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(3rd Century BCE) - Introduction of Small Pox 

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(3rd Century BCE) - Introduction of Small Pox 

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Smallpox is thought to have been introduced back to the Egyptian Empire around the 3rd century BCE (Before Common Era)!  This is due to smallpox-like rashes found on three mummies during that era!

Done by Madeleine Olson

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Origin of Smallpox

The origin of smallpox is unknown. The finding of smallpox-like rashes on Egyptian mummies suggests that smallpox has existed for at least 3,000 years. The earliest written description of a disease like smallpox appeared in China in the 4 th century CE (Common Era). Early written descriptions also appeared in India in the 7 th century and in Asia Minor in the 10 th century.

Spread of Smallpox

Historians trace the global spread of smallpox to the growth of civilizations and exploration. Expanding trade routes over the centuries also led to the spread of the disease.

Highlights from History:

6th Century-Increased trade with China and Korea brings smallpox to Japan.

7th Century-Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.

11th Century-Crusades further spread smallpox in Europe.

15th Century-Portugal occupies part of western Africa, bringing smallpox.

16th Century-European settlers and the African slave trade import smallpox into:

The Caribbean

Central and South America

17th Century-European settlers bring smallpox to North America.

18th Century-Explorers from Great Britain bring smallpox to Australia.

Early Control Efforts

Smallpox was a terrible disease. On average, 3 out of every 10 people who got it died. People who survived usually had scars, which were sometimes severe.

One of the first methods for controlling smallpox was variolation, a process named after the virus that causes smallpox (variola virus). During variolation, people who had never had smallpox were exposed to material from smallpox sores (pustules) by scratching the material into their arm or inhaling it through the nose. After variolation, people usually developed the symptoms associated with smallpox, such as fever and a rash. However, fewer people died from variolation than if they had acquired smallpox naturally.

The basis for vaccination began in 1796 when the English doctor Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. Jenner also knew about variolation and guessed that exposure to cowpox could be used to protect against smallpox. To test his theory, Dr. Jenner took material from a cowpox sore on milkmaid Sarah Nelmes' hand and inoculated it into the arm of James Phipps, the 9-year-old son of Jenner's gardener. Months later, Jenner exposed Phipps several times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise "On the Origin of the Vaccine Inoculation." In this work, he summarized his discoveries and expressed hope that "the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice."

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

Global Smallpox Eradication Program

In 1959, the World Health Organization (WHO) started a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from a lack of funds, personnel, and commitment from countries, and a shortage of vaccine donations. Despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks across South America, Africa, and Asia.

The Intensified Eradication Program began in 1967 with a promise of renewed efforts. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Other factors that played an important role in the success of the intensified efforts included the development of the bifurcated needle, the establishment of a case surveillance system, and mass vaccination campaigns.

By the time the Intensified Eradication Program began in 1967, smallpox was already eliminated in North America (1952) and Europe (1953). Cases were still occurring in South America, Asia, and Africa (smallpox was never widespread in Australia). The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977).

Last Cases of Smallpox

In late 1975, three-year-old Rahima Banu from Bangladesh was the last person in the world to have naturally acquired variola major. She was also the last person in Asia to have active smallpox. She was isolated at home with house guards posted 24 hours a day until she was no longer infectious. A house-to-house vaccination campaign within a 1.5-mile radius of her home began immediately. A member of the Smallpox Eradication Program team visited every house, public meeting area, school, and healer within 5 miles to ensure the illness did not spread. They also offered a reward to anyone who reported a smallpox case.

Ali Maow Maalin was the last person to have naturally acquired smallpox caused by variola minor. Maalin was a hospital cook in Merca, Somalia. On October 12, 1977, he rode with two smallpox patients in a vehicle from the hospital to the local smallpox office. On October 22, he developed a fever. At first healthcare workers diagnosed him with malaria, and then chickenpox. The smallpox eradication staff then correctly diagnosed him with smallpox on October 30. Maalin was isolated and made a full recovery. Maalin died of malaria on July 22, 2013, while working in the polio eradication campaign.

Janet Parker was the last person to die of smallpox. In 1978, Parker was a medical photographer at England's Birmingham University Medical School. She worked one floor above the Medical Microbiology Department where staff and students conducted smallpox research. She became ill on August 11 and developed a rash on August 15 but was not diagnosed with smallpox until 9 days later. She died on September 11, 1978. Her mother, who was providing care for her, developed smallpox on September 7, despite having been vaccinated two weeks earlier. An investigation suggested that Janet Parker had been infected either via an airborne route through the medical school building's duct system or by direct contact while visiting the microbiology corridor.

World Free of Smallpox

Almost two centuries after Jenner hoped that vaccination could annihilate smallpox, the 33 rd World Health Assembly declared the world free of this disease on May 8, 1980. Many people consider smallpox eradication to be the biggest achievement in international public health.

Stocks of Variola Virus

Following the eradication of smallpox, scientists and public health officials determined there was still a need to perform research using the variola virus. They agreed to reduce the number of laboratories holding stocks of variola virus to only four locations. In 1981, the four countries that either served as a WHO collaborating center or were actively working with variola virus were the United States, England, Russia, and South Africa. By 1984, England and South Africa had either destroyed their stocks or transferred them to other approved labs. There are now only two locations that officially store and handle variola virus under WHO supervision: the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia.

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smallpox (variola major and variola minor)

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(7th century) Small Pox eventually reaches Europe and begins to spread! 

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(7th century) Small Pox eventually reaches Europe and begins to spread! 

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Smallpox was introduced to Europe sometime between the fifth and seventh centuries!  Then became an epidemic during the Middle Ages.

Done by Madeleine Olson

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In science credit goes to the man who convinces the world, not the man to whom the idea first occurs.

-Francis Galton

For many centuries, smallpox devastated mankind. In modern times we do not have to worry about it thanks to the remarkable work of Edward Jenner and later developments from his endeavors. With the rapid pace of vaccine development in recent decades, the historic origins of immunization are often forgotten. Unfortunately, since the attack on the World Trade Center on September 11, 2001, the threat of biological warfare and bioterrorism has reemerged. Smallpox has been identified as a possible agent of bioterrorism ( 1). It seems prudent to review the history of a disease known to few people in the 21st century.

