Tag: pre-vaccine era

Why Do We Only Worry About Measles?

Anti-vaccine folks often claim that health officials only worry about measles and measles outbreaks.

They can’t understand why anyone gets concerned by a few measles cases here and there, not understanding that a lot of work goes into containing measles outbreaks and making sure that they don’t grow beyond a few cases.

And health officials don’t just worry about measles. They work to control outbreaks of mumps, pertussis, hepatitis A, and all other diseases too.

Why We Worry About Measles Outbreaks

We do get concerned about measles outbreaks though.

“Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be.

To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak.”

Seth Berkley on Measles Outbreaks Are a Sign of Bigger Problems

The measles vaccine is among the most effective vaccines we have, so if we are seeing outbreaks, even though measles is very contagious, it means there is a problem.

“A focus on measles surveillance can help detect populations unreached by immunization systems and, by extension, program weaknesses. Measles serves as the ‘canary in the coal mine’ for detecting problems with immunization programs, a characteristic whose importance has recently been highlighted in the context of global health security.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review

In the late 1980s, when we had large outbreaks between 1989 to 1991, with 55,622 cases and 123 deaths, it meant that we weren’t vaccinating enough kids because Federal support for vaccine programs had dropped.

As much as anti-vaccine folks like to try and minimize how serious measles can be, it is easy to see that measles is indeed a serious, life-threatening disease. We had good nutrition, proper sanitation, and modern health care in 1990, and still, a lot of people died with measles. Rates of subacute sclerosing panencephalitis (SSPE), a late complication of measles, went up too, in the years after these outbreaks.

“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”

Panel Ties Measles Epidemic to Breakdown in Health System

Those outbreaks were fixed, as we improved access to help kids get vaccinated and protected. Unfortunately, the issue with outbreaks today isn’t about access to vaccines, at least not in the developed world. It is about parents intentionally skipping or delaying vaccines.

How do you fix that?

Hopefully with education.

Why You Should Worry About Measles Outbreaks

Did you know that after the measles outbreaks of 1989, we also saw outbreaks of rubella and congenital rubella syndrome?

  • 396 cases of rubella, 4 deaths, and 2 cases of congenital rubella syndrome in 1989
  • 1,125 cases of rubella, 8 deaths, and 32 cases of congenital rubella syndrome in 1990
  • 1,401 cases of rubella, 1 death, and 34 cases of congenital rubella syndrome in 1991

Did you know that because they have overall lower vaccination rates, measles outbreaks in Europe grow far larger, into the tens of thousands of cases, with dozens of deaths?

“We must not tolerate a world in which a child dies from a disease that can be easily prevented with a low-cost vaccine.”

Dr Tedros, WHO Director-General on World Immunization Week 2018

We worry about measles outbreaks, because we don’t want to go back to anti-vaccine folks push us back to pre-vaccine era levels of disease and deaths.

We know what happens when vaccine levels drop too low.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this NY Times article reports.

We know that vaccines are safe and necessary.

You should know that anti-vaccine propaganda that scares parents away from vaccinating and protecting their kids is rooted in myths and misinformation. They often get away with it because most parents today ahve never seen how devastating measles and other diseases can really be, so they believe stories about the Brady Bunch, instead of the advice of real experts.

You hopefully understand that’s a mistake.

More on Worrying About Measles Outbreaks

Comparing Lightning Strikes to Measles Deaths

Have you ever heard that your child has more of a chance of getting hit by lightning than getting measles?

Since getting struck by lightning is rare, folks like to use it in comparisons to other things that they also think are low risk when trying to make a point.

There are problems with this type of argument though.

Understanding Risk Perception

In an age when many folks are overly anxious about things, it is important to understand the difference between real and perceived risks. Unfortunately, our biases often lead us to worry about the wrong things, sometimes with tragic consequences.

“No intervention is absolutely risk free. Even the journey to a physician’s office with the intention to receive a vaccination carries the risk of getting injured in an accident. With regards to risks of vaccination per se, one has to distinguish between real and perceived or alleged risks.”

