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Smallpox Outbreak a Century Ago Holds Clues for Today

Government researchers say Boston epidemic showed vaccinations helped

MONDAY, Dec. 16 , 2002 (HealthDayNews) -- A bit of history has just entered the current debate over President Bush's smallpox vaccination plan. And the page from the past could well provide a lesson for the future, experts say.

Even though smallpox was eradicated worldwide in 1977, there is plenty of concern that this viral killer could come back to haunt us in the form of a biological weapon. Knowledge of the disease, then, is as essential now as it ever was.

With this in mind, researchers at the National Institutes of Health used historical records to revisit the smallpox epidemic in Boston a century ago, in which 1,596 people fell ill and 270 people died. Their analysis, presented in tomorrow's issue of the Annals of Internal Medicine, found survival was strongly related to age, vaccination status and severity of the disease.

Specifically, in the 1901-1903 Boston epidemic, those younger than 5 and older than 45 were less likely to live, those who had been vaccinated, even if it was after exposure, were more likely to survive, and those with less severe infections were also more likely to live.

According to the article, the vast majority -- 95 percent -- of smallpox cases in the United States in the 20th century were caused by a mild variety of the disease. The Boston epidemic, however, was the result of a more virulent form and, consequently, had a much higher mortality rate.

Except for patients considered too sick to be moved, all victims of the Boston epidemic were taken to the Southampton Street or Gallop's Island hospitals and held in isolation. The authors of anaylsis pored through handwritten records of 243 smallpox patients who were admitted to the Southampton Street facility between Jan. 23 and April 2, 1902.

These records, the only surviving ones from the epidemic, were all meticulously recorded by Dr. Irving Reed Bancroft, a 1900 graduate of Harvard Medical School who trained as the resident physician at the hospital during the epidemic. The records were donated to Boston Medical Library in 1974.

The record-keeping was an event in itself. "He did every single one of 243 records. It's absolutely astounding," says Dr. Joel Breman, senior author of the study and senior scientific advisor at the NIH's Fogarty International Center "Plus, he was sitting in the middle of hundreds of smallpox patients who were presenting in the most horrific way possible."

The current-day researchers based their analysis on 206 patients for whom survival information was available. Of those, 36, or 17.5 percent, died.

The results, Breman says, were less surprising than they were a reinforcement of what is already known today.

Perhaps the most comforting lesson is that those who got vaccinated, even within three weeks of being exposed to smallpox, either did not get sick or had a much milder version.

"If you get the vaccine usually up to four to five days after being exposed, you may not have any symptoms at all or a very reduced case," says Gigi Kwik, a fellow at the Center for Civilian Biodefense Strategies at Johns Hopkins University in Baltimore. "That's the basis of the current plan in that you would have some time to vaccinate the population."

According to the study authors, management of an outbreak today would be much the same as it was 100 years ago, with isolation of patients, treatment of symptoms, and selective vaccination of medical staff, patients and anyone with whom they had come in contact.

Certainly, the modern day offers several advantages, including improvements in treatments, regulated production and quality of the vaccine and a more robust public health infrastructure.

And presumably a stronger concern for civil liberties.

When the Boston epidemic first started, health authorities, in their zest to vaccinate as many people as possible, stormed into homeless shelters and transient hotels, wrestled people to the ground, rolled up their sleeves and jabbed them forcefully with a needle, Breman says.

"A few people had bloodied heads," he adds.

What To Do

For more on smallpox, visit the U.S. Centers for Disease Control and Prevention, or for information on the President's vaccination program, check out the just-launched smallpox site from the U.S. Department of Health and Human Services.

SOURCES: Joel Breman, M.D., senior scientific advisor, Fogarty International Center, National Institutes of Health, Bethesda, Md.; Gigi Kwik, Ph.D., fellow, Center for Civilian Biodefense Strategies, Johns Hopkins University, Baltimore; Dec. 17, 2002, Annals of Internal Medicine
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