Smallpox: Your Questions Answered

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A Public Health Nurse in Greenville, N.C. holds the Smallpox vaccination

Last fall, anthrax occupied most of our bioterror nightmares. This year, our anxiety has refocused on an even more frightening biological threat, one that researchers once believed had been eliminated from the planet: Smallpox. Friday afternoon, President Bush announced that for the first time in 20 years, the U.S. will begin vaccinating members of the military and "first responders," including firefighters and emergency medical workers. What is smallpox, how dangerous is itand should we all be vaccinated?

What is smallpox?

Smallpox is a serious, highly contagious infectious disease. There are two forms of smallpox: variola major, which is the most severe and common form, manifests as a widespread, distinctive rash and high fever; and variola minor, which is far less common and also less dangerous. Variola major generally kills about 30 percent of its victims. The virus can be spread by bodily contact or by coughing.

Didn't we get rid of smallpox years ago?

For years, we believed we had. A worldwide eradication program had been so successful that in 1972 health care providers felt safe removing the vaccine from the list of childhood vaccinations. The last naturally occurring case of smallpox in the U.S. was recorded in 1949, worldwide, in Somalia in 1979. In the last 15 years, however, officials have become aware of a bioterrorism threat from countries, including Iraq, believed to have kept samples of the virus.

Why start the vaccinations now? Is there a specific threat of smallpox in the U.S.?

President Bush insists there are no direct threats against the U.S. involving smallpox. However, Iraq is believed to have stockpiles of the virus, and the administration believes the public should be informed of and vaccinated against any possible threat that might stem from a war against Iraq or its allies.

Who will be vaccinated immediately?

Under President Bush's plan, 500,000 members of the U.S. military will be vaccinated over the next few weeks. The President announced Friday he will also be vaccinated. In the coming weeks and months, workers who are considered "first responders" to emergencies, including firefighters, medical personnel and police officers, will be offered the vaccine as well.

Will the vaccine be offered to other U.S. citizens as well?

Yes, eventually all Americans will be offered the vaccine. It will not be mandatory; each person or family will decide who will get the vaccine. It is important for everyone to weight the risks of the vaccine against the risk of a bioterror attack using smallpox.

How does the vaccine work?

Unlike many other vaccines, smallpox contains live virus. A doctor or nurse takes a pronged instrument, dips it into the virus and gives the patient several pricks, usually on the upper arm, with the contaminated prongs. The result is a circular sore, which initially becomes filled with pus and eventually drains and scabs over. Within two weeks, the sore is gone and only a small scar remains. During the time that the sore is infected, the patient is contagious to others and should keep the vaccination site covered. Some people will experience soreness, fever, head and body aches after the vaccination, but in most people those symptoms will go away fairly quickly.

What are the risks of the vaccine?

According to studies conducted in the 1960s, the vaccine will result in death for 1 or 2 people out of each million vaccinated. Between 15 and 52 of those million people will develop life-threatening reactions, including but not limited to high fever, rash and toxic reactions at the vaccination site. We are still using the vaccine developed in 1796; researchers are working on less risky ways to protect against smallpox, but for the time being this vaccination is the best line of defense we have.

Who should not receive the vaccination?

Because the vaccine is made up of the live smallpox virus, it can be extremely dangerous to people whose bodies are not capable of fighting off disease. As many as 60 million Americans with compromised immune systems will not receive the vaccine. People with AIDS, HIV, cancer, who have had organ transplants or a history of eczema could suffer extremely serious side effects from exposure to the virus, including death. Pregnant women and women who are breastfeeding should also not receive the vaccine.

What if I was vaccinated against smallpox when I was a kid? Am I still protected?

The vaccine is not believed to last more than 5 or 10 years, so if you were given a vaccination in 1965, you're no longer protected against the virus. There is good news for those who've previously been vaccinated: If you didn't experience an adverse reaction to the vaccine the first time, it's very unlikely you'll develop one this time around.