Heininger on A risk–benefit analysis of vaccination

Vaccines have risks, but they are small risks, as we know that vaccines are safe and necessary and the decision to skip or delay your child’s vaccines carries with it a much greater risk.

Comparing Lightning Strikes to Vaccine Preventable Diseases

How common or rare do you think it is to get hit by lightning?

  • odds of being hit by lightning – 1 in 1,171,000 (each year)
  • odds of ever being hit by lightning – 1 in 14,600 (lifetime risk)
  • on average, 26 people die after being struck by lightning each year (since 2007), which is down from a recent historical average of 45 deaths per year (30 year average) and way down from when we used to see 400 lightning strike deaths each year before 1950
  • on average, 252 people are injured after being struck by lightning each year
Actually, just since 2000, at least 5 people have died of measles in Canada.
Actually, just since 2000, at least 6 people have died of measles in Canada.

Although 26 people dying after lightning strikes sounds like way too many to me, especially since one recent death was a 7-year-old boy in Tennessee playing under a tree, with 1 in 1,171,000 odds of getting hit, it sounds like we are pretty safe.

But is it fair to use those odds to justify your decision to keep your kids unvaccinated?

Of course not!

Why is our risk of getting struck by lightning so low?

What happens when we hear thunder or see lightning?

When Thunder Roars, Go Indoors!

What happens when a thunder storm approaches and you are at your kids soccer or baseball game?

“Postpone or suspend activity if a thunderstorm appears imminent before or during an activity or contest (irrespective of whether lightning is seen or thunder heard) until the hazard has passed. Signs of imminent thunderstorm activity are darkening clouds, high winds, and thunder or lightning activity.”

UIL on Lightning Safety

Many ball fields now have lightning detectors to alert officials of nearby storms. And just about everyone has access to weather apps on a smart phone that can alert them to an approaching thunder storm or nearby lightning strikes.

The point is that most of us understand that lightning is dangerous, so we go far out of our away to avoid getting hit. The risk of getting hit by lightning isn’t 1 in 1,171,000 with folks running around outside waving golf clubs in the air during thunder storms or sitting on their roofs under an umbrella watching the storm.

The risk of getting hit by lightning is 1 in 1,171,000 because most of us go inside once we know lightning is nearby.

“Based on the media reports of the fatal incidents, many victims were either headed to safety at the time of the fatal strike or were just steps away from safety. Continued efforts are needed to convince people to get inside a safe place before the lightning threat becomes significant. For many activities, situational awareness and proper planning are essential to safety.”

A Detailed Analysis of Lightning Deaths in the United States from 2006 through 2017

And the same is true with measles and other vaccine-preventable diseases. They aren’t as common as they once were because most of us are vaccinated and protected.

If you skip or delay your child’s vaccines, you will increase the risk that they will get one of these vaccine-preventable diseases. And you will increase the risk that they will get someone else sick.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

And if enough people don’t get vaccinated, herd immunity fails, and we will see a return of pre-vaccine era levels of disease.

What to Know About Vaccines and Risk Perception

Folks often misuse lightning strikes when they think about risks, not understanding that the risk of getting hit by lightning is low because we take a lot of precautions to avoid getting hit by lightning.

More on Vaccines and Risk Perception

How Many People Die from Vaccine Preventable Diseases These Days?

People don’t often die from vaccine-preventable diseases these days.

At least not in industrial countries.

Deaths from Vaccine-Preventable Diseases Today

Well, they aren’t supposed to.