SMALLPOX: THE ORIGIN OF A DISEASE

The origin of smallpox as a natural disease is lost in prehistory. It is believed to have appeared around 10,000 BC, at the time of the first agricultural settlements in northeastern Africa ( 3, 4). It seems plausible that it spread from there to India by means of ancient Egyptian merchants. The earliest evidence of skin lesions resembling those of smallpox is found on faces of mummies from the time of the 18th and 20th Egyptian Dynasties (1570-1085 BC). The mummified head of the Egyptian pharaoh Ramses V (died 1156 BC) bears evidence of the disease ( 5). At the same time, smallpox has been reported in ancient Asian cultures: smallpox was described as early as 1122 BC in China and is mentioned in ancient Sanskrit texts of India.

Smallpox was introduced to Europe sometime between the fifth and seventh centuries and was frequently epidemic during the Middle Ages. The disease greatly affected the development of Western civilization. The first stages of the decline of the Roman Empire (AD 108) coincided with a large-scale epidemic: the plague of Antonine, which accounted for the deaths of almost 7 million people ( 6). The Arab expansion, the Crusades, and the discovery of the West Indies all contributed to the spread of the disease.

Unknown in the New World, smallpox was introduced by the Spanish and Portuguese conquistadors. The disease decimated the local population and was instrumental in the fall of the empires of the Aztecs and the Incas. Similarly, on the eastern coast of North America, the disease was introduced by the early settlers and led to a decline in the native population. The devastating effects of smallpox also gave rise to one of the first examples of biological warfare ( 1, 7). During the French-Indian War (1754-1767), Sir Jeffrey Amherst, the commander of the British forces in North America, suggested the deliberate use of smallpox to diminish the American Indian population hostile to the British. Another factor contributing to smallpox in the Americas was the slave trade because many slaves came from regions in Africa where smallpox was endemic.

Smallpox affected all levels of society. In the 18th century in Europe, 400,000 people died annually of smallpox, and one third of the survivors went blind ( 4). The symptoms of smallpox, or the "speckled monster" as it was known in 18th-century England, appeared suddenly and the sequelae were devastating. The case-fatality rate varied from 20% to 60% and left most survivors with disfiguring scars. The case-fatality rate in infants was even higher, approaching 80% in London and 98% in Berlin during the late 1800s.

The word variola was commonly used for smallpox and had been introduced by Bishop Marius of Avenches (near Lausanne, Switzerland) in AD 570. It is derived from the Latin word varius, meaning "stained," or from varus, meaning "mark on the skin." The term small pockes ( pocke meaning sac) was first used in England at the end of the 15th century to distinguish the disease from syphilis, which was then known as the great pockes ( 8).

VARIOLATION AND EARLY ATTEMPTS OF TREATMENT

It was common knowledge that survivors of smallpox became immune to the disease. As early as 430 BC, survivors of smallpox were called upon to nurse the afflicted ( 9). Man had long been trying to find a cure for the "speckled monster." During medieval times, many herbal remedies, as well as cold treatment and special cloths, were used to either prevent or treat smallpox. Dr. Sydenham (1624-1689) treated his patients by allowing no fire in the room, leaving the windows permanently open, drawing the bedclothes no higher than the patient's waist, and administering "twelve bottles of small beer every twenty-four hours" ( 10).

However, the most successful way of combating smallpox before the discovery of vaccination was inoculation. The word is derived from the Latin inoculare, meaning "to graft." Inoculation referred to the subcutaneous instillation of smallpox virus into nonimmune individuals. The inoculator usually used a lancet wet with fresh matter taken from a ripe pustule of some person who suffered from smallpox. The material was then subcutaneously introduced on the arms or legs of the nonimmune person. The terms inoculation and variolation were often used interchangeably. The practice of inoculation seems to have arisen independently when people in several countries were faced with the threat of an epidemic. However, inoculation was not without its attendant risks. There were concerns that recipients might develop disseminated smallpox and spread it to others. Transmission of other diseases, such as syphilis, via the bloodborne route was also of concern.

Inoculation, hereafter referred to as variolation, was likely practiced in Africa, India, and China long before the 18th century, when it was introduced to Europe ( 9). In 1670, Circassian traders introduced variolation to the Turkish "Ottoman" Empire. Women from the Caucasus, who were in great demand in the Turkish sultan's harem in Istanbul because of their legendary beauty, were inoculated as children in parts of their bodies where scars would not be seen. These women must also have brought the practice of variolation to the court of the Sublime Porte ( 4, 10).

Variolation came to Europe at the beginning of the 18th century with the arrival of travelers from Istanbul. In 1714, the Royal Society of London received a letter from Emanuel Timoni describing the technique of variolation, which he had witnessed in Istanbul. A similar letter was sent by Giacomo Pilarino in 1716. These reports described the practice of subcutaneous inoculation; however, they did not change the ways of the conservative English physicians.

After these first professional variolation procedures, word of the practice spread to several members of the royal family ( 11). Charles Maitland was then granted the royal license to perform a trial of variolation on six prisoners in Newgate on August 9, 1721. The prisoners were granted the king's favor if they submitted to this experiment. Several court physicians, members of the Royal Society, and members of the College of Physicians observed the trial. All prisoners survived the experiment, and those exposed to smallpox later proved to be immune. In the months following this very first trial, Maitland repeated the experiment on orphaned children, again with success. Finally, on April 17, 1722, Maitland successfully treated the two daughters of the Princess of Wales. Not surprisingly, the procedure gained general acceptance after this last success.

THE SPREAD OF VARIOLATION

In Europe, where the medical profession was relatively organized, the new methods of variolation became known quickly among physicians. Since there was also a demand for protection against smallpox, physicians soon began the variolation procedure on a massive scale. Although 2% to 3% of variolated persons died from the disease, became the source of another epidemic, or suffered from diseases (e.g., tuberculosis and syphilis) transmitted by the procedure itself, variolation rapidly gained popularity among both aristocratic and common people in Europe. The case-fatality rate associated with variolation was 10 times lower than that associated with naturally occurring smallpox. In the 1750s more European princes died of smallpox, giving further impetus for the use of variolation ( 3). Among those variolated were Empress Marie-Therese of Austria and her children and grandchildren, Frederick II of Prussia, King Louis XVI of France and his children, and Catherine II of Russia and her son. King Frederick II of Prussia also inoculated all his soldiers. In fact, variolation was widely practiced in Europe until Jenner's discovery.

