vaccination & smallpox

One last post for raising-awareness-of-the-science-behind-vaccination week 🙂

On one of Grant’s threads, an antivaccination commenter has posted links to very old images of smallpox victims from a German publication.  The commenter implies that these patients acquired the infection as a result of a smallpox vaccination (as I don’t speak or read German I can’t comment on the information accompanying the images) and holds this up as an example of the ‘atrocity’ of vaccinations to support his argument that all vaccines should be done away with.

Sometimes strong emotions cloud our ability to look carefully at fact and context. And for sure, these are not nice images.

But let’s step back a bit. Smallpox is now extinct in the wild, as a direct result of vaccination. Before Jenner came up with the concept of inoculating people against smallpox by using pus & serum from active cowpox lesions (see Grant for more on this), smallpox was rightly feared. If people didn’t actually die from the disease they were usually left disfigured by the scars that formed as the pox lesions healed.  

And it wasn’t a pleasant disease. After a 12-14 day incubation period patients would suddenly come down with severe flu-like symptoms. A couple of days later they’d start to feel a bit better – only to develop the characteristic rash: a pustulent rash that lasted up to 2 weeks & spread all over the body, including lesions in nose & mouth, where they became ulcers that shed virus particles every time the patient coughed.

Death from smallpox was all too common. Around 30% of those infected, died of the disease.  In Europe, in the 1700s, smallpox killed between 1 in 7 & 1 in 10 children; overall, 400,000 people died of it, every year. Of the survivors, 60-80% were scarred, with many blinded.And no effective treatment has ever been developed. Our commenter’s ‘atrocity’, Edward Jenner’s development of vaccination, was in reality a ray of hope. (And not just in Europe. While smallpox appears to have originated in Africa, about 3000 years ago, it arrived in Europe in the Middle Ages & spread rapidly round the world from there.)

Jenner wasn’t actually the first to come up with the idea of vaccinating against this dreadful disease. People had known for centuries that if you survived, you were immune to further infection – that meant, of course, that you’d get to nurse those who were in their turn ill. In China, India & Africa the practice of inoculation (variolation) was relatively widespread: material from a ‘ripe’ pustule was smeared into a scratch on the inoculee’s arm or leg. It wasn’t always effective, but the risk of illness was much less than from exposure by the ‘normal’ route, and if you didn’t come down with smallpox straight away, you were likely to be immune to subsequent exposure.

The practice of variolation was introduced into England by Lady Mary Wortley Montague, wife of the British ambassodor to Turkey in 1717. She’d had smallpox herself, 2 years before, & although she survived she was badly scarred – something she wanted to spare her own children. When she found that the Turkish court practised variolation she had this done to her son &, on the family’s return to England, her daughter as well. The practice caught on & proved its worth, spreading quickly to the New World. Here, during a smallpox epidemic, two Boston doctors did perhaps the first scientific study of variolation’s effectiveness. Around 6000 people fell ill with smallpox. The death rate was around 14% – except for those who’d been variolated. Here the death rate was only 2%.

Edward Jenner’s great contribution was to take a scientific approach to developing the process of vaccination, which culminated in the elimination of smallpox in the wild, something that was confirmed by the World Health Organisation in 1980.

But in the absence of any reliable way of preventing its transmission, smallpox & its attendant deaths and disfigurations would still be with us. Our commenter should pause and think – surely a much greater atrocity would be for society to know there was a way to prevent all this and yet knowing, fail to use it?