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

Tragically, we are seeing more and more deaths from vaccine-preventable diseases every day in countries that once had these diseases under good control:

  • over 100 measles deaths across Europe and a measles death in the United States a few years ago
  • diphtheria deaths in Australia, Belgium, South Africa, and Venezuela
  • life-threatening tetanus cases in Australia, Canada, New Zealand, and Ukraine
  • a rabies death in the United States in a child who’s parents skipped the post-exposure rabies vaccine
  • pertussis deaths in the United States
  • influenza – a record number of deaths in the United States, with most kids unvaccinated
  • rotavirus – yes, unvaccinated kids still die of rotavirus in the United States in the 21st Century! In a recent outbreak in California, in which a child died, almost all of the kids were unvaccinated.

And not surprisingly, these deaths are almost always in unvaccinated children.

Deaths from Vaccine-Preventable Diseases in the Pre-Vaccine Era

While tragic, we are still fortunate that these deaths are no where close to the levels we once saw before we had vaccines to protect our kids.

In the pre-vaccine era, we used to see:

  • up to 15,000 deaths and 200,000 diphtheria cases each year until the 1940s
  • an average of 175,000 cases of pertussis each year in the early 1940s, with about 1,118 deaths from pertussis in 1950 and 467 deaths from pertussis in 1955
  • up to 20,000 cases of paralytic polio each year until the early 1950s
  • an average of about 186,000 cases of mumps each year before 1967, with an average of 40 deaths a year
  • up to 500 deaths and 500,000 measles cases each year until the early 1960s
  • a rubella epidemic in 1964-65 that caused 12.5 million rubella virus infections and “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome”
  • up to 20,000 cases of invasive H. influenzae (Hib) disease each year, with more than half of them having meningitis, and about 300 to 600 deaths, mostly children under age 2 years. In 1980, 45 children died with epiglottitis and there were an additional 222 deaths from Hib meningitis.
  • up to 11,000 hospitalizations and 100 chicken pox deaths each year until 1995
  • up to 17,000 cases of invasive pneumococcal disease in children younger than 5 years each year (before 2000), including 13,000 cases of bacteremia (blood infection) and 700 cases of pneumococcal meningitis, with 200 deaths.
  • just over 400,000 visits to the doctor and up to 272,000 visits to the emergency room, 70,000 hospitalizations and 20 to 60 deaths each year in children under age 5 years because of rotavirus infections until 2006

But that deaths from vaccine-preventable diseases aren’t common is hardly a reason to skip or delay your child’s vaccines, as some might suggest. It is just testament to the fact that vaccines work.

That these deaths from vaccine-preventable diseases quickly rise as rates of vaccinations drop is a tragic reminder that vaccines are necessary.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

And what makes it even more tragic is that this was all predicted and could have been prevented if folks didn’t listen to anti-vaccine propaganda that scares them away from vaccinating and protecting their kids.

Worldwide Deaths from Vaccine-Preventable Diseases

Of course, talk of deaths from vaccine-preventable diseases shouldn’t stop with the developed or industrial world.

Even as a lot of progress is being made, as more and more people get vaccinated, worldwide, there were:

  • about 89,780 measles deaths, mostly young children
  • about 215,000 deaths from rotavirus infections
  • at least 1 million deaths from hepatitis B
  • almost 200,000 deaths from Hib
  • over 4,200 deaths from chicken pox
  • about 50,000 deaths from meningococcal infections
  • about 160,000 deaths from pertussis
  • about 826,000 deaths from pneumococcal infections
  • almost 60,000 deaths from rabies
  • just over 70,000 deaths from tetanus
  • about 222,000 deaths from typhoid
  • between 30,000 to 60,000 deaths from yellow fever

As you can see, most of these diseases are still big killers around the world.

“You hear about people who don’t like to vaccinate their kids in the Western world, which I suppose is a personal choice, but when you’re out there, the result of your children not being vaccinated is that they’ll likely die, or be horribly maimed. So yes, I saw a real desire to have their children protected, and also a real understanding of it – I didn’t seem to come across anybody who went ‘What is it?’ Or ‘What does it do?’ They all seemed to know about it.”

Ewan McGregor on Cold Chain Mission

In most of these countries, the problem is access to vaccines though, not parents refusing to get their kids vaccinated.