The regular practice of variolation reached the New World in 1721 ( 9). Under the guidance of the Rev. Cotton Mather (1663-1728) and Dr. Zabdiel Boylston (1679-1766), variolation became quite popular in the colonies. Mather, a graduate of Harvard College, was always very interested in science and medicine. When a ship from the West Indies carried persons sick with smallpox into Boston in 1721, an epidemic broke out in Boston and other parts of Massachusetts. Mather wrote a cautious letter recommending immediate variolation. However, he persuaded only Dr. Boylston. With Mather's support, Boylston immediately started a variolation program and continued to inoculate many volunteers, despite many adversaries in both the public and the medical community in Boston. As the disease spread, so did the controversy around Mather and Boylston ( 12). At the height of the epidemic, a bomb was thrown into Mather's house.

To make their point, Mather and Boylston used a statistical approach to compare the mortality rate of natural smallpox infection with that contracted by variolation. During the great epidemic of 1721, approximately half of Boston's 12,000 citizens contracted smallpox. The fatality rate for the naturally contracted disease was 14%, whereas Boylston and Mather reported a mortality rate of only 2% among variolated individuals ( 12). This may have been the first time that comparative analysis was used to evaluate a medical procedure.

During the decades following the 1721 epidemic in Boston, variolation became more widespread in the colonies of New England. In 1766, American soldiers under George Washington were unable to take Quebec from the British troops, apparently because of a smallpox epidemic that significantly reduced the number of healthy troops ( 13). The British soldiers were all variolated. By 1777, Washington had learned his lesson: all his soldiers were variolated before beginning new military operations ( 14, 15). The success of variolation in the New World was not without effect on Europe. In fact, the rapid adoption of variolation in Europe can be directly traced to the efforts of Cotton Mather during the Boston smallpox epidemic in 1721. Although many British physicians remained skeptical even after Mather's success, the data he had published were eventually influential. Variolation was subsequently adopted in England and spread from there throughout Western Europe.

In 1757, an 8-year-old boy was inoculated with smallpox in Gloucester ( 4); he was one of thousands of children inoculated that year in England. The procedure was effective, as the boy developed a mild case of smallpox and was subsequently immune to the disease. His name was Edward Jenner.

EDWARD JENNER

Edward Jenner was born on May 17, 1749, in Berkeley, Gloucestershire, the son of the Rev. Stephen Jenner, vicar of Berkeley. Edward was orphaned at age 5 and went to live with his older brother. During his early school years, Edward developed a strong interest in science and nature that continued throughout his life. At age 13 he was apprenticed to a country surgeon and apothecary in Sodbury, near Bristol ( 16). The record shows that it was there that Jenner heard a dairymaid say, "I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face." It fact, it was a common belief that dairymaids were in some way protected from smallpox.

In 1764, Jenner began his apprenticeship with George Harwicke. During these years, he acquired a sound knowledge of surgical and medical practice ( 10). Upon completion of this apprenticeship at the age of 21, Jenner went to London and became a student of John Hunter, who was on the staff of St. George's Hospital in London. Hunter was not only one of the most famous surgeons in England, but he was also a well-respected biologist, anatomist, and experimental scientist. The firm friendship that grew between Hunter and Jenner lasted until Hunter's death in 1793. Although Jenner already had a great interest in natural science, the experience during the 2 years with Hunter only increased his activities and curiosity. Jenner was so interested in natural science that he helped classify many species that Captain Cook brought back from his first voyage. In 1772, however, Jenner declined Cook's invitation to take part in the second voyage ( 4).

Jenner occupied himself with many matters. He studied geology and carried out experiments on human blood ( 17). In 1784, after public demonstrations of hot air and hydrogen balloons by Joseph M. Montgolfier in France during the preceding year, Jenner built and twice launched his own hydrogen balloon. It flew 12 miles. Following Hunter's suggestions, Jenner conducted a particular study of the cuckoo. The final version of Jenner's paper was published in 1788 and included the original observation that it is the cuckoo hatchling that evicts the eggs and chicks of the foster parents from the nest ( 17, 18). For this remarkable work, Jenner was elected a fellow of the Royal Society. However, many naturalists in England dismissed his work as pure nonsense. For more than a century, antivaccinationists used the supposed defects of the cuckoo study to cast doubt on Jenner's other work. Jenner was finally vindicated in 1921 when photography confirmed his observation ( 19). At any rate, it is apparent that Jenner had a lifelong interest in natural sciences. His last work, published posthumously, was on the migration of birds.

In addition to his training and experience in biology, Jenner made great progress in clinical surgery while studying with John Hunter in London. Jenner devised an improved method for preparing a medicine known as tartar emetic (potassium antimony tartrate). In 1773, at the end of 2 years with John Hunter, Jenner returned to Berkeley to practice medicine. There he enjoyed substantial success, for he was capable, skillful, and popular. In addition to the practice of medicine, he joined two local medical groups for the promotion of medical knowledge and continued to write occasional medical papers ( 4, 18). He also played the violin in a musical club and wrote light verse and poetry. As a natural scientist, he continued to make many observations on birds and the hibernation of hedgehogs and collected many specimens for John Hunter in London.

In 1797, Jenner sent a short communication to the Royal Society describing his experiment and observations. However, the paper was rejected. Then in 1798, having added a few more cases to his initial experiment, Jenner privately published a small booklet entitled An Inquiry into the Causes and Effects of the Variolae Vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire and Known by the Name of Cow Pox ( 18, 10). The Latin word for cow is vacca, and cowpox is vaccinia; Jenner decided to call this new procedure vaccination. The 1798 publication had three parts. In the first part Jenner presented his view regarding the origin of cowpox as a disease of horses transmitted to cows. The theory was discredited during Jenner's lifetime. He then presented the hypothesis that infection with cowpox protects against subsequent infection with smallpox. The second part contained the critical observations relevant to testing the hypothesis. The third part was a lengthy discussion, in part polemical, of the findings and a variety of issues related to smallpox. The publication of the Inquiry was met with a mixed reaction in the medical community.

