What to do if smallpox gets loose

Vaccine reactions are almost inevitable, and even when rare, if you are vaccinating hundreds of thousands or millions or tens of millions, you get them. Some are worse than others, and generalized vaccinia from a smallpox vaccination is one of the worst. Vaccinia is cowpox, not smallpox, but since Jenner first discovered that milkmaids who had localized cowpox lesions then didn't get smallpox, infection with this live virus has been used to protect us against smallpox. Except we don't need to be protected anymore, because the last smallpox case died in 1978, ironically on September 11. The source was a research laboratory, although the victim was a medical photographer who worked on another floor. A real tragedy.

But since 2002 the Bush administration has been pushing a smallpox vaccination program on the premise that the few remaining stocks of the virus could fall into the hands of terrorists. The chances of this happening are unknown, but if it does, we are essentially defenseless. There would never be enough vaccine to immunize more than a tiny fraction of the globe, and since no one born after the early 1970s has any immunity, it would march around the globe faster than you can say, "neocon." Even if there were enough virus (which there isn't and won't be), tens of millions of people around the world are HIV positive and immunocompromised and this is a live virus vaccine. They would be in danger from the vaccine and from others who were vaccinated. In danger of what? Of the vaccinia virus becoming generally disseminated in their body to produce a life threatening infection. That used to happen occasionally when we routinely vaccinated people, and now it has happened to the mother and child of an active duty soldier given this vaccine, for no good reason.

In the first case of its kind in years, a 2-year-old boy is being treated in Chicago for a rare and life-threatening infection that he contracted from his father, a U.S. Army soldier recently vaccinated against smallpox.

The Indiana boy is in critical condition with eczema vaccinatum, an unusual side effect of the smallpox vaccine that can affect people who receive the shot or their close contacts.

Doctors also said the boy appears to have passed the infection to his mother, who has a much milder case of the virus in the smallpox vaccine, which is also called vaccinia.


There is no infection risk for the general population, government officials say, since the vaccine virus can spread only through close physical contact.

But the boy's diagnosis last week has prompted a frenzy of activity and daily conference calls involving the federal Centers for Disease Control and Prevention, the U.S. Department of Defense, and the state and city public health departments. The U.S. Food and Drug Administration gave emergency authorization for the hospital to treat the boy with ST-246, an experimental drug for smallpox that is untried as a therapy in humans. (Chicago Tribune, hat tip Max S.)

There are other risk factors for developing generalized vaccinia from the vaccination, and one is a history of eczema, which the toddler had. So allowing the soldier to have contact with his child was a major screw-up. But forcing him to have this vaccine, or the other mandatory vaccine military personnel for anthrax, is also a screw-up. No one we know is threatening anyone with weaponized anthrax, but if there were an attack an exposed population could be prophylaxed with cipro.

As for smallpox, if that got loose, the best policy would be to advise everyone to immediately sit down, put their head between their legs, and kiss their ass goodbye.


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Well hold on now for a minute. Its a well known fact that you can get smallpox from the bodies of the dead in proper condition (cold to cool environments). Graves in Alaska and Canada and other nice places have it. I wouldnt have everyone vaccinated for the reasons that Revere mentions but I would have the vaccine on hand. Another faux pas on the part of the Clinton Administration was to destroy all but a very small and very old supply of the virus and a equally as old supply of vaccine in a fridge in Pennsylvania. That virus now reconstituted has been moving around from lab to lab since 3 days after 9/11... Variola major Revere. Nice little refrigerators of it and via specially chartered airplanes with enough firepower on them to stop a herd of chargin rhino's. Dont ask... I wont say more than that.

Behind the scenes vaccine manufacture? I hope so. Smallpox in any form is bad and has all sorts of connotations. Sheeting smallpox where the pus lifts your skin from the connective tissues and you move and it falls away in a sheet and you die of shock within minutes. Black where I believe you hemmoragh underneath and bleed to death or have a combination of that and the sheeting kind. Lung type, internal types all of which will fuck you up like no tommorow.

Read this... its mandatory in the USAF biowarfare training guides. Little off in places but pretty damned close.


Punch up Black Smallpox pictures, small pox pictures into a search and decide whether one kid is worth a nation. Everyone is a soldier now as far as I am concerned. The kid took a hit, they are doing what they can for him/her but I dont think its an unnecessary vaccination. I actually tried to have my kids vaccinated after 9/11 and there was no vaccine available. There is now, and I did. One less thing as Gump used to say.