What to Know About Deaths from Vaccine Preventable Diseases

Unvaccinated kids are still dying from vaccine-preventable diseases.

More on Deaths from Vaccine Preventable Diseases

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

Of all of the myths about vaccines that confuse and scare some parents, those about infant mortality rates can be especially hard to easily put aside.

After all, why doesn’t the United States rank better for infant mortality rates since most parents do vaccinate and protect their kids?

Vaccines and Infant Mortality Rates

That’s actually fairly easy to answer.

“Globally, the infant mortality rate has decreased from an estimated rate of 64.8 deaths per 1000 live births in 1990 to 30.5 deaths per 1000 live births in 2016.”

WHO on Infant Mortality Situation and Trends

Vaccine-preventable diseases don’t have much effect on infant mortality rates in the United States these days.

What does?

  • birth defects
  • premature births
  • SIDS
  • maternal complications of pregnancy
  • injuries

Think about it… If vaccines did increase infant mortality rates, then why would infant mortality rates be dropping as we vaccinate more kids?

Has the United States’ Infant Mortality Rate Ranking Been Dropping as We Vaccinate More Kids?

The Wisconsin Coalition for Informed Vaccination is pushing myths about SIDS and vaccines.
The Wisconsin Coalition for Informed Vaccination is pushing myths about infant mortality rates and vaccines.

Do you know what has been dropping?

The infant mortality rate.

In fact, infant mortality rates continue to drop and are now at their lowest levels ever.

While it is good news that the rate is dropping, most folks think they can be better.

For one thing, some states, like Mississippi, Louisiana, Alabama, Arkansas, and West Virginia, etc., have much higher infant mortality rates than others. Why? Much of those differences, can be explained by socio-economic factors. That’s also though to explain much of the differences in infant mortality rates between the U.S. and other developed countries, most of which have universal health care.

New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.
New Jersey, although they have ranked high for autism rates, has lower than average rates of infant mortality.

Another big difference is that many countries count infant mortality rates using different criteria than the United States.

For example, it is estimated that at least 40% of the differences between infant mortality rates in the United States and other countries is due to those countries not counting extremely preterm births among their statistics.

But why has the United States’ infant mortality ranking fallen relative to other developed nations?

Most European Countries had much higher infant mortality rates than the US in the 1960s and 70s, which affected relative rankings, even as all countries saw infant mortality rates fall.
OECD data shows that most European Countries have historically had much higher infant mortality rates than the US, which have affected relative rankings, even as all countries have seen infant mortality rates fall.

Although anti-vaccine groups try to tie this to ‘routine vaccination,’ it is easy to see that other countries have historically had much higher infant mortality rates than the United States. As they have caught up, the United States’ ranking has dropped relative to theirs, even though all have seen infant mortality rates drop.

Infant Mortality Rates in the Pre-Vaccine Era

But if you really want to understand the relationship of vaccines to infant mortality rates, you just have to look back to the pre-vaccine era. Back then, now vaccine-preventable diseases did have a big effect on infant mortality rates in the United States and elsewhere.

In 1910, for example, the most common causes of death for infants under 1 year were:

  1. diarrhea and enteritis
  2. premature birth
  3. congenital debility
  4. bronchopneumonia
  5. pneumonia
  6. malformations
  7. bronchitis
  8. convulsions
  9. injuries at birth
  10. whooping cough
  11. tuberculosis
  12. meningitis
  13. measles
  14. accident
  15. diphtheria

Although advances in modern medicine would help decrease the mortality from many of those diseases, it was vaccines that truly worked to make sure they were no longer a big part of our infant mortality statistics.

How will we continue to decrease our infant mortality rates?

Most experts think that it will require better access to health care for all members of society.

What to Know About Infant Mortality Rate Rankings

Infant mortality rates are not linked to vaccines.

More Infant Mortality Rate Rankings

Why Didn’t Everyone Die with Our 1980s Level of Vaccination Rates?

