. We were able to eradicate smallpox because the WHO undertook an aggressive campaign in 1967 to do so, and because all cases were tracked down, isolated and all their contacts were isolated until no new cases occurred.

Virus samples had been held by the US, Great Britain and Russia but in 1978 after a lab accident in Great Britain led to a fatal infection only the US and Russia are now known to still hold specimens. That was the last known case of smallpox on Earth.

Vaccinia virus is not an attenuated smallpox virus. According to the Stanford web site

Vaccinia virus is a big mystery in virology. It is not known whether vaccinia virus is the product of genetic recombination, or if it is a species derived from cowpox virus or variola virus by prolonged serial passage, or if it is the living representative of a now extinct virus.

According to the CDC

The vaccinia virus is the "live virus" used in the smallpox vaccine. It is a "pox"-type virus related to smallpox. When given to humans as a vaccine, it helps the body to develop immunity to smallpox. The smallpox vaccine does not contain the smallpox virus and it cannot cause smallpox.

This differs considerably from polio. In polio, 95% of cases do not involve paralytic disease. So it is very hard to track down every last case. However, there still are no animal reservoirs. So after maintaining a high percentage of vaccination in the population of Western countries, we have nonetheless managed to eliminate all wild virus infection except that which is occasionally imported.

The polio vaccine which is an attenuated vaccine can very rarely cause paralytic disease usually after it passes through the gut of the vaccinated person and infects an unvaccinated person. A couple years ago the few cases of polio found in the Americas were all identified as vaccine strains and none were wild virus strains. The decision was made that because the wild virus was eliminated (except for imported cases) it was no longer true that the vaccine was safer than the disease. However, the killed vaccine is still safer than the disease risk. So the ACIP (Advisory Committee for Immunization Practices) changed the recommendation to killed vaccine in the USA. Other countries in the Western Hemisphere I believe followed suit but I am not positive of that.

However, in countries where wild polio virus infection is still occurring, the live vaccine is more effective, only requires one dose instead of three, and doesn't require the use of injections, a problem that has resulted in blood borne infections like HIV and hepatitis B in poverty stricken countries tempted to reuse disposable syringes. Live polio vaccine is still recommended in third world countries outside of the Western Hemisphere and the WHO is trying to wage an aggressive campaign against polio like they did against smallpox.

 

[Skeptic Ginger]

More smallpox trivia:

Routine vaccinations in the USA ended in 1972. If you were born in the US before that you were likely vaccinated. After 1972 the military continued to vaccinate soldiers until the 1980s when that was also stopped.

After the anthrax incident and 911, the US tried to implement a voluntary smallpox vaccine program for key health care workers who would then be able to respond to a bioterrorism incident. But a few cases of cardiac infection with the vaccinia virus resulted in the campaign being halted. You can be vaccinated at the time of an exposure (you have about 48 hours) and still be protected or at least have milder disease.

The military resumed vaccinations after 911 and apparently are still giving the vaccine. The sad thing about this infected child in the news is that it was preventable either by better screening of the servicemen and women vaccinated (you don't vaccinate people with eczema or with household members with eczema) or with proper education of the vacinee in how to care for the vaccine site and keep the vaccinia virus from being transmitted to others.

Regarding whether having had a smallpox vaccine 30+ years ago is still protecting you, two studies which looked at two different outcomes came to the opposite conclusions. (Reminds me I could use this example in the thread where we are discussing when evidence does and does not actually apply to one's hypothesis.)

 

[Skeptic Ginger]

Still, are any pathologists or epidemiologists out there to prove me right, cough cough, I mean show that my wife may have been just a little bit mistaken?

You can quote me, infectious disease is my field and I've been practicing in it for 16 years.

 

[Skeptic Ginger]

It could have been the physician who was mistaken. A lot of people think the smallpox vaccine was/is attenuated smallpox, so the physician could have assumed the complication with the vaccination was mild case of breakthrough smallpox.

Definite possibility.

 

[Skeptic Ginger]

Are there not other diseases still out there that look like, produce symptoms similar to, or are related to smallpox? The vaccination one is known, but there may be others. She MAY have mistaken the disease name as chicken pox, for example, which has a number of strains and similar dangerous variants.

While there are related diseases (vaccinia, monkeypox and cowpox are related - orthopoxviruses), and there are 'pox' diseases, (chicken pox - not related, it is in the herpes virus family), smallpox has unique symptoms and other infections are not easily mistaken for small pox.

