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Um, isn't smallpox gone?

autumn1971

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So my wife works at a hospital clinic, and tonight, as happens once in a while, she and other staff members were treated to a dinner where medical things were discussed, and needs to purchase items pursuant to whatever was being talked about came up. My wife is not a physician, but she mentioned to me that the general discussion tonight was about vaccines and such. We talked about the apparent resurgence of pertussis, which is pretty disturbing, and then she mentioned that a physician there said that the entire clinic should be vaccinated for smallpox because new cases were being seen.
This surprised me.

I asked my wife (gently and non-judgementally) if she was sure that this guy wasn't just talking about possible biological terrorism, because I was fairly certain that smallpox in its natural state was extinct. I asked (again, not implying that she was not well informed or a bad listener) if she had heard correctly that new cases of smallpox had been reported.

After being chewed out quite thoroughly for being such a know-it-all bastard, I found that our phone connection had somehow been compromised (darn cell phones).

My question, for those here who know much more than I about epidemilogical matters (read: everyone) is, does the smallpox virus exist in nature, or only in labs like the CDC and secret installations devoted to biological weapons? I seem to even recall a controversy about destroying lab stocks, as this would be a deliberate extinction event.
 
A toddler and his mother got sick reportedly from the father's smallpox vaccination. http://www.edmontonsun.com/News/World/2007/03/18/3775663-sun.html

... Doctors stressed that the boy was not suffering from smallpox, but from the related vaccinia virus which is used to convey immunity to the much deadlier disease.

They said the boy, who seemed to be improving, may lose 20% of his outer skin layer.

The boy and his mother remained in hospital in a specially ventilated room, though there is no infection risk for the general population because the vaccinia virus can be spread only through close physical contact. The family's name was not released at their request.

Doctors said the infection was a rare condition called eczema vaccinatum, which has not been reported since at least 1990, when the U.S. military ended a previous program of smallpox vaccination. Smallpox was declared eradicated in 1980.

The military began smallpox vaccinations again in 2002 because of bioterrorism fears.
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I also thought other than a small sample possessed by the CDC and someone else, it was gone.
 
autumn1971 said:
...she mentioned that a physician there said that the entire clinic should be vaccinated for smallpox because new cases were being seen.
This surprised me.

My question, for those here who know much more than I about epidemilogical matters (read: everyone) is, does the smallpox virus exist in nature, or only in labs like the CDC and secret installations devoted to biological weapons? I seem to even recall a controversy about destroying lab stocks, as this would be a deliberate extinction event.
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I'm with you. I googled smallpox and all I got was a wide variety of health-related sites saying that the last known case was in 1977. I sure hope your wife is wrong and I think the MD she listened to was wrong as this would be fairly important news to all of us. I don't know where the MD expects to find the vaccine as I think it's tightly controlled by the CDC. I don't think it will be distributed unless there is a CDC-confirmed outbreak.

Good luck lying low for a while! :)
 
Thanks for the link, LostAngeles, but the boy's infection is not smallpox, and the article made no link between the infection and smallpox. Except to note that it had not been seen since before the military ended its smallpox vaccination program, there was not a relation between the specific pathogen and the general disorder seen among those unfortunate few with a predisposition to aquire a disorder from those around them who had been vaccinated for any general virus. Note the name of the disease is eczema vaccinatum, a disease of the skin related to vaccination, not to smallpox. I think the "since the military ended its vaccination" bit is a little slice of fear mongering.
 
Slimething, I said the same thing to my wife; did I miss two inch headlines in every major newspaper shouting about the impending doom? Wouldn't a doctor with a new case of smallpox be instantly elevated to celebrity? How would I not know about a case of smallpox?

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?
 
autumn1971 said:
Thanks for the link, LostAngeles, but the boy's infection is not smallpox, and the article made no link between the infection and smallpox. Except to note that it had not been seen since before the military ended its smallpox vaccination program, there was not a relation between the specific pathogen and the general disorder seen among those unfortunate few with a predisposition to aquire a disorder from those around them who had been vaccinated for any general virus. Note the name of the disease is eczema vaccinatum, a disease of the skin related to vaccination, not to smallpox. I think the "since the military ended its vaccination" bit is a little slice of fear mongering.
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I know, but it's the closest thing I found to what you were talking about. Maybe that's the source of the confusion, though?
 