This is actually a real question that someone recently asked:

“Can someone please explain how we survived the 1980s with vaccination rates well below “herd immunity” thresholds and far fewer vaccines? Why didn’t everyone die?”

J.B. Handley

Mr. Handley even provides a nice chart to give his question some context.

Vaccination rates for 2 year old children in 1985.
The chart shows vaccination rates for 2 year old children in 1985.

So why didn’t everyone die?

That’s easy.

While vaccine-preventable diseases can be life-threatening, they certainly don’t kill everyone who gets them. They are not 100% fatal. Well, rabies usually is, but not surprisingly, rabies wasn’t on his little chart…

Deaths from Vaccine-Preventable Diseases, 1985

What else does Mr. Handley miss?

“Comparisons between rates obtained from immunization records versus the total sample (records and recall) conducted on data collected between 1979 and 1983 showed that the USIS, which accepted parental recall, underestimated the true vaccination rate in preschoolers by as much as 23% for some antigens.”

Simpson et al on Forty years and four surveys: How does our measuring measure up?

The vaccination rates he is citing were based on a phone survey that wasn’t thought to be very accurate, underestimating true vaccination rates. It was last used in 1985.

While vaccination rates weren’t great at the time, they just weren’t as horrible as he makes it seem, but we still had some deaths from vaccine-preventable diseases. Not as bad as the pre-vaccine era though, when hundreds of people died with measles each year.

Here’s the data from the CDC for 1985:

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/E/reported-cases.pdf

  • 23 deaths from tetanus
  • 4 deaths from pertussis
  • 4 deaths from measles
  • 1 death from rubella
  • 2 cases of congenital rubella syndrome

Unfortunately, it got worse. This was just before the large measles outbreaks from 1989 to 1991, when 123 people died. During those three years, there were also 28 deaths from pertussis, 6 deaths from mumps, 13 deaths from rubella and 77 cases of congenital rubella syndrome!

But then we learned our lesson and we got kids vaccinated. But most of the problems then were about access to vaccines, not parents who intentionally skipped or delayed vaccines for their kids.

Deaths from non-Vaccine-Preventable Diseases, 1985

The CDC Morbidity and Motality Weekly Report includes summaries of notifiable diseases in the United States.Many of the diseases on J.B. Handley’s chart weren’t yet vaccine-preventable in 1985. They were quite deadly though, which is why vaccines were being developed and were eventually added to the schedule to protect our kids from getting them.

But in 1985 (*or in the years before the vaccine was introduced), tragically, the CDC lists:

  • 80 deaths from hepatitis A
  • 490 deaths from hepatitis B
  • 68 deaths from chicken pox
  • 219 deaths from Hib meningitis in children and about another 45 deaths from Hib epiglotittis
  • at least 200 deaths from pneumococcal disease in children*
  • 257 deaths from meningococcal infections
  • 20 to 60 deaths each year from rotavirus infections*

Want us to Turn Back the Clock and go back to an immunization plan (the Jenny McCarthy schedule) that didn’t include vaccines against any of these diseases? We would end up back to when kids still died of meningitis, pneumonia, blood infections, severe dehydration, epiglottitis, and cancer from Hib, pneumococcal disease, rotavirus, hepatitis B, hepatitis A, chicken pox, HPV, and meningococcal disease.

And the answer to Mr. Handley’s question becomes even more obvious.

How did we survive the 1980s with vaccination rates well below “herd immunity” thresholds and far fewer vaccines?

Many people didn’t.

What to Know About Deaths and Vaccination Rates

Poor vaccination rates and fewer vaccines led to more deaths from now vaccine preventable diseases in the mid-1980s.

More on Deaths and Vaccination Rates

 

Why Do We Only Fear Vaccine Preventable Diseases?

How many diseases can be prevented with vaccines?

Would you believe that there are about 29 vaccine-preventable diseases, from adenovirus and anthrax to typhoid fever and yellow fever?