Poxviridae
Poxviridae
Orthopoxvirus
Herpesviridae

 

[Skeptic Ginger]

The chickenpox virus, varicella, doesn't have dangerous variants or strains, but it can be deadly when the host factors are all wrong. But the virus itself is one of the most stable known to man.

But yeah...there are a number of other orthopox viruses (varicella isn't an orthopox virus, by the way...it's a member of the alpha herpes family of viruses...smallpox, cowpox, and vaccinia are orthopox viruses, though) that have been known to infect humans, but I still think someone somewhere heard about the vaccinia (smallpox vaccination virus) complication, and assumed that there were cases of smallpox popping up.

Ooops, you beat me to it.

I think you are correct about someone mistaking what they heard/read in the news.

 

[Skeptic Ginger]

Well, they do have a shingles vaccine now. But I'd still go rub any chickenpox infested kids on me if I got the chance.
In defense of the varicella vaccine, they didn't know until a couple of years ago that the vaccine viruses ability to infect the dorsal root ganglia (and thus re-emerge as shingles) wasn't actually attenuated at all. And childhood mortality from varicella, while low to begin with, is now down to almost nothing.

I'm confused about this post. I sure as he11 wouldn't go out and try to get a varicella infection were I not immune. And what do you mean not attenuated at all? Think you might want to update your varicella vaccine knowledge with more accurate information.

Do you have any cases of fatal disseminated shingles in a person who has a normal immune system? Know of any fatalities related to varicella vaccine? Know of any cases of fatalities from varcella vaccine shingles?

Because I can find you the fatal cases from wild varicella infection.

 

[timhau]

A little-known fact about smallpox:

The last person to catch smallpox was Chuck Norris. This was in 1977; today, smallpox lives in a crummy low-rent apartment in Central LA under an assumed name, goes to therapy twice a week, and still has nightmares about Chuck.

 

[Skeptic Ginger]

I found one reference to a fatality from the varcella vaccine in a child with asthma but to read the details requires a subscription so I have no idea what the circumstances were. The Google entry reads,

Varicella Vaccine Fatality Reports. Patient A. Shortly before her eighth birthday, a girl with history of chronic severe asthma received a tuberculosis ...

Chicken pox, OTOH, causes a number of hospitalizations, deaths and permanent brain and respiratory sequelae in some cases every year.

Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data

On average, 25 people a year die from chickenpox. Overall case fatality was 9.22 per 100 000 consultations for chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths were twice as common in men as in women. More of those who died were born outside United Kingdom than expected (12% v 4%).

Conclusions
Chickenpox is not a mild disease. Deaths in adults are increasing, both in number and proportion.

Severe Complications of Varicella in Previously Healthy Children in Germany: A 1-Year Survey

The most frequent complications were neurologic, which were reported in 73 children (61.3%); cerebellitis was the leading diagnosis (n = 48), followed by encephalitis (n = 22), meningitis (n = 2), and central facial palsy (n = 1). A total of 46 (38.6%) infectious complications were identified. Superinfections of the skin were present in 31 (26.0%), pyogenic arthritis was present in 5 (4.2%), osteomyelitis was present in 4 (3.3%), necrotizing fasciitis was present in 3 (2.5%), orbital cellulitis was present in 2 (1.6%), and pneumonia was present in 1 (0.8%). Streptococcus pyogenes was the leading cause of bacterial infections (18 cases [15.1%]), with invasive disease in 6 patients (8.4%) and linked to 4 of 8 cases with defect healing. Infectious complications were reported in the majority in younger children up to 4 years of age, whereas neurologic complications occurred more frequently in an older age range. Five children experienced thrombocytopenia or severe anemia. There was no bleeding disorder, no fatality, and no case of Reye syndrome reported during the 1-year observation period. In total, 8 (6.7%) of 119 patients reported having long-term sequelae, 6 attributable to infectious complications and 2 to persistent deficits after neurologic complications.

Conclusion. This is the first prospective nationwide study of severe complications of varicella in immunologically healthy children. Related to 14 025 867 children up to the age of 16, a crude incidence of severe chickenpox complications of 8.5/100 000 could be calculated. The actual hospitalization rate attributable to complicated chickenpox is probably much higher, because this calculation refers to a population theoretically at risk and not the truly susceptible individuals. The results of this study demonstrate considerable morbidity with a comparatively high rate of encephalitis, osteomyelitis, and pyogenic arthritis.