Jenner went to London in search of volunteers for vaccination. However, after 3 months he had found none. In London, vaccination became popular through the activities of others, particularly the surgeon Henry Cline, to whom Jenner had given some of the inoculant ( 4). Later in 1799, Drs. George Pearson and William Woodville began to support vaccination among their patients. Jenner conducted a nationwide survey in search of proof of resistance to smallpox or to variolation among persons who had cowpox. The results of this survey confirmed his theory. Despite errors, many controversies, and chicanery, the use of vaccination spread rapidly in England, and by the year 1800, it had also reached most European countries ( 10).

Although sometimes embarrassed by a lack of supply, Jenner sent vaccine to his medical acquaintances and to anyone else who requested it. After introducing cowpox inoculation in their own districts, many recipients passed the vaccine on to others. Dr. John Haygarth (of Bath, Somerset) received the vaccine from Edward Jenner in 1800 and sent some of the material to Benjamin Waterhouse, professor of physics at Harvard University. Waterhouse introduced vaccination in New England and then persuaded Thomas Jefferson to try it in Virginia. Waterhouse received great support from Jefferson, who appointed him vaccine agent in the National Vaccine Institute, an organization set up to implement a national vaccination program in the United States ( 20).

Although he received worldwide recognition and many honors, Jenner made no attempt to enrich himself through his discovery. He actually devoted so much time to the cause of vaccination that his private practice and his personal affairs suffered severely. The extraordinary value of vaccination was publicly acknowledged in England, when in 1802 the British Parliament granted Edward Jenner the sum of £10,000. Five years later the Parliament awarded him £20,000 more. However, he not only received honors but also found himself subjected to attacks and ridicule. Despite all this, he continued his activities on behalf of the vaccination program. Gradually, vaccination replaced variolation, which became prohibited in England in 1840.

Jenner married in 1788 and fathered four children. The family lived in the Chantry House, which became the Jenner Museum in 1985. Jenner built a one-room hut in the garden, which he called the "Temple of Vaccinia" (Figure ​(Figure4 4 ), where he vaccinated the poor for free ( 10, 17). After a decade of being honored and reviled in more or less equal measure, he gradually withdrew from public life and returned to the practice of country medicine in Berkeley. In 1810, his oldest son, Edward, died of tuberculosis. His sister Mary died the same year and his sister Anne 2 years later. In 1815, his wife, Catherine, died of tuberculosis ( 17). Sorrows crowded in on him, and he withdrew even further from public life. In 1820, Jenner had a stroke from which he recovered. On January 23, 1823, he visited his last patient, a dying friend. The next morning Jenner failed to appear for breakfast; later that day he was found in his study. He had had a massive stroke. Edward Jenner died during the early morning hours of Sunday, January 26, 1823. He was laid to rest with his parents, his wife, and his son near the altar of the Berkeley church.

CONCLUSION

Jenner's work represented the first scientific attempt to control an infectious disease by the deliberate use of vaccination. Strictly speaking, he did not discover vaccination but was the first person to confer scientific status on the procedure and to pursue its scientific investigation. During the past years, there has been a growing recognition of Benjamin Jesty (1737-1816) as the first to vaccinate against smallpox ( 21). When smallpox was present in Jesty's locality in 1774, he was determined to protect the life of his family. Jesty used material from udders of cattle that he knew had cowpox and transferred the material with a small lancet to the arms of his wife and two boys. The trio of vaccinees remained free of smallpox, although they were exposed on numerous occasions in later life. Benjamin Jesty was neither the first nor the last to experiment with vaccination. In fact, the use of smallpox and cowpox was widely known among the country physicians in the dairy counties of 18th-century England. However, the recognition of these facts should not diminish our view of Jenner's accomplishments. It was his relentless promotion and devoted research of vaccination that changed the way medicine was practiced.

Scientific advances during the two centuries since Edward Jenner performed his first vaccination on James Phipps have proved him to be more right than wrong. The germ theory of disease, the discovery and study of viruses, and the understanding of modern immunology tended to support his main conclusions. The discovery and promotion of vaccination enabled the eradication of smallpox: this is Edward Jenner's ultimate vindication and memorial.

References

3. Hopkins DR. Chicago: University of Chicago Press; 1983. Princes and Peasants: Smallpox in History. [ Google Scholar]

5. Lyons AS, Petrucelli RJ., II . New York: Abradale Press, Harry N Abrams Inc; 1987. Medicine-An Illustrated History. [ Google Scholar]

8. Moore JC. The History of the Smallpox. London: Longman; 1815. [ Google Scholar]

12. Beall OT, Shryock RH. Cotton Mather: First Significant Figure in American Medicine. Baltimore: Johns Hopkins University Press; 1954. [ Google Scholar]

13. Bardell D. Smallpox during the American war of independence. ASM News. 1976;42:526-530. [ Google Scholar]

16. Parish HJ. Victory with Vaccines: The Story of Immunization. Edinburgh: E & S Livingstone; 1968. [ Google Scholar]

19. Scott EL. Edward Jenner FRS and the cuckoo. Notes and Records of the Royal Society. 1974;28(2):235-240. [ Google Scholar]

20. Underwood EA. Edward Jenner, Benjamin Waterhouse and the introduction of vaccination into the United States. Nature. 1949;163:823-828. [ Google Scholar]

22. World Health Organization. The Global Eradication of Smallpox: Final Report of the Global Commission for the Certification of Smallpox Eradication. Geneva: World Health Organization; 1980. Global Commission for Certification of Smallpox Eradication. [ Google Scholar]

Articles from Proceedings (Baylor University. Medical Center) are provided here courtesy of Baylor University Medical Center

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Edward Jenner and the history of smallpox and vaccination

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In science credit goes to the man who convinces the world, not the man to whom the idea first occurs. -Francis Galton For many centuries, smallpox devastated mankind. In modern times we do not have to worry about it thanks to the remarkable work of Edward Jenner and later developments from his endeavors.

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(18th Century) Small Pox affects societies greatly! 

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(18th Century) Small Pox affects societies greatly! 

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Smallpox has affected all levels of society. 400,000 people have died annually of smallpox, and one third of the survivors have gone blind!

Done by Madeleine Olson

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In Asia, practitioners had developed an idea called variolation! This is the practice of dried smallpox scabs being blown into the nose of an individual who then contracted a mild form of the disease! Between 1% to 2% of those variolated died as compared to 30% who died when they contracted the disease naturally.