That’s a lot more than the 16 that kids today routinely get vaccinated against…

Diseases That Are Not Vaccine Preventable

Whether you think about 16 or 29 vaccine-preventable diseases, they are a drop in the pocket when you think about all of the diseases that can’t be prevented with a vaccine.

Just consider all of the viruses and bacteria that can get you sick during cold and flu season:

  • group A Streptococci – strep throat and scarlet fever
  • Human metapneumovirus (HMPV) – bronchiolitis, colds, and viral pneumonia
  • Human parainfluenza viruses (HPIVs) – bronchiolitis, bronchitis, colds, croup, or viral pneumonia
  • norovirus – diarrhea and vomiting
  • respiratory adenovirus – bronchitis, colds, croup, viral pneumonia, pink eye, and diarrhea
  • Respiratory syncytial virus (RSV) – wheezing and bronchiolitis in younger children, but colds in older kids and adults
  • rhinovirus – the classic common cold
  • rotavirus – diarrhea and vomiting, was much more common in the pre-vaccine era
  • seasonal coronavirus – colds, bronchitis, and viral pneumonia
  • Streptococcus pneumoniae – ear infections, meningitis, sinus infections, and pneumonia

In addition to the flu, only rotavirus and Streptococcus pneumoniae (pneumococcal vaccines) are vaccine preventable.

And there are still thousands of other diseases that aren’t vaccine preventable, including African trypanosomiasis, Chagas disease, Chikungunya, Cytomegalovirus (CMV), Dengue fever, Ebola, Herpes Zoster, HIV, Hookworm disease, Leishmaniasis, Malaria, Schistosomiasis, and Zika, some of the most deadly diseases around.

Why Do We Only Fear Vaccine-Preventable Diseases?

So is it true that we only fear vaccine-preventable diseases and that’s why folks get vaccinated?

“Why aren’t you walking around concerned about leprosy every day? Why aren’t you concerned about someone from another country bringing leprosy into Australia or the US and somehow exposing all of our most vulnerable to this illness? I’ll tell you why. Because there’s no vaccine for leprosy. You are afraid of what we vaccinate for because these illnesses are hyped up all of the time. It’s propaganda. You are told what to fear, so they can then sell you an alleged solution.
The only diseases we fear are the ones that a vaccine has been developed and marketed for. We never feared measles and mumps in the early 20th century… Because its what the media tells us to do.”

Learn the Risk – Why aren’t we afraid of all diseases?

Did you know that there actually is a vaccine for leprosy? Don’t expect it to be added to our immunization schedule any time soon or to increase your fears about leprosy, as leprosy is not highly contagious and it can be cured.

Forget about leprosy though… If folks didn’t fear measles and mumps in the early 20th century, before we had vaccines to control these diseases, then why did epidemics so often lead to newspaper headlines, quarantines, and school closings?

Quarantines were routine in the pre-vaccine era.
Quarantines were routine in the pre-vaccine era.

And if we only fear diseases that a vaccine has been developed and marketed for, then why are so many parents afraid of RSV and herpes?

How many new parents won’t even let family members kiss their newborns because they are worried about herpes, even if they don’t have a cold sore? How many parents get panicked if they hear RSV, which can cause severe disease in high risk babies, but typically only causes cold symptoms in most others.

Anyway, fear doesn’t drive most of us to vaccinate and protect our kids. We just understand that vaccines are safe and necessary and that getting vaccinated is a smart decision.

It is the diseases that aren’t vaccine preventable that might scare us a little bit…

What to Know About Fearing Vaccine-Preventable Diseases

Anti-vaccine folks push propaganda to make parents afraid of vaccines and to scare them away from vaccinating and protecting their kids. The idea that we are only afraid of vaccine preventable diseases is a good example.

More on Fearing Vaccine Preventable Diseases

The Hospital Rock Engravings of Farmington, Connecticut

Vaccines are a lot safer than they used to be in the old days.

No, I’m not talking about the “crude brew” that was the original DTP vaccine.