Varicella-Related Deaths Among Adults — United States, 1997 (3 case descriptions)

The cost-effectiveness of varicella vaccine programs for Australia.

strategy I (no vaccination) was compared with three different varicella vaccination programs: strategy II - all infants; strategy III - adolescents without a history of varicella; and strategy IV ('catch-up')- all infants plus, for the first 11 years, adolescents without a history.Outcome measures: fatalities and hospitalisations for varicella and its complications (encephalitis, pneumonitis, long-term disability).Results: the average cost per case of chickenpox averted was $64, $530 and $418 in the infant, adolescent and catch-up programs, respectively. The infant program was the most cost-effective of the three. This program could avert 4. 4 million cases, 13,500 hospitalisations and 30 fatalities for chickenpox over a 30-year period. Results were sensitive to the price of the vaccine and the discount rate, but relatively insensitive to changes in vaccine efficacy, coverage rates or vaccine complication rates. Improved accuracy of a negative varicella history in adolescents would substantially reduce the costs of the adolescent and catch-up programs making these programs feasible.Conclusions: the infant vaccine program is the preferred program, but the direct costs of any of the vaccination programs considered here are greater than the direct costs of no vaccination program.

PubMed citations for varicella fatalities including the above citation:

lias A, Galanakis E, Raissaki M, Kalmanti M. Related Articles, Links
Abstract Childhood encephalitis in Crete, Greece.
J Child Neurol. 2006 Oct;21(10):910-2.
PMID: 17005114 [PubMed - indexed for MEDLINE]
2: Abuhammour W, Hasan RA, Unuvar E. Related Articles, Links
Free Full Text Group A beta-hemolytic streptococcal bacteremia.
Indian J Pediatr. 2004 Oct;71(10):915-9.
PMID: 15531835 [PubMed - indexed for MEDLINE]
3: Scuffham PA, Lowin AV, Burgess MA. Related Articles, Links
Abstract The cost-effectiveness of varicella vaccine programs for Australia.
Vaccine. 1999 Oct 14;18(5-6):407-15.
PMID: 10519929 [PubMed - indexed for MEDLINE]
4: Gangaram HB, Cheong IK. Related Articles, Links
Abstract Fatal haemorrhagic chickenpox complicating nephrotic syndrome.
Med J Malaysia. 1993 Dec;48(4):446-8.
PMID: 8183171 [PubMed - indexed for MEDLINE]
5: Ceyhan M, Kanra G, Secmeer G, Okuyan K, Kale G. Related Articles, Links
Abstract [Fatal varicella pneumonia unresponsive to acyclovir therapy in a child with a malignancy]
Mikrobiyol Bul. 1992 Jul;26(3):266-70. Turkish.
PMID: 1528147 [PubMed - indexed for MEDLINE]

Nothing else came up for vaccine fatalities or varicella zoster fatalities.

 

[Skeptic Ginger]

Link

.... I am amazed that the doctors did not call BS when someone mentioned it.

Sadly, I am not. I'm convinced the chapter on infectious disease in med school is a short one.

 

[Big Les]

By-the-by really, but archaeologists concern themselves over diseases like smallpox, for example at the excavation of burial vaults at Christ Church, Spitalfields, London.

The reference to disease risk is fairly brief, but the linked pdf ought to be of interest to anyone of an historical, archaeological, or just plain morbid bent.

 

[ponderingturtle]

Sadly, I am not. I'm convinced the chapter on infectious disease in med school is a short one.

But the point is the so many people with no medical training know that small pox is the one disease that has been effectively eradicated from the world.

 

[patnray]

Thanks Skeptigirl for all your information and for correcting my misuse of the word "vector". One of the things I love about this site is the way we correct each other's errors.

 

[Skeptic Ginger]

Thanks Skeptigirl for all your information and for correcting my misuse of the word "vector". One of the things I love about this site is the way we correct each other's errors.

 

[Skeptic Ginger]

But the point is the so many people with no medical training know that small pox is the one disease that has been effectively eradicated from the world.

I bet less of them know that than you estimate.

Ever watch Jay Leno's Jaywalking? Have you seen the Harvard grad interviews where the majority of graduates couldn't explain why we see Moon phases or what causes the seasons?

We had local Pertussis epidemics 3-4 years in a row when I called to follow up on a patient taken to the ED to see if Pertussis was being ruled out. The ED doctor told me, "adults don't get pertussis." 60% of the local annual cases which numbered in the hundreds were in adults. Here was an ED doctor who was oblivious to a current ongoing epidemic in the same county he worked in. And Pertussis is a life threatening infection.