Done by Madeleine Olson

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In 1717, Lady Mary Wortley Montagu, the wife of the British ambassador, learned about variolation in Constantinople. In 1721, at the urging of Montagu and the Princess of Wales, several prisoners and abandoned children were inoculated by having smallpox inserted under the skin. Several months later, the children and prisoners were deliberately exposed to smallpox.

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(1796, 18th Century Cont.) Small Pox Vaccine developed! 

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(1796, 18th Century Cont.) Small Pox Vaccine developed! 

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The smallpox vaccine was finally introduced in 1796 by Edward Jenner! This was the first successful vaccine to be developed which impacted the hurting societies greatly!

Done by Madeleine Olson

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The history of smallpox holds a unique place in medicine. It was one of the deadliest diseases known to humans, and to date (2016) the only human disease to have been eradicated by vaccination. The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed. He observed that milkmaids who previously had caught cowpox did not catch smallpox and showed that inoculated vaccinia protected against inoculated variola virus.

The global eradication effort initially used a strategy of mass vaccination campaigns to achieve 80% vaccine coverage in each country, and thereafter by case-finding, followed by ring vaccination of all known and possible contacts to seal off the outbreak from the rest of the population.

In 1961 the bifurcated needle was developed as a more efficient and cost effective alternative, and was the primary instrument used during the eradication campaign from 1966 to 1977. The bifurcated needle vaccination required only one-fourth the amount of vaccine needed with previous methods and was simpler to perform.

Different types of vaccine

Smallpox vaccines produced and successfully used during the intensified eradication program are called first generation vaccines in contrast to smallpox vaccines developed at the end of the eradication phase or thereafter and produced by modern cell culture techniques. Second generation smallpox vaccines use the same smallpox vaccine strains employed for manufacture of first generation vaccines or clonal virus variants plaque purified from traditional vaccine stocks, whereas third generation smallpox vaccines represent more attenuated vaccine strains specifically developed as safer vaccines at the end of the eradication phase by further passage in cell culture or animals. Second and third generation vaccines are produced using modern cell culture techniques and current standards of Good Manufacturing Practices (GMP).

The need for WHO to maintain an emergency reserve of smallpox vaccine following eradication was recognized in 1980 when WHO was given a set of formal responsibilities for maintaining capacity and expertise to respond to a re-emergence of smallpox in the post-eradication era as both a component of a preparedness strategy and a possible deterrent to intentional release. The Smallpox Vaccine Emergency Stockpile (SVES) was originally created by consolidating WHO Member State donations given in support of the Intensified Smallpox Eradication Programme.

In 2002, World Health Assembly (WHA) Resolution 55.16 urged Member States to share expertise, supplies and resources to rapidly contain a public health emergency or mitigate its effects. The resolution further requested the WHO Director General to examine the possible development of collaborative mechanisms to prepare and stockpile resources for a potential PHEIC. The SVES currently consists of two components:

A physical stockpile of vaccine held by WHO Headquarters in Switzerland, which is composed of calf-lymph smallpox vaccines from a variety of sources dating from the final years of the eradication program that are regularly tested for potency. It is estimated to consist of approximately 2.4 million doses when reconstituted and delivered by bifurcated needle.

A pledged stockpile held by Donor countries in their respective national stockpiles for use in time of international need upon request by WHO, which currently consists of 31.01 million doses of smallpox vaccine held by France, Germany, Japan, New Zealand, and the United States.

SAGE

Given the different set of vaccines available (1st generation vaccines used during the eradication campaign and made from the lymph or skin of inoculated animals, 2nd generation vaccines produced in tissue cells and further attenuated, and 3rd generation vaccines based on replicating or non-replicating virus) WHO needs to be able to make an informed decision on which vaccines to include in the stockpile for use in case of a re-emergence of smallpox. Therefore, Strategic Advisory Group of Experts on immunization (SAGE) was asked to respond to the following questions: Which vaccine should be recommended for use during an outbreak of smallpox and how many doses should be stockpiled? What groups should be targeted for vaccination if an outbreak occurs? Which groups should be vaccinated for preventive use and with which vaccine?

GACVS

The Global Advisory Committee on Vaccine Safety (GACVS) was requested to review the safety of smallpox vaccination. The Committee was provided with updated safety information for 1st, 2nd and 3rd generation smallpox vaccines in order to make informed decisions regarding emergency smallpox vaccine stockpiling and future use. The safety update also included an overview of the safety of smallpox vaccines used in the smallpox eradication efforts.

WHO Smallpox Vaccine Emergency Stockpile

This document describes the WHO Smallpox Vaccine Emergency Stockpile (SVES) and the considerations and processes needed for countries to request vaccine in the event of a smallpox outbreak.

Smallpox vaccine readings

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The history of smallpox holds a unique place in medicine. It was one of the deadliest diseases known to humans, and to date (2016) the only human disease to have been eradicated by vaccination. The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed.

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A vaccine helps by stimulating your immune system to produce antibodies, exactly like it would if you were exposed to a type of disease! After getting vaccinated, one would then develop immunity to that disease, without having to get the disease first.

Done by Madeleine Olson

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Vaccines contain the same germs that cause disease. (For example, measles vaccine contains measles virus, and Hib vaccine contains Hib bacteria.) But they have been either killed or weakened to the point that they don't make you sick. Some vaccines contain only a part of the disease germ.

A vaccine stimulates your immune system to produce antibodies, exactly like it would if you were exposed to the disease. After getting vaccinated, you develop immunity to that disease, without having to get the disease first.

This is what makes vaccines such powerful medicine. Unlike most medicines, which treat or cure diseases, vaccines prevent them.

For more than the basics, see:

See also:

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Vaccines contain the same germs that cause disease. (For example, measles vaccine contains measles virus, and Hib vaccine contains Hib bacteria.) But they have been either killed or weakened to the point that they don't make you sick. Some vaccines contain only a part of the disease germ.

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(1800's) Vaccinations become more common! 

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(1800's) Vaccinations become more common! 

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The small pox vaccination became widely accepted! Then also continued to gradually replaced the practice of variolation. At some point in the 1800s (the precise time remains unclear), the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

Done by Madeleine Olson

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U.S. President Thomas Jefferson wrote to Jenner in 1806. The following year, Bavaria declared vaccination mandatory, and Denmark did the same in 1810.

