Tag: smallpox vaccine

Did Edward Jenner’s Son Die from a Vaccine Reaction?

Maybe people know that Edward Jenner first gave his new smallpox vaccine to James Phipps, the 8-year-old son of Jenner’s gardener.

What they might now know is that two years later, in 1798, he also vaccinated his own son Robert F. Jenner, when he was eleven months old.

Did Edward Jenner’s Son Die from a Vaccine Reaction?

Did he die after getting vaccinated?

Did he suffer brain damage?

Of course not!

Edward Jenner vaccinated his youngest son, Robert.
Edward Jenner vaccinated his youngest son, Robert.

He didn’t even have a reaction and was later inoculated after being exposed to smallpox.

“My two eldest children were inoculated for the smallpox before I began to inoculate for the cow-pox. My youngest child was born about the time my experiments commenced, and was among the earliest I ever vaccinated. By referring to the first work I published on the subject in the spring of the year 1798, page 40, you will find his name, Robert F. Jenner, and you will observe it noticed that on his arm the vaccine lymph did not prove infectious. It advanced two or three days, and then died away.”

Edward Jenner on the Life of Dr. Jenner

He died 56 years later.

Edward Jenner’s other children didn’t receive his smallpox vaccine. As they were all born before his experiments with cowpox, they had already received traditional smallpox inoculations.

“Edward is growing tall, and has long looked over my head. Catherine, now eleven years old, is a promising girl; and Robert, eight years old, is just a chip of the old block.”

Edward Jenner on the Life of Dr. Jenner

Edward Robert Jenner did die young, but it certainly wasn’t an effect of his father’s smallpox vaccine. He died of tuberculosis, which was a common killer at the time. He was 21 and had always had health problems, but again, he never received his father’s new vaccine, so how could he be the “first child to suffer vaccine damage???”

This myth is easy to debunk. Jenner's son that died young was never vaccinated!
This myth is easy to debunk. Jenner’s son, Edward, that died young was never vaccinated!

What about the ethical implications of giving an experimental vaccine to your own child? A vaccine made with cow pus?

Remember, Jenner’s smallpox vaccine was made with cowpox virus. It was replacing variolation, a procedure in which people were actually inoculated with smallpox virus. While much better than getting smallpox, variolation was still dangerous and some people died from the procedure.

His smallpox vaccine was a much safer option.

More on Edward Jenner’s Son

How Many Vaccines Did Kids Get in the 1950s?

I recently posted an immunization schedule from the 1960s to bust the myth that kids didn’t get many vaccines before the 1970 and 80s, even though they actually got multiple doses of DTP, polio, and smallpox vaccines.

But how about if we go back even earlier than that?

My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.
My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.

In 1951, infants got multiple doses of diphtheria, tetanus, and pertussis vaccines and the smallpox vaccine by the time they were 6 months old, with boosters through age 10 years.

Multiple doses with aluminum. And thimerosal. And far more antigens than kids are exposed to today, even though they now get many more vaccines.

“Tetanus toxoid recall injections should be continued every 3 years throughout life in dosage of 0.1cc to 0.2cc.”

AAP Report of the Committee on the Control of Infectious Diseases 1951

Oh, they also got revaccinated with the smallpox vaccine “every five years.”

And yes, most of the vaccines contained aluminum.

“The Committee recommends that all infants be immunized actively against diphtheria, pertussis, and tetanus with a course of injections of combined alum or aluminum phosphate precipitated, or aluminum hydroxide adsorbed diphtheria and tetanus toxoids containing H. pertussis vaccine. These products are considered preferable to fluid mixtures for the following reasons: (1) more prolonged antitoxic immunity produced by precipitated or adsorbed mixtures, (2) greater effectiveness as immunizers against pertussis in early infancy, and (3) less likelihood of producing systemic reactions because of lower protein content and slower absorption.”

AAP Report of the Committee on the Control of Infectious Diseases 1951

Other vaccines were also available for special situations, including rabies, typhoid, parathyphoid, and the BCG vaccine.

“Acetylsalicylic acid, 65 mg per year of age, should be given within an hour or two of injections and repeated 4 hours thereafter.”

