Saturday, March 26, 2016

Small pox

Small pox is a live vaccine, meaning it will die if not stored correctly.

So how did they keep vaccines "viable" in the days before refrigeration?

Preventig smallpox by variolation (giving people a small dose of smallpox from a known case) goes back to antiquity, and was practiced in China and in Africa and some Muslim lands in the Middle East, but was introduced into England from the Ottoman empire partly thanks to Lady Montague (and into America by preacher Cotton Mather).

 Dr. Emmanuel Timoni of Constantinople promoted the practice that variolation began its spread through Western Europe. After coming across the practice in Constantinople, Timoni wrote a letter describing the method in detail which was later published in thePhilosophical Transactions in early 1714.[5]:77 His account would become the first medical account of variolation to appear in Europe. Although the article did not gain widespread notoriety, it caught the attention of two important figures in the variolation movement, Bostonian preacher Cotton Mather and wife of the British Ambassador to theOttoman EmpireLady Mary Wortley Montagu.

there were various regimens on how to do this: A chapter in the book The Hemmings Family describes the regimen and how Jefferson paid to have his slaves in Paris get variolated.

There were many smaller epidemics in the Americas,  but a lot of rural people were vulnerable, and this included those joining armies during the revolutionary war.

For example, black slaves who joined the British loyalists on the promise of freedom had a terribly high mortality rate when they got accidentally exposed.

In contrast, Washington, who had almost died of small pox as a youth and knew about variolation, recognized the threat and tried to protect his solders, first by quarantine and then by imposing variolation to any recruit who never had the disease (i.e. most of the recruits).

More HERE.

Weighing the risks, on February 5th of 1777, Washington finally committed to the unpopular policy of mass inoculation by writing to inform Congress of his plan. Throughout February, Washington, with no precedent for the operation he was about to undertake, covertly communicated to his commanding officers orders to oversee mass inoculations of their troops in the model of Morristown and Philadelphia (Dr. Shippen's Hospital). At least eleven hospitals had been constructed by the year's end.
Variola raged throughout the war, devastating the Native American population and slaves who had chosen to fight for the British in exchange for freedom. Yet the isolated infections that sprung up among Continental regulars during the southern campaign failed to incapacitate a single regiment. With few surgeons, fewer medical supplies, and no experience, Washington conducted the first mass inoculation of an army at the height of a war that immeasurably transformed the international system. Defeating the British was impressive, but simultaneously taking on Variola was a risky stroke of genius.
So Washington's controversial decision was one reason why the USA became an independent state: But ironically smallpox is also one reason why Canada never became part of this independent nation: The rebel forces sent to conquer Canada were essentially wiped out by smallpox.

in the days when small pox was rampant, finding a case to use for variolation was not a problem, especially since the dried sores from recovering cases could still spread the disease.

Enter Jenner, whose observation that dairy maids had beautiful complexions, and linked that observation to the fact they often contracted cowpox from milking, began the modern era of vaccines. Cowpox (which eventually evolved into the vaccinia virus) was essentially an "attenuated" vaccine, where giving a mild case of the disease gave you immunity, albeit sometimes only temporary immunity. Measles vaccine is another version of the attenuated virus being used.

Since the virus is live, it has to be kept in a controlled environment (i.e. refrigeration or freezing).

So how did they do that in the good old days before refrigeration? Vaccination would give you a small pustule for a short time only: In the days when it took weeks to travel across oceans or between cities, it would not persist long enough in a person to use by the time you arrived.

Key word: A person.

From Listverse:

(via a headsup from Presurfer)

Francisco Balmis’s Smallpox Mission.
Photo credit: Ecelan

The solution involved passing it arm to arm between orphans. Twenty-two orphan boys between eight and 10 were brought along and given the vaccine successively.
It reached Colombia, Ecuador, Peru, Venezuela, Cuba, and Mexico. Based on its success, Charles IV ordered the campaign to continue in the Philippines

this article includes a section on the Spanish and later the American attempts to vaccinate people in the Philippines. One major problem was that often the vaccination was not "successful": either the vaccine was of poor quality (i.e. not enough live virus, often from poor storage) or the vaccination was not done properly and no infection resulted.

another problem was that people didn't cooperate and get the vaccine, resulting in essentially the militarization or big brother government enforcing it on the unwilling.

Immunization produces "herd immunity", so that epidemics don't spread: Lower the herd immunity, and the unvaccinated are at risk. (the vulnerable include those who refused the vaccine by choice or where the vaccine didn't work: i.e. bad vaccine, or sometimes health problems so your body didn't produce antibodies).

One result was a lot of small pox cases continued so a lot of anti vaccine folk back then insisted the vaccine was evil: like today, the anti vaccine crowd was lead by celebrities, e.g. George Bernard Shaw.

the problem was complicated because now the disease was reported in government statistics, whereas in past days often cases died without being reported or were misdiagnosed: e.g. cases of chickenpox, impetigo. Also, mild cases of small pox where the vaccination was out of date  or "didn't take", but the person naively didn't get a booster vaccination, are reported.

Typical screed about manipulation by public health authorities such as this one ignores the simple fact: We don't see small pox nowadays, so if the vaccine programs didn't work, where are the cases now?

We had the small pox "headsup" after 9-11, where worries about bioterrorism included an attack with smallpox.

The problem was that if we saw a case, there were only two physicians in our small town who might recognize it. No, I was not one of them: even though I had worked in rural Africa, the disease had been eliminated from our area. But my husband saw it in Sulu (Philippines) in the early 1950's (the Moros didn't like vaccination) and one elderly psychiatrist saw it in the 1940's....the last US outbreak was in the late 1940's. Like other outbreaks, that last one was stopped by giving everyone in the area vaccinations (50 thousand people).

That is why a real problem is quality control. (again I refer to the Chinese story of a previous post of not storing vaccines correctly: The authorities know from experience that giving bad vaccines is worse than no vaccines: this could allow epidemics to arise while lowering the public trust that vaccines work, leading to fewer getting the vaccines, which could result in a death spiral to huge epidemics.)

Finally: The elimination of smallpox from the modern world is one of the unsung successes of the United Nations.

but even before the disease was eliminated, they stopped giving it to people in the USA because the "side effect profile" was high.


The traditional vaccination had problems: Including spreading the pustule into open scratches in kids with ecsema, and in people with weak immune systems actually giving them a severe infection that could kill you. This includes spreading to caretakers with cancers, on chemo, or who had HIV: not just those who were vaccinated, but sometimes in those who accidentally touched the lesion.

The military however still gets the vaccine. That is because there is a worry about biowarfare by nut cases who might steal the few remaining small pox viruses from storage and release it.

So there is now a new vaccine used whose advantage is that it doesn't replicate in the body. PDF...

In other words, it doesn't give you a mini disease to make antibodies: It just gives you the virus that sits there and the body will make antibodies.

cross posted from my main blog.

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