This older vaccine used more antigens than the DTaP vaccine that replaced it, so could cause more side effects. Even before that though, there was less oversight of vaccine manufacturers in the early 20th century. This could lead to vaccines that were contaminated or which simply didn’t work.

That certainly was a problem with the early smallpox vaccine, which is typically considered to be the most dangerous vaccine ever routinely used.

Variolation and Smallpox

But even before the smallpox vaccine was developed by Edward Jenner in 1796, we had variolation.

While the smallpox vaccine involved the cowpox virus, variolation actually infected someone with smallpox. The idea was to give the person a milder form by exposing them to a weaker, or attenuated, form of the virus.

They got this weakened virus from the smallpox scabs of someone who had already recovered and:

  • blowing dried smallpox scabs into their nose
  • applying pus from smallpox scabs to a small puncture wound on their skin

Variolation worked, giving the person immunity to smallpox – if they survived.

Unfortunately, about 1 to 3% of people who underwent variolation died.

And people who had recently undergone variolation could be contagious, leading to smallpox epidemics.

So why did folks undergo variolation if they had a chance of dying from the procedure?

It’s simple.

A natural smallpox infection was so much more deadly. Up to 30% of people who got smallpox died, and many people eventually got caught up in the regular smallpox epidemics that plagued people in the pre-vaccine era.

The Hospital Rock Engravings of Farmington, Connecticut

We don’t have to worry about smallpox anymore.

Well, not about natural smallpox infections, since smallpox was eradicated back in 1980.

And there are many other diseases that we get vaccinated against, with it being extremely easy to get that protection, especially compared to what folks did in the old days.

Do you know how far folks went to make variolation safer?

“Every year, thousands undergo this operation, and the French Ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries. There is no example of any one that has died in it, and you may believe I am well satisfied of the safety of this experiment, since I intend to try it on my dear little son. I am patriot enough to take the pains to bring this useful invention into fashion in England…”
Lady Mary Wortley Montagu On Small Pox in Turkey (1717)

They actually went to smallpox hospitals to get vaccinated, remaining in quarantine for up to three weeks so that they wouldn’t get others sick.

In Farmington, Connecticut, two doctors established the Todd-Wadsworth Smallpox Hospital and had a lot of success with variolation.

Patients were no longer starved before inoculation, and many had begun to doubt the efficacy and safety of vomiting, sweats, purges, mercurials (toxic mercury salts such as calomel), and bleeding which had previously weakened both inoculees and those who “took the pox in the natural way.”

Charles Leach, MD on Hospital Rock

There, up to 20 patients at a time stayed in quarantine to get variolated, as a smallpox epidemic hit nearby Boston.

Patients engraved their name on Hospital Rock in the late 1700s near Farmington.
Patients engraved their name on Hospital Rock in the late 1700s near Farmington. Photo by Keith Wilkens

Between 1792 and 1794, many who got variolated wrote their names on what is now known as Hospital Rock.

“Many have supposed that the names on this rock were those who had did of the small-pox, but this is a great mistake. Every name on the rock is that of a person who was living when the name was placed there. Norris Stanley lived to own ships which were captured in the war of 1812 by Algerian pirates and still later to receive from the United States an indeminity therefor amounting to a large sum.”

James Shepard on The Small Pox Hospital Rock

The nearby town of Durham seemed to go a different way.

Instead of an inoculation hospital, they had a pest house to quarantine folks with natural smallpox infections.

Adding to the history of smallpox in Connecticut – a smallpox burying ground in Guilford.

Why wasn’t variolation popular everywhere? Folks didn’t have to wait for the first vaccine for the anti-vaccine movement to get started.

What to Know About Smallpox and the Hospital Rock Engravings

Hundreds of people got safely inoculated against smallpox and left their names on Hospital Rock near Farmington, Connecticut just before Edward Jenner discovered the first smallpox vaccine.

More on the Hospital Rock Engravings