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Smallpox is believed to have first infected humans around the time of the earliest agricultural settlements some 12,000 years ago. No surviving evidence of it, however, predates the so-called New Kingdom of Egypt, which lasted from about 1570 B.C. to 1085 B.C.

A few mummies from that era contain familiar-looking skin lesions. Ramses V, for example, who ruled for roughly four years in the 12th century B.C., looks to have had the raised bumps on his face and body for which smallpox is named (it's derived from the Latin word for "spotted").

Moreover, an ancient Egyptian papyrus scroll briefly describes what could be smallpox, as do Hittite clay tablets. The Hittites, who lived in the Middle East, even accused the Egyptians of infecting them during a war between the two empires.

Many historians speculate that smallpox likewise brought about the devastating Plague of Athens in 430 B.C. and the Antonine Plague of A.D. 165 to 180, the later of which killed an estimated 3.5 million to 7 million people, including Emperor Marcus Aurelius, and hastened the decline of the Roman Empire.

At any rate, it reached Europe no later than the 6th century, when a bishop in France unmistakably described its symptoms-a violent fever followed by the appearance of pustules, which, if the patient survived, eventually scabbed over and broke off. By that time, the contagious disease, caused by the variola virus, had spread all across Africa and Asia as well, prompting some cultures to worship special smallpox deities.

In the Old World, the most common form of smallpox killed perhaps 30 percent of its victims while blinding and disfiguring many others. But the effects were even worse in the Americas, which had no exposure to the virus prior to the arrival of Spanish and Portuguese conquistadors.

Tearing through the Incas before Francisco Pizarro even got there, it made the empire unstable and ripe for conquest. It also devastated the Aztecs, killing, among others, the second-to-last of their rulers. In fact, historians believe that smallpox and other European diseases reduced the indigenous population of North and South America by up to 90 percent, a blow far greater than any defeat in battle.

Recognizing its potency as a biological weapon, Lord Jeffrey Amherst, the commander-in-chief of British forces in North America during the French and Indian War, even advocated handing out smallpox-infected blankets to his Native American foes in 1763.

Knowing that no one can contract smallpox twice, survivors of the disease were often called upon to try and nurse victims back to health. Throughout much of the last millennium, this involved herbal remedies, bloodletting and exposing them to red objects.

One prominent 17th-century English doctor realized that those who could afford care actually seemed to be dying at a higher rate than those who couldn't. Yet that didn't stop him from telling a smallpox-infected pupil to leave the windows open, to draw the bed sheets no higher than his waist and to drink profuse quantities of beer.

Far more effective was inoculation, also called variolation, which involved taking pus or powdered scabs from patients with a mild case of the disease and inserting them into the skin or nose of susceptible, healthy people. Ideally, the healthy people would suffer only a slight infection this way and, in so doing, would develop immunity to future outbreaks.

Some people did die, but at a much lower rate than those who contracted smallpox naturally. Practiced first in Asia and Africa, variolation spread to the Ottoman Empire around 1670 and then to the rest of Europe within a few decades. Its first proponent in the present-day United States was Cotton Mather, a Puritan minister best known for vigorously supporting the Salem witch trials. Benjamin Franklin, who lost a son to smallpox, was another early American supporter.

Variolation notwithstanding, smallpox continued wreaking havoc on princes and paupers alike. In the 17th and 18th centuries, it killed several reigning European monarchs, including Habsburg Emperor Joseph I, Queen Mary II of England, Czar Peter II of Russia and King Louis XV of France, as well as an Ethiopian king, a Chinese emperor and two Japanese emperors.

Queen Elizabeth I of England and U.S. President Abraham Lincoln also apparently contracted smallpox during their time in office, though they fortuitously lived to tell the tale. Meanwhile, in Europe alone, an estimated 400,000 commoners were succumbing to smallpox annually.

Finally, in 1796, English doctor Edward Jenner performed an experiment that would, in good time, cause the virus' downfall. By inserting pus from a milkmaid with cowpox, a disease closely related to smallpox, into the arms of a healthy 8-year-old boy and then variolating him to no effect, Jenner was able to conclude that a person could be protected from smallpox without having to be directly exposed to it. This was the world's first successful vaccine, a term that Jenner himself coined. He tried to get his results published by the prestigious Royal Society, only to be told not to "promulgate such a wild idea if he valued his reputation."

Persisting anyway, his vaccine gradually started catching on. The advantages over variolation were many. Unlike a variolated person, a vaccinated person could not spread smallpox to others. Moreover, the vaccine seldom left a rash and proved fatal in only the rarest of circumstances.

"Future generations will know by history only that the loathsome smallpox existed and by you has been extirpated," U.S. President Thomas Jefferson wrote to Jenner in 1806. The following year, Bavaria declared vaccination mandatory, and Denmark did the same in 1810.

Because the vaccine originally had to be transferred from arm to arm, its use spread slowly. It was also much less effective in tropical countries, where the heat caused it to quickly deteriorate. Nonetheless, one country after another managed to rid itself of the disease. The last reported U.S. case came in 1949.

Spurred by two new technological advances-a heat-stable, freeze-dried vaccine and the bifurcated needle-the World Health Organization then launched a global immunization campaign in 1967 with the goal of wiping out smallpox once and for all. That year, there were 10 million to 15 million cases of smallpox and 2 million deaths, according to WHO estimates. Yet just a decade later, the number was down to zero. No one has naturally contracted the virus since a Somali hospital worker in 1977 (though a laboratory accident in England did kill someone in 1978).

After searching far and wide for any remaining trace of smallpox, the WHO's member states passed a resolution on May 8, 1980, declaring it eradicated. "The world and all its peoples have won freedom from smallpox," the resolution stated, adding that this "unprecedented achievement in the history of public health ... demonstrated how nations working together in a common cause may further human progress."

Today, guarded laboratories in Atlanta and Moscow hold the only known stores of the virus. Some experts say these should be destroyed, whereas others believe they should be kept around for research purposes just in case smallpox somehow remerges.

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Take a look back at the history of the pernicious disease.

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The U.S. Congress decided to  pas "An act to regulate the sale of viruses, serums, toxins, and analogous products,"  which was then later referred to as the Biologics Control Act! This was indeed the first modern federal legislation to control the quality of drugs. Which has made a great impact today on drugs and marketing.