By M. Randolph Kruger (not verified) on 18 Mar 2007 #permalink

Randy: If smallpox gets loose, it's all over. I'll probably survive because I've been vaccinated, but will it be a worth surviving in? Even if there were some vaccine, there's not enough for everyone nor could everyone be vaccinated in time if there were enough. We'd have a worldwide depression as travel and trade evaporated. You seem to like Armageddon scenarios. This is one.

Revere, wasn't there a variant of the vaccinia virus in used in Europe which had a much more benign history of vaccination side effects than the one in use here, before Dryvax was pulled from general use? Tracing back to Ankara, if memory serves?

We really ought to seriously consider what an "acceptable" peacetime risk level ought to be. Much smaller than the one Dryvax affords, methinks.

And then we should work towards that end.

Of course, in order to even attempt that, we need a Federal government that isn't run by a gang of criminal incompetents whose only real skills are pillage and destruction.

Worse than Ghengis Khan. Most assuredly less competent. Really. He was quite capable of ordering the slaughter of every single last inhabitant of a city, right down to companion animals. But he drew a strict line at torture.

We don't. Khalid Sheikh Mohammed's "confession" means exactly as much as those made by the wretches being "prepped" for show trials in Moscow in 1937.

You can make somebody confess to anything if you torture them long enough.

By Charles Roten (not verified) on 18 Mar 2007 #permalink

Charles: Didn't know about another vaccinia variant. But I don't see the use of a smallpox vaccine at this juncture.

As for the rest, couldn't agree more, except for the smallpox part.

Q & A From the CDC site:
How long does a smallpox vaccination last?
Past experience indicates that the first dose of the vaccine offers protection from smallpox for 3 to 5 years, with decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts longer. (added Nov 13, 2002)

I know that when I traveled to Europe in 1969 we were required to get a smallpox vaccine shot. Perhaps even this boost will add something to the shots we got as babies. Of course now being in my 60's there's probably little left from EITHER shot! I'm not really counting on it.

Smallpox admits of one mitigation that nobody has mentioned yet. Besides depopulation, I mean. And it's a classic: SOP in the British Army at the time of the American Revolutionary War. Innoculation.

I'm sure Revere has heard of this one. It's pretty horrific: lethality at a nominal 1%, which makes Dryvax look attractive in comparison.

But it can be done with the Big Nasty Itself, variola major. The immunity, for those who survive the ordeal, isn't capped out at a nominal 10 years.

If we don't have an alternative in hand, and smallpox does get loose, how long do you think it will be before we resort to that? After the number of corpses runs up into enough tens of millions, you betcha it will be used.

I don't think it's wise to simply decide that if smallpox comes again, "its all over", and choose not to prepare.

And I do think it's wise, if we prepare, to use the time we have to get it right this time.

Not that I think we're going to, of course. It is my long and carefully considered opinion that species homo sapiens is too hardwired with maladaptive instinctual responses, and has far too poor a brain, to long manage a planetary technical civilization without an ultimate and permanent collapse.

By Charles Roten (not verified) on 18 Mar 2007 #permalink

EMA: This was discussed quite a bit a couple of years ago when they were trying to decide what to do about the Bush-Cheny smallpox debacle. It was decided we really didn't know. My recollection is that vaccinations were evry ten years, but I may be wrong.

Charles: I don't think there is a way to get it right. Yes, variolation was the method before vaccination. Cotton Mather tried it in the colonies and it was quite common in Britain, as you note. I wouldn't put much effort in a smallpox program. It would detract from other things we need more. And we are quite powerless against it, IMO. The globe is virgin population now, for the first time in known history. It would be horrific. We'd have a better chance of deflecting an asteroid.

Revere-I dont like Doomsday scenarios, far from it. I prepare for them and even if they included/exclude the efforts of this nation. Its kind of like Iraq. We all knew we would be going back there and probably not for WMD's. Its really for the worlds economies and S.pox would sorely fuck that up to the nth degree.

Should we be vaccinated again? I dont know, I am not a doctor. But I did get vaccinated again and got no rise on the shoulder at all. No scar, no nothing. I was vaccinated 4 times and the estimate that I saw on official letterhead from a govt. agency was that after three it might be redundant. USAF saw that we got them every 8 years regardless.

It took almost 20 years to stamp it out and all some yo-yo would need to do is exhume a body that had it and start his fizzy factory... simplification of course. Then there is the stuff that Vektor had in Russia. Super smallpox but Unkle Viktor said they couldnt get it to work... it just killed everything. People, dogs, cows, cats etc. He works for us now.

