The History of Vaccines Blog

Aylward at JHSPH: Eradicating Polio

Early 1960s Pfizer monovalent OPV On Friday, September 27, Johns Hopkins Bloomberg School of Public Health held its annual Vaccine Day. Bruce Aylward, MD, MPH, Assistant Director-General, Polio, Emergencies and Country Collaboration, World Health Organization, gave the keynote address. His title was "Eradicating Polio: Is the Juice Worth the Squeeze?" Aylward’s riveting Ted Talk explores similar topics, and so I won’t summarize much of what he discussed. But his picture of the economic benefits of polio eradication was quite interesting. Aylward noted that “It’s not enough that the cost benefit ratio is positive. It has to be very much in favor of the benefits, because the risks to failure are high.” Smallpox eradication provides a model for estimating the cost/benefit ratio of eradication. Aylward noted that the US saved about 159 dollars for every 1 dollar spent on eradication. For the international campaign, the ratio is about 400:1. And the United States recoups its financial investment in the smallpox eradication campaign every 26 days. So, he asserts, smallpox eradication was unequivocally worth the “squeeze.” More

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The Stranger in the Mirror in Bleak House

Nurse and Patient, Bleak House As I was reading Charles Dickens’s Bleak House, I was interested to find a description of an illness that most likely was smallpox. The incident involves Esther Summerson, the self-sacrificing heroine. At one point in the book, she performs the kind of act of charity we so often read about in novels from the era – a kind woman ministering to the poor and ill. She walks into a house to which her maid has brought her and notices an unpleasant fact.  “The place … had an unhealthy and a very peculiar smell.” Many reminiscences of smallpox mention the characteristic smell of the disease. In “The Demon in the Freezer,” Richard Preston quotes D.A. Henderson, director of the WHO’s Smallpox Eradication Programme: “My God, they talk about the odor of smallpox. It is an odd smell, not like anything else…It's a sickly odor, like rotting flesh, but it's not decay, because the skin remains sealed and the pus isn't leaking out….That smell is one of the mysteries of smallpox. No one knows what it is. " A boy in the house is feverish, and Esther and the maid tend to him. More

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Philly Students Learn About Smallpox

KJF students playing Illsville Yesterday I had the pleasure of working with the College's new group of Karabots Junior Fellows. The Karabots Junior Fellows Program uses the resources of The College of Physicians of Philadelphia to provide practical assistance, mentoring, and academic and social support to a select group of Philadelphia high school students from communities under-represented in current healthcare professions. This three-year program is designed to facilitate their continuation into post-secondary education required for a career in health care. A new cohort of rising tenth-grade students arrived a few weeks ago for a summer intensive program before the afterschool program begins in September. They've been learning about skin as a focus of all their activities, and have explored body modifications including tattooing and piercing, as well as the subject of amputation, especially in relation to our new Civil War medicine exhibit, opening at the Mutter Museum shortly. More

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1945 Diphtheria Antitoxin Production Film

Diphtheria Incidence and Deaths, England and Wales In preparation for a talk I’m giving in September, I searched the The Internet Archive for information about diphtheria antitoxin (AT) production. Though I was really investigating very early AT production (1890s), I couldn’t help but get drawn in by a 1945 Wellcome Physiological Research Laboratories film of diphtheria AT and toxoid production in England. The film is part of the Wellcome Library's collection on The Internet Archive. Before World War 2,  there was “…no appreciable effort to immunize children to a level that would have materially altered the occurrence of [diphtheria]” (Smallman-Raynor & Cliff, p. 46). However, the Ministry of Health launched a national immunization campaign in late 1940 to attempt to protect children vulnerable to diphtheria in the straitened, crowded war-time conditions. By the end of 1945, about 62% of Welsh and English children had received diphtheria toxoid. Still, as the Wellcome film notes, during the war years, more child deaths resulted from diphtheria than from bombing (9,000 deaths from diphtheria versus 8,000 deaths from bombing). More