AAP Report of the Committee on the Control of Infectious Diseases 1951

While it is likely a very big surprise to anti-vaccine folks that kids got multiple doses of DPT, tetanus, and smallpox vaccines back then, unfortunately, it means that they were susceptible to many diseases that are now vaccine-preventable.

Diseases that our kids don’t have to get, because they can be vaccinated and protected with vaccines that are safe, with few risks, and still necessary.

How Many Vaccines Did Kids Get in the 1950s?

What is Eczema Vaccinatum?

Did you know that having eczema is a contraindication to getting a vaccine?

Which vaccine?

The smallpox vaccine!

Yes, smallpox has been eradicated, but the vaccine is sometimes still used in very specific situations, especially in the military.

What is Eczema Vaccinatum?

Not only is eczema a contraindication to getting the smallpox vaccine, you shouldn’t even get it if a household contact has eczema.

Why not?

Shedding.

Yes, although anti-vaccine folks needlessly worry about shedding when kids get routine childhood vaccines and even talk about a shedding season, with the smallpox vaccine, problems with shedding are really a thing.

Since the smallpox vaccine is a live virus vaccine and since it very commonly causes a skin reaction at the injection site, shedding can spread it to others. While that’s a good thing with some vaccines, like the oral polio vaccine, because it increases herd immunity, it isn’t with the smallpox vaccine.

If the weakened smallpox vaccine can cause a skin reaction on your arm where you got the shot, what is it going to do if it gets on a child’s skin that is irritated all over with eczema?

An 8-month-old boy with eczema vaccinatum.
An 8-month-old boy with eczema vaccinatum. Photo by CDC/Arthur E. Kaye

It’s a good thing that we don’t routinely have to use the smallpox vaccine anymore.

“Because persons with eczema are deferred from vaccination, only a single, accidentally transmitted case of EV has been described in the medical literature since military vaccination was resumed in the United States in 2002.”

Reed et al on Eczema vaccinatum.

And that it doesn’t happen with any other vaccines!

More on Eczema Vaccinatum

Should I Be Worried That My Kids Didn’t Get the Smallpox Vaccine?

Routine vaccination with smallpox vaccines ended in the US in 1972, a short time before smallpox was declared eradicated (1980).

Do you have a smallpox vaccine scar?
Do you have a smallpox vaccine scar?

It was also before the last case of wild smallpox was found (1977).

Why?

Because smallpox had been declared eliminated in North America long before (1952), following the last natural outbreak of smallpox in the United States (1949).

Should I Be Worried That My Kids Didn’t Get the Smallpox Vaccine?

Although smallpox has been eradicated, some folks still worry about it.

“There are now only two locations where variola virus is officially stored and handled 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.”

CDC on History of Smallpox

Of course, the concern now is not naturally occurring smallpox, but instead bioterrorism.

Could the smallpox virus be made into a weapon to be used in a bioterrorist attack?

We hope not, but if it was, none of us would be immune, not even the folks who were vaccinated long ago. The smallpox vaccine doesn’t provide life-long immunity.

So should you be worried?

“Some people have been vaccinated through the military or because they were part of Smallpox Response Teams that were formed after the 9/11 terrorist attacks.”

CDC on Why is Smallpox a Concern?

Almost certainly not.

Plans are in place if there ever was a smallpox attack and if necessary, there is actually enough smallpox vaccine stockpiled to vaccinate everyone in the United States!

More on Smallpox Worries

Recognizing Old Vaccine Scars

Do you have a scar on your arm and you aren’t sure why it is there?

Having a smallpox vaccine scar makes you a part of history.
Having a smallpox vaccine scar makes you a part of history.

Is it from the smallpox vaccine?

Recognizing Old Vaccine Scars

Classically, there are two vaccines that can leave a scar – the ones that protect us against smallpox and tuberculosis.

“BCG scar is a surrogate marker of vaccination and an important index in the vaccination program.”

Dhanawade et al on Scar formation and tuberculin conversion following BCG vaccination in infants: A prospective cohort study

And there are a few easy ways to tell if you have a smallpox scar.

When were you born? Remember, the smallpox vaccine hasn’t been used in the United States since the early 1970s and its use stopped everywhere in 1986.

