The Smallpox Vaccine and Postvaccinal Encephalitis

ABSTRACT

Smallpox is one of the deadliest infectious diseases in history. The discovery by Edward Jenner that inoculation with a droplet of pus from a cow with cowpox protected a person from smallpox resulted in the successful vaccination of millions of people. There were, however, complications associated with smallpox vaccination; the most serious complication was postvaccinal encephalitis, which was reported to occur with an incidence of 1 in 110,000 vaccinations and a case-fatality rate of 50%. Before we become complacent with the idea that we will respond to a bioterrorism attack with a mass immunization program for smallpox, it is important to be reminded of the risk and clinical manifestations of postvaccinal encephalitis and the efficacy of antivaccinia gamma-globulin in preventing this complication. The first case of postvaccinal encephalitis as a complication of the Jennerian cowpox inoculation was observed in 1905. A century later, there is no effective therapy.

Smallpox - postvaccinal encephalitis - antivaccinia gamma-globulin - history of medicine

REFERENCES

• 1 Henderson D A, Inglesby T V, Bartlett J G. Smallpox as a biological weapon: medical and public health management.  JAMA . 1999;  281 2127-2137
• 2 Henderson D A, Fenner F. Recent events and observations pertaining to smallpox virus destruction in 2002.  CID . 2001;  33 1057-1059
• 3 Fifty-Second World Health Assembly. Smallpox eradication: destruction of variola virus stocks 1999; Resolution 52.10
• 4 Broad W J, Miller J. Government report say 3 nations hide stocks of smallpox.  New York Times . 1999;  June 13 1
• 5 Recommendations of the Advisory Committee on Immunization practices (ACIP), 2001. Vaccinia (smallpox) vaccine MMWR .  2001;  50(RR10) 1-21
• 6 Preston R. Updating the smallpox vaccine.  New Yorker . 2000;  January 17 27-29
• 7 Lane J M, Ruben F L, Abrutyn E, Millar J D. Deaths attributable to smallpox vaccination, 1959 to 1966, and 1968.  JAMA . 1970;  212 441-444
• 8 Lane J M, Ruben F L, Neff J M, Millar J D. Complications of smallpox vaccination, 1968; results of ten statewide surveys.  J Infect Dis . 1970;  122 303-309
• 9 Neff J M, Lane J M, Pert J H. Complications of smallpox vaccination: I. National Survey in the United States, 1963.  N Engl J Med . 1967;  276 125-132
• 10 Lane J M, Millar J D. Routine childhood vaccination against smallpox reconsidered. N Engl J Med .  1969;  281 1220-1224
• 11 Lane J M, Ruben F L, Neff J M, Millar J D. Complications of smallpox vaccination, 1968; national surveillance in the United States.  N Engl J Med . 1969;  281 1201-1208
• 12 Neff J M, Levine R H, Lane J M. Complications of smallpox vaccination United States 1963; results obtained by four statewide surveys.  Pediatr . 1967;  39 916-922
• 13 Greenberg M. Complications of vaccination against smallpox.  Am J Dis Child . 1948;  76 492-502
• 14 Rivers T M. Viruses.  JAMA . 1929;  92 1147-1152
• 15 Nanning W. Prophylactic effect of antivaccinia gamma-globulin against post-vaccinal encephalitis.  Bull Wld Hlth Org . 1962;  27 317-324
• 16 Rosenthal S R, Merchlinsky M, Kleppinger C, Goldenthal K L. Developing new smallpox vaccines.  Emerg Infect Dis . 2001;  7 920-926
• 17 Vaccinia (smallpox) vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001 MMWR .  2001;  50(RR10) 1-25
• 18 Henderson D A, Inglesby T V, Bartlett J G. Smallpox as a biological weapon: medical and public health management.  JAMA . 1999;  281 2127-2137
• 19 Preston R. The demon in the freezer.  New Yorker . 1999;  July 12 44-61
• 20 Bray M, Martinez M, Smee D F, Kefauver D, Thompson E, Huggins J W. Cidofovir protects mice against lethal aerosol or intranasal cowpox virus challenge.  J Infect Dis . 2000;  1811-19
• 21 Institute of Medicine. Assessment of future scientific needs for live variola virus.  Washington: National Academy Press 1999