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Sioux City Polio Epidemic 1952

Iron Lung, Sioux City Museum I was raised in Sioux City, Iowa, a town of about 80,000 people on the very western edge of the state, where the Big Sioux and Floyd rivers join the Missouri. Much of the town's history and identity comes from the rivers -- French fur traders used them for transporting goods, Lewis and Clark traveled up the Missouri, burying their only casualty on a river bluff in what is now Sioux City, and later, steamboats and barges moved material up and down the river. As they did in 2011, the rivers frequently flooded, with disasterous consequences. I hadn't known before that a flood in 1952 was linked to a polio epidemic in the town. More

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American Presidents and Infectious Diseases

We've expanded and updated a popular post from 2012 by History of Vaccines former intern Alexandra Linn. Happy Fourth of July! In honor of this historic U.S. holiday, we’ve compiled a list showing how infectious diseases have affected the lives of our most heralded leaders – the American presidents. These concise accounts are evidence that diseases can strike anyone, anywhere at any time, and even in the White House. More

Revisiting Early Uses of Diphtheria Anti-Toxin in the United States

NYC anti-toxin horse, "Old Faithful." From Park, 1929. I’ve previously written about an early use of diphtheria anti-toxin in the United States, on October 16, 1894. A pair of young Cincinnati physicians managed to find some anti-toxin in the possession of a local physician who had brought it back from Europe. They treated a young girl who survived, and a Cincinnati newspaper trumpeted on October 20 that the doctors had used the new serum. The typescript memoir of this incident says that this was the first use of anti-toxin in the country, but I knew that there were probably other uses around this time. A recent note from an NIH researcher prompted me to look at the timing once again to try to establish, if not the definitive first use of anti-toxin in the states, then at least an earlier use than the one in Ohio. More

Video: Do Vaccines Overwhelm the Infant Immune System?

Courtesy Academic Earth AcademicEarth, an educational video and online course provider, has just produced a video for its collection of video electives-–standalone videos that illustrate interesting concepts across a variety of disciplines.In this video, they take on the “too many, too soon” argument often made by vaccine objectors: that receiving multiple vaccines at one time is harmful to a baby or child. The narrator tries to estimate total antigen exposure to age 18 and then compares that figure with antigen exposure via vaccination to age 6. More

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Circulating Vaccine-Derived Poliovirus and the Eradication Endgame

CDC, MMWR, 9/12/12 A recent paper published in Journal of Virology describes sporadic and sustained outbreaks of illness from vaccine-derived polioviruses in Nigeria. This study draws attention to what is often called the polio endgame – the vaccines and immunization activities that will be necessary to eradicate polio, given the ability of vaccine-derived viruses from the live polio vaccines to circulate and cause disease. To understand the complications of eradicating polio, it’s necessary to know that three types of wild poliovirus have been identified. Types 1 and 3 are responsible for all cases of wild polio in the remaining polio-endemic countries of Pakistan and Nigeria. (Very recent polio cases in Kenya and Somalia are due to Type 1 wild poliovirus.) Type 2 wild poliovirus has not been detected since 1999, when it was found in Uttar Pradesh, India. It is presumed to be eliminated. More

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Testing a Smallpox Digital Game

Pox in the City, courtesy Lisa Rosner Yesterday I spent some time working with students from nearby Science Learning Academy. We were testing a version of a medical history game in development by Lisa Rosner, PhD, and her colleagues at Richard Stockton College in New Jersey. It’s a bit of a challenge to transport 10th grade urban high school students to 19th century Edinburgh where the game is set. But the students were willing to make the leap, and they spent about an hour in the role of a young doctor who must build a practice, court wealthy patrons, gain entry to a medical society, and protect his patients from disease. The students initially didn’t know much about smallpox (though I did show them this illustration of the course of the disease in a young man in the 1880s). But they soon came to see the threat the disease posed: if they didn’t act quickly to vaccinate the other children in a family after one child became ill with smallpox, all the children died. More

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