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Associated Media Filename

The U.S. Congress passed "An act to regulate the sale of viruses, serums, toxins, and analogous products," later referred to as the Biologics Control Act (even though "biologics" appears nowhere in the law). This was the first modern federal legislation to control the quality of drugs. This act emerged in part as a response to the 1901 St. Louis and Camden contamination events.

The Act created the Hygienic Laboratory of the U.S. Public Health Service to oversee manufacture of biological drugs. The Hygienic Laboratory eventually became the National Institutes of Health.

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The Biologics Control Act | History of Vaccines

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Associated Media Filename The U.S. Congress passed "An act to regulate the sale of viruses, serums, toxins, and analogous products," later referred to as the Biologics Control Act (even though "biologics" appears nowhere in the law). This was the first modern federal legislation to control the quality of drugs.

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Dr. Benjamin Rubin patented the bifurcated needle as a new and improved method of delivering the smallpox vaccine. This made it easier and more affordable to administer the vaccine.

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Included in All Dates?

Associated Media Filename

Dr. Benjamin Rubin of Wyeth Laboratories patented the bifurcated needle for delivery of smallpox vaccine. Using bifurcated needles for vaccination required less vaccine material for each dose, and was easier than previous methods. This development would have large implications for smallpox vaccination campaigns.

" Back to results

Caption:

Scanning electron microscope photograph of bifurcated needle

Description:

Benjamin Rubin, MD, of Wyeth Laboratories patented the bifurcated needle for delivery of smallpox vaccine. Bifurcated needle vaccination required one-fourth the amount of vaccine needed with previous methods and was simpler to perform. Shown here is a scanning electron microscope photograph of a bifurcated needle.

Creator:

Janice Carr, Centers for Disease Control and Prevention

Timeline Category:

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The Bifurcated Needle | History of Vaccines

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Included in All Dates? Associated Media Filename Dr. Benjamin Rubin of Wyeth Laboratories patented the bifurcated needle for delivery of smallpox vaccine. Using bifurcated needles for vaccination required less vaccine material for each dose, and was easier than previous methods. This development would have large implications for smallpox vaccination campaigns.

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(1967) Global immunization campaign began!

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(1967) Global immunization campaign began!

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Due to the two new technological advances—a heat-stable, freeze-dried vaccine and the bifurcated needle, the World Health Organization then launched a global immunization campaign! In 1967, they created the goal of wiping out smallpox once and for all.

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Smallpox is believed to have first infected humans around the time of the earliest agricultural settlements some 12,000 years ago. No surviving evidence of it, however, predates the so-called New Kingdom of Egypt, which lasted from about 1570 B.C. to 1085 B.C.

A few mummies from that era contain familiar-looking skin lesions. Ramses V, for example, who ruled for roughly four years in the 12th century B.C., looks to have had the raised bumps on his face and body for which smallpox is named (it's derived from the Latin word for "spotted").

Moreover, an ancient Egyptian papyrus scroll briefly describes what could be smallpox, as do Hittite clay tablets. The Hittites, who lived in the Middle East, even accused the Egyptians of infecting them during a war between the two empires.

Many historians speculate that smallpox likewise brought about the devastating Plague of Athens in 430 B.C. and the Antonine Plague of A.D. 165 to 180, the later of which killed an estimated 3.5 million to 7 million people, including Emperor Marcus Aurelius, and hastened the decline of the Roman Empire.

At any rate, it reached Europe no later than the 6th century, when a bishop in France unmistakably described its symptoms-a violent fever followed by the appearance of pustules, which, if the patient survived, eventually scabbed over and broke off. By that time, the contagious disease, caused by the variola virus, had spread all across Africa and Asia as well, prompting some cultures to worship special smallpox deities.

In the Old World, the most common form of smallpox killed perhaps 30 percent of its victims while blinding and disfiguring many others. But the effects were even worse in the Americas, which had no exposure to the virus prior to the arrival of Spanish and Portuguese conquistadors.

Tearing through the Incas before Francisco Pizarro even got there, it made the empire unstable and ripe for conquest. It also devastated the Aztecs, killing, among others, the second-to-last of their rulers. In fact, historians believe that smallpox and other European diseases reduced the indigenous population of North and South America by up to 90 percent, a blow far greater than any defeat in battle.

Recognizing its potency as a biological weapon, Lord Jeffrey Amherst, the commander-in-chief of British forces in North America during the French and Indian War, even advocated handing out smallpox-infected blankets to his Native American foes in 1763.

Knowing that no one can contract smallpox twice, survivors of the disease were often called upon to try and nurse victims back to health. Throughout much of the last millennium, this involved herbal remedies, bloodletting and exposing them to red objects.

One prominent 17th-century English doctor realized that those who could afford care actually seemed to be dying at a higher rate than those who couldn't. Yet that didn't stop him from telling a smallpox-infected pupil to leave the windows open, to draw the bed sheets no higher than his waist and to drink profuse quantities of beer.

Far more effective was inoculation, also called variolation, which involved taking pus or powdered scabs from patients with a mild case of the disease and inserting them into the skin or nose of susceptible, healthy people. Ideally, the healthy people would suffer only a slight infection this way and, in so doing, would develop immunity to future outbreaks.

Some people did die, but at a much lower rate than those who contracted smallpox naturally. Practiced first in Asia and Africa, variolation spread to the Ottoman Empire around 1670 and then to the rest of Europe within a few decades. Its first proponent in the present-day United States was Cotton Mather, a Puritan minister best known for vigorously supporting the Salem witch trials. Benjamin Franklin, who lost a son to smallpox, was another early American supporter.

Variolation notwithstanding, smallpox continued wreaking havoc on princes and paupers alike. In the 17th and 18th centuries, it killed several reigning European monarchs, including Habsburg Emperor Joseph I, Queen Mary II of England, Czar Peter II of Russia and King Louis XV of France, as well as an Ethiopian king, a Chinese emperor and two Japanese emperors.

Queen Elizabeth I of England and U.S. President Abraham Lincoln also apparently contracted smallpox during their time in office, though they fortuitously lived to tell the tale. Meanwhile, in Europe alone, an estimated 400,000 commoners were succumbing to smallpox annually.