And where were you born?

The BCG (bacille Calmette-Guerin) vaccine, on the other hand, is still in use in many countries, and is given at birth to prevent tuberculosis disease, including meningitis and disseminated tuberculosis. It isn’t routinely used in the United States though “because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity.”

Do you have a vaccine scar on your arm?
Do you have a vaccine scar on your arm? Photo by Earl Hershfield

In general though:

  • the BCG vaccine scar has a raised center
  • the smallpox vaccine scar is depressed, with lines that radiate to the edges

Complicating matters is the fact that you can have multiple scars from each vaccine…

“In 1972, the National Advisory Committee on Immunization in Canada recommended that routine immunization of infants for smallpox be stopped. Very few Canadians born after 1972 have been immunized against smallpox. Those, like me, who were immunized prior to that date have little or no immunity left. Nothing, but a small scar as testimony to a grand global achievement.”

Diane Kelsall on A Small Scar

Do you have any vaccine scars?

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Vaccines While Immunosuppressed

It seems to be a big surprise to many folks, but kids can get most vaccines when they are immunosuppressed. In fact, they sometimes get extra some extra vaccines, like Pneumovax, because the  “incidence or severity of some vaccine-preventable diseases is higher in persons with altered immunocompetence.”

They should also get all of their vaccines if they are around someone who is immunosuppressed.

Surprised?

Vaccines While Immunosuppressed

Which vaccines your kids can get while they are immunosuppressed is going to depend greatly on the reason why they are  immunosuppressed.

Are they getting chemotherapy?

Did they just get a stem cell transplant?

Were they born with a specific immunodeficiency, like X-linked agammaglobulinemia, selective IgA deficiency, severe combined immunodeficiency, or chronic granulomatous disease?

Whatever the reason, they likely won’t get a medical exemption to skip all of their vaccines.

“Killed vaccines will not cause infection in immunodeficient or any other children. The fear of increased community-acquired vaccine-preventable diseases should lead to adherence to and completion of recommended immunization schedules in the community to reinforce herd immunity, such that all vaccine-preventable diseases become exceedingly rare.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

In most cases, immunocompromised kids can get all inactivated vaccines. It is only live vaccines that could pose a problem. Even then, it depends on the specific immunodeficiency as to whether avoiding live vaccines is necessary.

For example, after chemotherapy and a stem cell transplant, kids can usually get live vaccines.

Your doctors can review the latest guidelines to come up with a safe vaccination plan for your child with an immune system problem. If necessary, consultation with an infectious diseases or immunology specialist can also be helpful.

Don’t overlook other causes of possible immunosuppression when getting vaccinated, like taking daily oral steroids for more than two weeks, certain biologic immune modulators, or other medications like methotrexate, azathioprine, 6-mercaptopurine.

“Limited evidence indicates that inactivated vaccines generally have the same safety profile in immunocompromised patients as in immunocompetent individuals. However, the magnitude, breadth, and persistence of the immune response to vaccination may be reduced or absent in immunocompromised persons.”

2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

And keep in mind that just because they can and should get vaccinated, it doesn’t mean that their vaccines are going to work as well as in someone who isn’t immunocompromised.

That’s why herd immunity is so important for these kids.

Vaccines for Close Contacts of Immunocompromised People

What about people who come into contacts with kids and adults who are immunocompromised?

Can they get vaccines?

“Close contacts of patients with compromised immunity should not receive live oral poliovirus vaccine because they might shed the virus and infect a patient with compromised immunity. Close contacts can receive other standard vaccines because viral shedding is unlikely and these pose little risk of infection to a subject with compromised immunity.”

Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

Yes, close contacts can get vaccinated, especially since we don’t use the oral polio vaccine in the United States anymore.

There are some exceptions for the smallpox vaccine, which few people get, and Flumist, but only in very specific situations, including a recent hematopoietic stem cell transplant.

Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and the The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.
Johns Hopkins Medicine, which includes the Johns Hopkins University School of Medicine and the The Johns Hopkins Hospital and Health System went out of their way to correct this anti-vaccine misinformation.

Worried about shedding?

