SIZING UP SMALLPOX

Question: I thought we got rid of smallpox in the 1950s. What’s with this talk of vaccine?

Answer: The last case of smallpox (AKA variola virus) in the USA was in 1949. In 1977, a Somalian man was the last person on earth to ever suffer from the disease. Smallpox has no natural host other than humans. You won’t catch it from animals or bugs. Man-made laboratory stockpiles loom on as the sole source of smallpox virus.

Question: I’ve heard that smallpox is always fatal and definitely ugly, so I want to get the vaccine right away, just in case.

Answer: According to the Centers for Disease Control, the smallpox virus commands a fatality rate of just 30%. This means that most people who contract the illness will survive. In the event of bioterrorism, there’s sufficient smallpox vaccine to protect everyone in the country.

Question: Good, then since we have enough, I’m going out for the shot this instant.

Answer: Wait! Right now, the only people receiving the vaccine are health care workers volunteering for the Massachusetts Smallpox Response Team and certain military personnel. The Massachusetts Department of Public Health & the Smallpox Working Group of the Statewide Bioterrorism Task Force determined this distribution as part of the pre-event vaccination plan.

Question: Come on. We’ve got enough vaccine, let’s protect everybody. Israel didn’t have a problem with it.

Answer: The Israelis immunized their military with a different strain of smallpox vaccine than ours. Theirs is the Lister vaccine. It won’t give you fresh minty breath, but it does elicit fewer side effects than our supply. The bi-monthly Massachusetts Nurse calls our smallpox vaccine the most dangerous inoculation ever invented. This vaccine contains the live virus, vaccinia, a close relative to smallpox. Historically, 15 people per million inoculated developed serious side effects. Two people per million died.

Question: My word! Just warn me about the minor side effects for now.

Answer: According to the CDC, standard responses to the vaccine include a sore arm, fever, and body aches. The Massachusetts Nurse cautions about additional reactions including swollen underarm glands and generalized malaise disturbing all regular activities including sleep.

Question: That’s it?

Answer: Those were the safer side effects. More serious reactions can occur. Touching the open sore at the vaccination site and then touching another part of your body can lead to a localized “vaccinia rash”, typically affecting the gonads or the eyes. Blindness can result. If the virus seeds in the bloodstream, open sores afflict the whole body. Finally, the dreaded allergic Erythema multiforme can emerge. The CDC estimates that 1000 people per 1 million vaccinated will experience these serious reactions.

Question: That’s a lot. What about those fatal reactions you mentioned?

Answer: The Massachusetts Nurse divides these fatal reactions into 3 categories: Swelling of the brain (encephalitis), destruction of the skin leading to death, and eczema vaccinatum, disastrous skin rashes. Anywhere from 14-52 people per million vaccinated will experience these life threatening emergencies.

Question: Is there no telling who will fare well and who we’ll farewell?

Answer: So far, we do know that certain populations, like pregnant women and babies, are more prone to harboring severe, life threatening responses to the vaccine. Forego the vaccine if you’ve ever had eczema or atopic dermatitis. Immunosuppression caused by cancer, substance abuse, organ transplantation, HIV/AIDS, anorexia, or steroids also precludes inoculation, unless exposed to smallpox. Smallpox itself is more hazardous than the smallpox vaccine, even for those in a high risk category. Do you have any other questions about the vaccine?

Question: Yes. Do they make a bubble with it or do they stick it in your arm?

Answer: Neither. The smallpox vaccine currently employs a 2-pronged needle. The vaccine-coated needle repeatedly pricks a tiny patch of skin to form a small sore.

Question: Gross! They use the same needle over and over again! Is that safe?

Answer: It’s dubious. The needles selected for smallpox vaccine administration do not pass muster with the Needlestick Safety and Prevention Act of 2000. Consequently, there exists an unnecessarily high risk of needlestick injury to the inoculating Nurse. Needlestick injuries can cause bloodborne illness such as Hepatitis or HIV. Adhere to strict post-vaccination care guidelines because the inoculation sore has the potential to spread vaccinia to others and to self. The vaccination site starts as a bump, fills with pus, blisters up, and eventually pops.

Question: So there are problems with the vaccine. For all these drawbacks, the thing better work.

Answer: Yes, the vaccine is deemed 95% effective for 3-5 years. After 5 years, immunity starts to wane.

Question: What about duct tape?

Answer: Adds rough elegance to torn parkas purchased during Y2K.