Then there was the orthopedic surgeon whose wife was the director of nurses at a moderate size hospital I worked at at the time. The doctor got a needlestick and while he had had many before, this was the first one since we implemented a policy of offering employee health services to the doctors for exposures.

Turned out he wasn't vaccinated for hepatitis B. Orthopedic doctors have one of the highest exposure rates because they are working with carpenter's tools and it's very bloody. Of course, without the vaccine 200 health care workers were dying of hepatitis B every year in the US alone. And a few surgeons who contracted hepatitis B from their patients have gone on to infect more patients before realizing they had it.

But it wasn't so much a surprise he wasn't vaccinated as he didn't know the difference between HBIG and vaccine. He had no clue about the different types of hepatitis and no clue he was in danger of contracting the infection from blood. Most unvaccinated health care workers underestimate the risk, but they at least know there is one. And a nurse wife might want to know her husband wasn't going to bring the infection home to her.

I have many of these anecdotes.

 

[LostAngeles]

I honestly have trouble doing moon phases without making a fist in front of my face. It sounds stupid, but I have trouble visualizing it so I can explain it to someone else unless I do that.

The seasons are easy. Winter is cause the vegetation god was born and then Spring comes when he dies and ressurects again.

...

...wait...

 

[Skeptic Ginger]

I like the one I read from another member,

"Earth's rotation on the axis is the reason for the season."

 

[andyandy]

in other news, the black death is back

A multiple drug-resistant form of the plague, one of the oldest and most lethal diseases in human history, has been identified by scientists, prompting fears of devastating future outbreaks that cannot be contained by antibiotics.

Tests on a strain of the disease-causing bacterium, Yersinia pestis, taken from a 16-year-old boy in Madagascar revealed the organism has developed resistance to eight antibiotics used to treat the infection, including streptomycin and tetracyclin.

The bacterium is believed to have become resistant to drugs after swapping genes with common food bacteria such as salmonella, E coli and klebsiella, probably while being carried in the guts of fleas, which spread the disease by biting infected rodents.


snip

The plague first emerged several thousand years ago and swept across Asia and Europe during the Black Death pandemic between the 14th and 17th centuries. Successive pandemics are estimated to have claimed some 200m lives. Antibiotics brought the disease under control, but in recent decades the World Health Organisation has recorded outbreaks in 25 countries, most recently in the Democratic Republic of Congo, which last year reported 1,174 suspected cases and 50 deaths

yikes - lock up your fleas!

 

[LostAngeles]

There's a plush black death somewhere in the pile o' crap next to me...

 

[elgarak]

I bet less of them know that than you estimate.

Ever watch Jay Leno's Jaywalking? Have you seen the Harvard grad interviews where the majority of graduates couldn't explain why we see Moon phases or what causes the seasons?

We had local Pertussis epidemics 3-4 years in a row when I called to follow up on a patient taken to the ED to see if Pertussis was being ruled out. The ED doctor told me, "adults don't get pertussis." 60% of the local annual cases which numbered in the hundreds were in adults. Here was an ED doctor who was oblivious to a current ongoing epidemic in the same county he worked in. And Pertussis is a life threatening infection.

Then there was the orthopedic surgeon whose wife was the director of nurses at a moderate size hospital I worked at at the time. The doctor got a needlestick and while he had had many before, this was the first one since we implemented a policy of offering employee health services to the doctors for exposures.

Turned out he wasn't vaccinated for hepatitis B. Orthopedic doctors have one of the highest exposure rates because they are working with carpenter's tools and it's very bloody. Of course, without the vaccine 200 health care workers were dying of hepatitis B every year in the US alone. And a few surgeons who contracted hepatitis B from their patients have gone on to infect more patients before realizing they had it.

But it wasn't so much a surprise he wasn't vaccinated as he didn't know the difference between HBIG and vaccine. He had no clue about the different types of hepatitis and no clue he was in danger of contracting the infection from blood. Most unvaccinated health care workers underestimate the risk, but they at least know there is one. And a nurse wife might want to know her husband wasn't going to bring the infection home to her.

I have many of these anecdotes.

Yup. I knew a doctor (internist, family doctor) once whose wife got pregnant while she was still breastfeeding the first child. Cause you can't impregnate a breastfeeding woman, as any doctor knows .

On topic stupidity: Guy stops flight with smallpox scare. Forum rules do not allow me do use words I would like to describe this 'person'.