You should be worried about getting a vaccine-preventable disease and giving it to those around you with immune system problems. That’s the real risk!

This is the modern anti-vaccine movement - taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.
This is the modern anti-vaccine movement – scaring parents and taking an immoral stand against vaccines and putting sick kids at risk for life-threatening disease.

And no, you are not being selfish to expect those around you to get vaccinated.

Vaccines are safe and necessary – for all of us.

More on Vaccines While Immunosuppressed

Which Vaccines Do You Get When You Join the Military?

The oral adenovirus vaccine is approved to prevent adenovirus infections in military populations.

Believe it or not, many vaccines are available that we don’t routinely get.

Some we only get if we travel, like vaccines for yellow fever and typhoid. Others we only get in high risk situations, like if you get exposed to a bat with rabies.

And one, the adenovirus vaccine, you can only get if you join the military.

Which Vaccines Do You Get When You Join the Military?

But don’t folks get a lot of vaccines when they join the military?

It depends…

Whether you join the Army, Navy, Air Force, Marine Corps, or Coast Guard, health personnel will evaluate your immunity status by checking your titers to routine vaccine-preventable diseases. So no, if you were wondering, it doesn’t seem like they just check the vaccine records that you might bring from your pediatrician.

And then once they assess your immunization or immunity status, you will get vaccinated:

  • upon accession – adenovirus, influenza, meningococcal, MMR, Tdap, and chicken pox
  • during the first or second half of collective training – hep A, hep B, and polio (if needed, although a dose of IPV after age 18 is required) and other vaccines based on risk

So, in addition to getting caught up on all routine vaccines that they might be missing, there are other “military vaccines” that they might need, including:

  • Adenovirus vaccine – given to enlisted soldiers during basic training
  • Anthrax vaccine – only military personnel with extra risk, although some civilians can get this vaccine too
  • Smallpox vaccine – only military personnel who are high risk and smallpox epidemic response team members, although some civilians can get this vaccine too

Which vaccines you get in the military might be determined by where you are getting deployed to.
Which vaccines you get in the military will likely be determined by where you get deployed.

Like the recommendations for civilians, other vaccines are mainly given to military personal if they have extra risk based on where they are being deployed.

  • Cholera – only military personnel with extra risk based on deployment or travel to endemic areas
  • Japanese encephalitis – only military personnel with extra risk based on deployment or travel to endemic area in Eastern Asia and certain western Pacific Islands
  • Rabies vaccine – pre-exposure vaccination is only for military personnel with animal control duties or with extra risk based on deployment, including special operations personnel
  • Typhoid vaccine – only military personnel with extra risk based on deployment or travel to typhoid-endemic areas and other areas with poor sanitation.
  • Yellow fever vaccine – only military personnel with extra risk based on deployment or travel to yellow-fever-endemic areas in sub-Saharan Africa and tropical South America.

These are the same vaccines that we would get if we traveled to high risk areas.

Military Vaccines in Development

It shouldn’t be a surprise that the military does research on infectious diseases and vaccines.

Members of the military are often put at great risk for known and emerging diseases, like Ebola, Zika, and malaria.

That’s why some vaccines might have been given as an investigational new drug in special situations, typically when “individuals who have a high occupational risk – laboratory workers, facilities inspectors, vaccine manufacturers and certain military response teams.”

These vaccines, which were initially developed at US Army labs, are no longer being produced, but have included:

  • Argentine hemorrhagic fever (Junin virus) vaccine
  • Chikungunya fever vaccine
  • Eastern equine encephalitis vaccine
  • Q fever vaccine
  • Rift Valley fever vaccine
  • Tularemia vaccine
  • Venezuelan equine encephalitis vaccine
  • Western equine encephalitis vaccine

Today, the Walter Reed Army Institute of Research (WRAIR) “is a leader in global efforts against the world’s most pervasive and high impact infectious diseases.”

WRAIR is working on vaccines for HIV, Ebola, MERS, and Zika.

What to Know About Military Vaccines

You will need some extra vaccines when you enlist in the military, but how many will depend on if you are up-to-date when you join and your area of responsibility. So there is no one-size-fits-all military immunization schedule.

More on Military Vaccines