Finally, in 1796, English doctor Edward Jenner performed an experiment that would, in good time, cause the virus' downfall. By inserting pus from a milkmaid with cowpox, a disease closely related to smallpox, into the arms of a healthy 8-year-old boy and then variolating him to no effect, Jenner was able to conclude that a person could be protected from smallpox without having to be directly exposed to it. This was the world's first successful vaccine, a term that Jenner himself coined. He tried to get his results published by the prestigious Royal Society, only to be told not to "promulgate such a wild idea if he valued his reputation."

Persisting anyway, his vaccine gradually started catching on. The advantages over variolation were many. Unlike a variolated person, a vaccinated person could not spread smallpox to others. Moreover, the vaccine seldom left a rash and proved fatal in only the rarest of circumstances.

"Future generations will know by history only that the loathsome smallpox existed and by you has been extirpated," U.S. President Thomas Jefferson wrote to Jenner in 1806. The following year, Bavaria declared vaccination mandatory, and Denmark did the same in 1810.

Because the vaccine originally had to be transferred from arm to arm, its use spread slowly. It was also much less effective in tropical countries, where the heat caused it to quickly deteriorate. Nonetheless, one country after another managed to rid itself of the disease. The last reported U.S. case came in 1949.

Spurred by two new technological advances-a heat-stable, freeze-dried vaccine and the bifurcated needle-the World Health Organization then launched a global immunization campaign in 1967 with the goal of wiping out smallpox once and for all. That year, there were 10 million to 15 million cases of smallpox and 2 million deaths, according to WHO estimates. Yet just a decade later, the number was down to zero. No one has naturally contracted the virus since a Somali hospital worker in 1977 (though a laboratory accident in England did kill someone in 1978).

After searching far and wide for any remaining trace of smallpox, the WHO's member states passed a resolution on May 8, 1980, declaring it eradicated. "The world and all its peoples have won freedom from smallpox," the resolution stated, adding that this "unprecedented achievement in the history of public health ... demonstrated how nations working together in a common cause may further human progress."

Today, guarded laboratories in Atlanta and Moscow hold the only known stores of the virus. Some experts say these should be destroyed, whereas others believe they should be kept around for research purposes just in case smallpox somehow remerges.

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Take a look back at the history of the pernicious disease.

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In May of 1980, the 33rd World Health Assembly officially declared the world free of smallpox. Smallpox is no longer contracted naturally.

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Smallpox is an acute contagious disease caused by Variola virus, a member of the orthopoxvirus family. It was one of the world's most feared diseases until it was eradicated by a collaborative global vaccination programme led by WHO.

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Because smallpox is eradicated, the vaccine is no longer given to the general public. A large amount of the population has not received the vaccine and is not protected against smallpox in case an outbreak did manage to happen.

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After smallpox was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer needed. However, because of concern that variola virus might be used as an agent of bioterrorism, the U.S. government has stockpiled enough smallpox vaccine to vaccinate everyone who would need it if a smallpox outbreak were to occur.

When there is NO smallpox outbreak, you should get the smallpox vaccine if you:

Are a lab worker who works with virus that causes smallpox or other viruses that are similar to it.

If you need long-term protection, you may need to get booster vaccinations regularly. To stay protected from smallpox, you should get booster vaccinations every 3 years.

When there IS a smallpox outbreak, you should get the smallpox vaccine if you:

Are directly exposed to smallpox virus. For example, if you had a prolonged face-to-face contact with someone who has smallpox.

If there is a smallpox outbreak, public health officials will say who else should get the vaccine. CDC works with federal, state, and local officials to prepare for a smallpox outbreak.

Getting the Smallpox Vaccine

The smallpox vaccine is given by a special technique. It is not administered as a "shot" in the way that most other vaccines are. It is given using a two-pronged (bifurcated) needle that is dipped into the vaccine solution. When removed, the needle holds a droplet of the vaccine. The needle is used to prick the skin a number of times in a few seconds. The pricking is not deep, but it will cause a sore spot and one or two drops of blood to form. The vaccine usually is given in the upper arm.

If the vaccination is successful, a red and itchy lesion develops at the vaccine site in 3 to 4 days. In the first week, the lesion becomes a large blister, fills with pus, and begins to drain. During the second week, the lesion begins to dry and a scab forms. The scab falls off in the third week, leaving a small scar.

People who are being vaccinated for the first time have a stronger reaction than those who are being revaccinated. The following pictures show the progression of the site where the vaccine is given in someone who has not gotten the vaccine before.

Caring for the vaccine site

Because the vaccinia virus is live, it is important to follow care instructions for the vaccination site. You can spread the vaccinia virus by touching the vaccination site before it has healed or by touching bandages or clothing that have been in contact with the live virus from the vaccination site.

After you are vaccinated, you must:

Cover the vaccination site loosely with a piece of gauze held in place with first aid tape or a semi-permeable bandage (one that allows air to flow through, but not fluids).

Wear a shirt with sleeves that cover the bandage.

Keep the vaccination site dry.

If the gauze bandage gets wet, change it right away.

While bathing, cover your vaccination site with a waterproof bandage, and don't share towels.

Change your bandage at least every 3 days. Change it sooner if it gets dirty or wet.

Wash your hands carefully every time after you touch the vaccination site or anything that might be contaminated with the virus from the vaccination site.

Try not to touch your vaccination site. Do not let others touch the site or items that have touched it such as bandages, clothes, sheets, or towels.

Do your own laundry. Use a separate laundry hamper for clothes, towels, sheets, and other items that may come into contact with your vaccination site or pus from the site. Machine wash items that have touched the vaccination site in hot water with detergent and/or bleach.

Put used bandages in plastic zip bags, then throw them away in the regular trash.

After the scab falls off, put it in a plastic zip bag and throw it away.

If you do not follow these instructions, you can spread the virus to other parts of your body or to other people.

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After smallpox was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer needed. However, because of concern that variola virus might be used as an agent of bioterrorism, the U.S. government has stockpiled enough smallpox vaccine to vaccinate everyone who would need it if a smallpox outbreak were to occur.

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(Unknown Date) The future of small pox!!!!!

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(Unknown Date) The future of small pox!!!!!

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If a single confirmed case of smallpox were to occur today  it would be considered an emergency. If the virus that causes smallpox were even used in a bioterrorist attack, people who come into contact with the virus would be at risk of getting sick.