LostAngeles said:
I know, but it's the closest thing I found to what you were talking about. Maybe that's the source of the confusion, though?
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I'm sure it is.
If there were cases of smallpox popping up again, it would be all over the news and on the front page of the CDC's site.
 
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?
 
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.
 
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.
 
Zep said:
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.
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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.
 
Zep said:
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.
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No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.
 
autumn1971 said:
No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.
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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.
 
autumn1971 said:
No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.
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Well, if you'd like help with the hypochondria, might I refer you to WebMD.com where every little symptom means you're dying a horrible, horrible death.
 
LostAngeles said:
Well, if you'd like help with the hypochondria, might I refer you to WebMD.com where every little symptom means you're dying a horrible, horrible death.
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I'll be 57 in a few days (jeez, I was going to say "a couple of weeks," but I just looked at the calendar), and I had thought I was on death's door; there was an almost constant pain in my legs when I walked, I couldn't get to the top of the stairs without running out of breath, and I wheezed in bed. My GP had diagnosed asthsma, and is considering COPD, as well as Peripheral Artery Disease. I quite literally made out my will.

Then I got referred to a urologist, who decided my prostate has to come out, and he told me to lose some tonnage before surgery. After just two weeks on a treadmill (one mile per day, 2.5 mph, 2.5% incline), and a 1500-calorie diet, I'm down two pounds (not much, but it's a start), the pain in the legs is gone, and I no longer wheeze or gasp.

I'm a confirmed lazy slob, but the best cure I've found for hypochondria is to get up off your ass. And I would like to extend my fondest thanks to my GP for all the ennabling.
 
CDC said:
Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention
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Link

So the CDC does not think there have been any recent cases of it. I am amazed that the doctors did not call BS when someone mentioned it.
 
Smallpox was the first disease targeted for world wide elimination precisely because the vaccine was cheap, stable, easily administered, and there are no non-human vectors. Any such effort also requires a large PR campaign to convince everyone to participate. The first round of smallpox eradication appeared to succeed, but then new cases began popping up. Turns out that some rural chieftains were told of the importance of the campaign, but took it to mean that their villages would be seen in an unfavorable light if they reported cases of smallpox. So they stoppped reporting them. Workers had to go back and convince them that they would be seen as heros for reporting cases and for encouraging everyone to get vaccinated. With that second effort smallpox was finally eliminated, although, because of the first experience, it took a few years to be confident.
 
autumn1971 said:
No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.
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There is a big misconception that shingles is more dangerous than chicken pox or that the vaccine for chicken pox causes a worse problem than it prevents.

The initial infection EVERYONE has if infected with chicken pox is chicken pox. About 90% of people have had the infection by age 19 and close to 100% have had it by the age of 40. But a good number of cases have no accompanying rash so not everyone knows they have had it.

After being infected, the virus is not cleared from your body and instead remains dormant in specific nerve cells. Some people later develop shingles when they virus is reactivated. This typically occurs once in people unless they have a seriously weakened immune system. Only then is shingles life threatening.

Shingles and chicken pox can both be treated with acyclovir and the newer versions of the drug.

However, for chicken pox, the vaccine is still safer than waiting for the roulette wheel of wild virus infection. Chicken pox kills a small number of people every year including some children. Some people also end up with permanent lung damage from chicken pox and secondary infection of the pox is common. There have been outbreaks of rapidly invasive streptococcal disease (flesh eating bacteria) in children with pox rashes.

The vaccine does not increase your risk of shingles and the chances you are not going to get chicken pox is close to nil if you are not vaccinated so you will be at risk for shingles anyway.

The shingles vaccine is too new to say with any certainty whether in people with normal immune systems the vaccine is better than anti-viral drugs during an outbreak. I have not read up on who should be getting the vaccine. Once it has been in use for a while, we'll know if everyone should get it or not.
 
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