EMA as I understand it it may have to do with each persons physiology but it would be like starting all over and costly as Hell as Revere says. Historically you could stop it by quarantine as they did in the days of old but not before it whcaked one heck of a lot of people. Revere might think that is a debacle to start working on that. I for one dont. The true screwup isnt mitigation Revere, its sitting back and doing nothing. Could it break out again? Yup! So we spend money that IYO might be used somewhere else, or cutting out of Iraq and watch it decimate the economies of the world in under a year after a Iranian incursion into Pakistan and/or Iraq. One thing is sure these uncertain times mean that you take and make decisions on uncertain information. Anthrax was one of them. Taking the shot under orders is a lawful and direct order. If you got sick you were put out and given your 100% disability. Some did, most didnt. We wont have that program for the citizens of the planet much less the US and Charles is 100% correct that they would try anything and everything to stop it. Not much good as Revere said, but eventually the asteroid would turn and we would start population growth again. It would cost us a lot but not everything which is extinction level event or catastrophe.

By M. Randolph Kruger (not verified) on 18 Mar 2007 #permalink

Can you say a little more about why a smallpox outbreak seems so uncontrollable to you? To me it seems like it would be easier [relatively speaking, of course] to deal with a smallpox outbreak than a severe influenza pandemic with a high case-fatality rate.

There would probably be fewer people spreading smallpox asymptomatically compared to influenza. Unlike influenza, smallpox patients are unlikely to be spreading virus before they become symptomatic (with prodromal symptoms). With a longer incubation period, you can do ring vaccination around smallpox cases to prevent spread from identified cases (or maybe ring "variolation" in parts of the world without vaccine). This approach takes only a small fraction of the vaccine doses needed compared to trying to vaccinate everyone. Vaccination within a couple days of smallpox exposure can prevent or attenuate symptoms. Combined with isolation of patients and quarantine of contacts to the extent possible, it seems like you'd stand a much better chance on controlling smallpox than a "category 50 " flu pandemic, which hardly anyone believes would be controlled through a "ring vaccination/Tamiflu administration" approach. There's also probably some protection that still remains for many of those who received smallpox vaccinations a long time ago.

I just wondered, because I've had to do planning for both, and I find community pandemic flu planning more overwhelming (and more likely to happen) than smallpox planning. (Especially if you try to plan for a pandemic strain has the kind of mortality rate we're seeing in current human cases of H5N1 infection.)

If I had to pick my disaster outbreak, I'd pick smallpox over a very severe pandemic flu because I feel like we could do more. Fortunately, many of the things we're doing to prepare for pandemic flu will be helpful in the unlikely event that smallpox should be re-introduced.

BC-For the better part Smallpox is a contact sport. Large droplet transmission is possible but more likely coming into contact with pustules or contaminated clothing, blankets. The British gave it to the Indians on blankets to suppress their ability to fight.

Problem is that since its invisible and a contact sport as I said, walk thru the house and say to yourself that I am infected. Then put some of that black light powder on your hands and do your normal routine. Then get the black light out and see how many surfaces you just came into contact with. Incubation periods are long and short depending on the person. Now infect one schmo in an airport and put him/her onto a plane. How many people did they contact? How many did they breathe on? Then how many did they go on to infect. Problem is that once its out, it goes like the wind and I believe that the Joint Services Biowarfare manual states that one person would infect five and by like the 5th-6th iteration they would have 3200 and change, then they would go on to infect 3200 to the 5th power. Thats textbook I believe if memory serves me. But they surely would go on to infect more and more. It also takes you like 2 weeks to become shitty symptomatic and two or three days after you contract it you are shedding virus...if memory serves me again. So how many people could you infect in a day, a week and two weeks before you showed up at the ER and scared the living shit out of everyone? A bunch and those others would be all across a country in todays transportation scenario. Every state though I understand now has at least enough to vaccinate about 600 people in the event of an outbreak. They would be hunting people down like dogs too that were on this flight and that bus, and on this subway and etc. They would be asked to identify themselves over a phone and then isolated in their own homes. Again, you dont want this shit in a hospital. I dont know whether you can give vaccinations to people who are already sick, but many, many people recover and many, many people die. Its painful and think of having painful zits all over your body. You get secondary infections thru them and it kills you from that too. Lungs, organs, eyes, ears, everything becomes a place for the pustules to form. And everywhere the pustules touch, its a vector and invisible to boot.

