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Victors Fear Old Foe: Pox

Survivors of the war on smallpox recall it as a vicious disease and worry that terrorists may exploit a more virulent form.


Joaquin Duarte thought his 1939 battle with smallpox--the sweats, the delirium and the scarring sores--was among the scourge's last gasps in this country.

Six decades later, he is sweating over the possibility that terrorists will bring it back.

"It's pretty bad," said Duarte, 81, recalling the days he lay inside his "covered wagon," a tent of blankets, struggling not to scratch the pus-filled pox. "I wouldn't want anybody to go through it. It's an awful thing to go through."

Health officials are worried, too, that one of the greatest triumphs of public health--the eradication of this terrible virus--could be in peril. So much so that they are ordering 300 million doses of vaccine, enough for every American, in case smallpox reemerges.

Federal health officials have also begun inoculating doctors, lab workers and other experts against smallpox, and training them to identify and contain possible outbreaks.

Los Angeles Times Wednesday November 14, 2001 Home Edition Part A Part A Page 2 A2 Desk 1 inches; 27 words Type of Material: Correction
Smallpox epidemic--A graphic about smallpox in Section A on Nov. 6 said the first epidemic of the disease in North America was 1617-1619. That was the first epidemic in the area north of Mexico.

As survivors and medical veterans of the last smallpox war well know, there are good reasons for hope and fear.

Sixty or 70 years ago, public health officials were able to quickly respond to outbreaks and vaccinate enough people to prevent mass infections. But survivors in this country, such as Duarte, had a relatively mild form of smallpox, which kills 1% of those it infects.

Experts believe that the type of smallpox used in a bioterrorist attack would be much more virulent, killing 30% or more.

In any case, smallpox is highly contagious, making it an even more frightening prospect than anthrax, a noncontagious disease that in the past month has severely shaken the nation.

The chances of smallpox being used as a biological weapon remain small, experts say--but with anthrax now being sent through the mail, no one is feeling complacent.

Smallpox survivors and their caretakers can take pride, and even offer some lessons, in defeating a deadly disease. But they shudder at the thought of seeing it emerge again, perhaps more powerful and widely spread than before.

"I just imagine, if it starts spreading, how it [could] stop a country," said James Orr, 53, the last smallpox victim in North America.

Long before there was any such concept as terrorism, smallpox was sowing terror.

American colonists were so fearful of the scourge that many forbade their children to travel overseas--even to attend England's most prestigious colleges--lest they be infected. "The smallpox was always present, filling the churchyard with corpses, tormenting with constant fears all whom it had not yet stricken," British historian Thomas Babington Macaulay wrote in his 1848 "History of England."

The disease, which has been traced to the time of the ancient Egyptians, claimed hundreds of millions of lives over the centuries. In the United States by the 1930s--more than 130 years after a vaccine was developed--the number of annual reported cases ranged from 5,000 to 15,000.

If history is any guide, the panic surrounding the disease can be even more contagious than the virus. Until its eradication in the United States in 1949 and in North America in 1962, even an isolated case could produce near-hysteria.

Officials scurried to vaccinate people wherever smallpox surfaced. In 1947, after a businessman returning by bus from Mexico to New York City infected four people before dying, New York officials vaccinated 6 million people in a month. Only 12 people became sick and two died--but the city, in a dramatic overreaction, virtually exhausted its vaccine supply, said Jonathan Tucker, author of "Scourge: The Once and Future Threat of Smallpox."

Fear was the public's gut response once more in 1962, when Orr fell ill.

The 14-year-old son of missionaries, he was on his way back from Brazil, on a New York-to-Toronto train, when a rash broke out on his body.

"I saw the pox and I thought, 'I wonder what this is?' "

When word got out that it was smallpox, "People [in New York] just started to panic," he said. All it took was "just that one case."

U.S. officials were so alarmed that they considered sealing the country's border with Canada and vaccinating millions of Americans.

That step was averted when Dr. Donald A. Henderson, a federal disease control official who later led the World Health Organization's smallpox eradication effort, urged a more measured response. He suggested treating the case as though it had emerged on American soil, in effect treating Canada as the 51st state.

The government settled on vaccinating the 3,000 or so people who had walked through Grand Central Station the same day Orr passed through, as well as fumigating the planes and trains that he took from Brazil to Toronto.

Orr's proved to be the last case of smallpox on the continent.

Henderson, 73, chosen last week by the Bush administration as a top bioterrorism official, employed a strategy of rapid containment--building a firewall around victims by vaccinating everyone with whom they had had contact.

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