Medicine: Exit Smallpox

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The smallpox was always present, filling the churchyards with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.

In his History of England, Macaulay was writing about the late 17th century when, he said, smallpox was "the most terrible of all the ministers of death." But a mere 25 years ago, smallpox was still a scourge prevalent in 80 countries. A majority of the world's population lived in areas where the disease was endemic. Now the malady is so close to extinction that it is expected to become the first "natural" disease—as opposed to a man-made ailment, like radiation sickness—to be eradicated worldwide.

Smallpox is presently found in only seven nations: Sudan, Ethiopia, Afghanistan, Pakistan, India, Nepal and Indonesia. In 1967. the World Health Organization counted 131,160 smallpox cases; by 1970. despite better reporting methods, the number was down to 30,812.

The improvement results almost entirely from vaccination. In the U.S., where immunization of infants has long been routine, there has not been a recorded case of smallpox since 1949. In other countries, the disease has declined dramatically since WHO began a global inoculation campaign in 1967. Brazil, the Western Hemisphere's last reservoir of the disease, has not reported a case since last April. Once the remaining trouble spots in Asia and Africa have been cleansed, smallpox should be dead. No animal is known to harbor the virus (although monkeys can be infected with it), and every confirmed case in modern times has been traced to human contact.

Because the malady is waning, immunization now poses a greater risk than smallpox itself. Some people react badly to the vaccine, and in 1968, when more than 14 million people were immunized worldwide, at least nine are known to have died as a result. Therefore the U.S. Public Health Service no longer requires travelers entering the U.S. to produce proof of recent vaccination unless they are coming from one of the areas where the disease remains endemic.

In virtually all of the U.S., state or local regulations still demand that school-age children be vaccinated. However, at least 15 state legislatures are now considering bills to relax that requirement. The U.S. Center for Disease Control in Atlanta believes that by the end of this year most states will have given up mandatory vaccination.