That cover it? Do I think we have to prepare for it? Well has anything else gone our way in the last 10 years?

By M. Randolph Kruger (not verified) on 18 Mar 2007 #permalink

"but will it be a" (world?) "worth surviving in? "

This is not the first public health -or other official, for that matter -I've heard say this as an excuse not to warn or prepare the populace at large.
Why do they get to choose for everyone that they'd be better off dead?

"Even if there were some vaccine, there's not enough for everyone nor could everyone be vaccinated in time if there were enough. We'd have a worldwide depression as travel and trade evaporated"...

This is exactly what is going on with not acting on pandemic influenza preparedness.
If our officials and leaders plan to sit down and "check out" if they can't keep their status quo lifestyle, wouldn't it be more ethical to warn the public and let them decide if they want to give up or try and get ready?
Some people will want to continue and try and make the future better for future generations. Shouldn't they be warned their leaders have hit personal overload and hope not to be around for the aftermath - and consequences?

By crfullmoon (not verified) on 19 Mar 2007 #permalink

crfullmoon: You wish to choose, too. You wish to choose putting everything into pandemic preparations, in the process making less resources for malaria, AIDS, substance abuse, etc. Who gave you the right to choose? No one. You just advocate what you think is the best course of action, which is what we are doing. Please cite one example of someone who uses this as an excuse not to prepare for flu, as you claim is common.

Now let's take smallpox. Do you want the world to go into high gear to make enough smallpox vaccine for the globe? If so, then say it. Then consider the consequences for pandemic flu preparations. It's easy sitting at your keyboard and rant, crfullmoon. I know. I do it every day. So we all need to be a bit reflective and disciplined and think through our positions instead of having a knee jerk reaction to everything, In your case, it's "our leaders aren't listening to us, we who know better."

You don't agree with my position on smallpox. I don't mind. I do mind when you are internally inconsistent. Do you want them to go full steam ahead and make smallpox vaccine for everyone on earth? Do you? If not, who do you want to leave out? and how many? I'd like to know.

rats- I just lost a long post - I will try later.
I think you and I have different definitions of preparedness; no one has to steal your part of the project money pie. The public can be told by the right people opening their mouths.

The health official who "owns" panflu preparedness in my town thinks "there is nothing the public can do"; because we won't have a vaccine- that's part of his excuse for not telling the public, and, he's been misleading the Selectmen. They think "it is a health dept problem not a town problem; Selectmen will do nothing and aren't concerned - he has a plan he's been working on for over a year." Panic or despair by honchos, or, considering the public too stupid to tell, or, since not everyone can afford the same level of preparedness, tell no one anything but two weeks,
is not ethical, and it is not going to get us to a Recovery period.

Neither are "leaders" who say things like, "Who would want to be alive anyway, if it's that bad?" Sounds like they plan to "check out" -without giving anyone else a chance now to prepare.

By crfullmoon (not verified) on 19 Mar 2007 #permalink

Revere, how do they grow smallpox vaccine? Is it an egg based operation or do they infect monkeys or what? What IS the cost of making the vaccine? The shit in the fridge at CERN and Pennsylvania were whisked away and not heard from again so that source of info has dried up.

That would only leave the Ruskies. My question is whether it WOULD be more cost effective to expend funds to revaccinate the population or to let them get sick? Its a 30-50% killer as I understand it in Variola Major, but its fairly easily contained. Isolation/quarantines worked pretty good in the past. But could we afford to have that many that got it going down? Since the country is virgin territory except for guys like me I wonder. If BF is any indication of the costs then man we cant afford it. BF is far more dangerous at least for now but I wonder. So whats your read on the cost against loss, and what it costs to vaccinate?

Vaccine is out there and available now as I understand it. So why not get yourselves (readers) vaccinated. Costly for sure but not prohibitively so. It was 250 for me and family to get done. Here is another look at it. Post of every pandemic or major epidemic in countries there have been secondary causal death resulting from all sorts of other infections. Malaria, dengue, typhoid, typhus, STD's (yep, but they were generally non fatal), polio. So I personally have scheduled the family for boosters and primary shots for most of this stuff. I get a lot of weird looks at the Health Dept when I wheel the kids and wife in about once a month. My yellow book vaccination record is full and I am on number two. They are just starting. Prepared is just that. Then all I have to worry about is food and water... and ammo.

By M. Randolph Kruger (not verified) on 19 Mar 2007 #permalink

Randy, I infer from your comments that you were able to source smallpox vaccine through ordinary non-military channels.

What might those have been? I am aware of current offerings via our local public health authorities, and travel medicine clinics, which between them offer a very large array of vaccines, and none of those places have made any indication that SP immunization is available to the general public, at any price.


I don't know of any public health department anywhere in the U.S. who would provide a smallpox vaccination to a member of the general public, unless there was a compelling reason, such as the person was doing research on poxviruses.

Marquer-Remember boys and girls, NGO status and they specifically said it would be provided to responders, doctors and emergency personnel, cops etc and their families. The idea was that they would do it if it became a problem. Until then you have to pay for it and it does take a LOT of red tape. Its government funded stuff and generally a call to your Senators office and showing up with some letterhead as a request gets the job done. There was a lot of reluctance on their part to do it.

Some of it was the reasons that Revere mentioned. They were advising against it, the were saying it could cause an illness and that it could infect people who had never had it and on and on. So I said, how long before I can go out into the world and ensure that I wouldnt make someone sick? 5-10 days and keep that damned vaccination site covered. So we did it last year before school started. Yes, the kids and mommy both felt a little crappy but an X-box game or two and a new book for mom settled that out. Mostly over a weekend kind of thing. I didnt feel bad at all. You might be able to get it if you live in the US and they have a supply in your state. I dont know about any other countries. Its only coming available very, very slowly. Must have a hell of a growth period to make it. They did discuss all of the possibilities about being around HIV/AIDs patients, immunocompromised types, Hear patients? (Didnt get that one). I just did what they said. Amazing since they just lined us up in the military like cows in the abbatoir and started poking. One arm got this and the other arm got that. Three days later we were back, one arm this and one arm that.

Melanie is right as well. Its based on each states availability. I called for almost two years and the best they had in their little hollow tube supply was enough to vaccinate maybe a handful and I mean a handful of people. So dont expect to find it in small town USA. You might have to go to your state level or to the biggest town in it.

Canada as I understand it is now making it available to its citzenry for a fee. Dont know how much but thats the rumor. If you have the bucks, go pay for it and get it if you can. If not well lets hope it doesnt get loose. Nothing would make Greg more unhappy to find out that people like me were in charge post of the fact. I was told there was a lot in the VA, DC, MD area. Obvious reason in the region.

By M. Randolph Kruger (not verified) on 19 Mar 2007 #permalink

Mr. Krueger, Having worked with a state smallpox vaccination program, I find it extremely hard to believe that any public health agency would vaccinate a child. If your children did receive smallpox vaccine, I would like to know where you received it.

My local county Public Health Dept. was kind enough to respond last year when I inquired about Pneumovax availability. I said I thought it was a good idea in case of Bird Flu Pandemic. The correspondent agreed, but said it was not being recommended by the PHD at this point. She suggested I try with my own MD.

I did end up requesting it for my 18 yr old daughter. She was getting boosters and such for college, so I asked for Pneumovax as well. There was some waffling, and why did I want this, anyway? I mentioned H5N1, and the NP said this wouldn't prevent it. Sure, but it would be good for secondary illnesses. Anyway, I pointed out that my daughter tends to get really sick with upper-respiratory stuff, and I would feel better if she had a little more protection.

So I had success, but I'm doubtful that I could get smallpox vax for any of us now. Even contacting the travel vax clinics looked like it required a note from my doctor, and would route me through the hospital where he teaches. If he isn't willing up front (I haven't asked,) how could I expect him to sign off on some other entity giving me the vax?

By wenchacha (not verified) on 20 Mar 2007 #permalink

Smokers, people who have respirator problems, people who live with or work with populations at risk, have better luck getting pneumovax.

If I had not given up smoking several years ago, I could get it for free, because of where I work. My doctor said she prefer I pay than take up smoking again, so I paid for the serum and she neglected to charge for the injection.

No, Kruger, if we have a pandemic, influenza or smallpox, every cluster of humans that survives is a chance.. God-given, if you wish to say it that way. However, your kind will dominate at most one generation. If your grandchildren inherit your fear, they won't survive.

Last year, the sibling of one of the people I work with, who works in a lab in an Arab country, typed small pox from a human sample. I do not know the details around the infection, just that everyone was rocked to the core to see it.

Depends on how hard you want to look, and where, as to what you find.

Don't discount anything. I can't reveal where, because obviously I could get people into very deep trouble.

By Anonymous for … (not verified) on 24 Mar 2007 #permalink