Monkeypox, a relative of smallpox, has made the news recently with some outbreaks. Death rates have been mentioned between 1% and 10%.
Fortunately, the US has a stockpile of smallpox vaccines for the entire population, and smallpox vaccines appear to be mostly effective against monkeypox.
However, smallpox vaccines have a rate of life threatening reactions of 14 to 52 per million (death rate from such 1 to 2 per million), which is higher than for any COVID-19 vaccine. So if monkeypox does become a problem that requires breaking out the vaccines for, it is likely that refusal will be common, like with COVID-19 vaccines.
Do we know whether a smallpox vaccination from 60 years ago still works now against monkeypox?
I would hope that a vaccine could be made available (eg, for our kids) if monkeypox spreads. From what I have heard it seems more likely that the spread will be contained.
Or more specific. I never had a small pox vaccination that scabbed over. My doctors tell me that I had a natural immunity…I got at least 8 small pox vaccinations last one when I was entering college.
I also had a grad total of 3 chicken pox when I had the chicken pox at age 12.
Just an FYI. Smallpox (variola) and chickenpox (varicella zoster) are caused by viruses from different families. Monkeypox is a relative of smallpox, but much less deadly (only 3-6% of cases have been fatal by some data).
Monkeypox is far, far less easily transmitted - only by respiratory droplets (not aerosols), or close contact with bodily fluids or shared bedding. It’s being spread largely by men having sex with men, and then close contacts of those men. The thought is not that it’s being sexually transmitted per se, more that a sex partner means close contact, so sex tourism and with many partners is spreading it.
There are antivirals that can help, but by the time the pox appear, it’s probably too late for that, and it’s not as if it’s going to be easily diagnosed in the febrile, malaise stage before the pox appear. What medical provider is going to think of monkeypox in a person with fever?
Death rate is much lower than smallpox. Still, I wouldn’t want to get it, and any degree of immunosuppression would make it deadly; in fact, in the old days of chicken pox and frequent use of oral steroids for asthma, children who had just recently been treated with oral steroids for asthma or other reasons, would die of overwhelming chicken pox.
It still doesn’t appear that there has been some change in the monkeypox virus to make it more contagious. Seems more likely that like HIV, it has gotten into a population that has high exposure rates, and so it is spreading. Because, unlike HIV, it makes people very sick very quickly, it’s unlikely to spread very extensively. It will probably be brought under control very soon.
I strongly doubt that the US will be breaking out the stores of smallpox vaccine. And yes, antivaxxers will most definitely be anti-smallpox vaccine, never mind that it’s been safely used for over 200 years. Supposedly, we are no longer protected by those smallpox vaccines some of us oldsters had 50 or more years ago. I’ve often worried about the fact that my kids are not vaccinated against smallpox, and so would be vulnerable if there were an outbreak.
No, it doesn’t. You’re probably not immune to smallpox either. Vaccines wear off. Vaccines keep communicable diseases at bay by interrupting transmission and thereby reducing circulation of the pathogen. With smallpox, we reduced circulation to zero because everybody got vaccinated. So it doesn’t exist in the wild any more. But individuals who got the vaccine are unlikely to have robust immunity, if any, anymore.
Vaccines for communicable diseases are more of a public health solution than an individual solution.
Vaccines have both purposes. In places where public health fails (e.g. due to vaccine refusal), getting vaccinated is a tool that individuals could use to reduce their personal risk from the infectious disease.
Whether immunity from smallpox vaccination from the 1970s or earlier is still sufficient is not that well known. One antibody study in 2009 found that antibody levels from vaccination are long lasting even up to 88 years later. Another antibody study in 2003 found a similar result. But another study from from smallpox was still around found that vaccination 20 years prior was less effective than more recent vaccination at preventing death (52% death rate unvaccinated, 11% death rate vaccinated >20 years prior, 1.4% vaccinated <10 years prior), suggesting some decline in effectiveness.
Eh. Sort of. In the short term. Vaccines wear off. That’s why in the medium- to long-run they only work if a threshold percentage of the population gets them. The lower the effectiveness of the vaccine (see: mumps) the higher the percentage of the population that has to be vaccinated for long-term population protection.
That’s why when you go to Afghanistan or Pakistan, where polio still circulates, you have to get revaccinated. Your individual immunity is not reliable there.
Where public health fails (like in the US), most individuals can improve personal protection with vaccination, including boosters as needed (depending on the duration of immunity, which varies from a few months for mismatched COVID-19 vaccines to many decades for measles and rubella).
We do not really know the duration of immunity from smallpox vaccination.
Although I do believe I’ve read studies that found robust immune responses decades after vaccination. But, again, not to be relied on. I’d say close to zero people in the United States have solid immunity to smallpox at this point. Of course, if you’ve ever had the disease, you have life-long immunity.
Interesting results regarding efficacy of smallpox vaccine in preventing infection/serious disease/death years later. I’ve always wondered whether the inevitable intermittent exposure that one got to viruses that still circulated, before the vaccine had essentially eliminated them in the population, such as measles, acted as a booster dose. Whenever I saw a suspected case of chicken pox, I’d breathe deeply, figuring that it was a free zoster vaccine! I do believe that the virtual elimination of chicken pox in the population via immunization is what has led to an increased incidence of shingles - people aren’t getting exposed to chicken pox, and hence don’t have an inciting exposure that induces an antibody response.
Before vaccination, there was variolation. This consisted of scratching a tiny bit of matter from a smallpox lesion into the skin of a person who hadn’t yet had smallpox, and hoping that they had only the very mildest reaction, that would induce immunity. It had a death rate of only about 1:100, vs 1:3-1:10 for actual smallpox. Plus those who were successfully variolated only got one scar, vs hundreds. There must have been data regarding those who had been successfully variolated getting smallpox (or not) ten, twenty, even fifty years later, since it was an endemic disease. But I have never read that anyone had the procedure repeated, and I never read of anyone having gotten smallpox in their lifetime after having been variolated once. But of course, that was with the smallpox virus itself, not the vaccinia virus.
You get shingles ONLY if you’ve had chicken pox. That’s why I got my kids vaccinated against cp the second they were eligible. I would never try to get cp as a natural immunity. The disease itself can be horrible and shingles is even worse. Ugh.
The varicella vaccine isn’t 100% effective, so vaccinated people can get shingles but they do so at a reduced rate as compared to the unvaccinated.
Here’s some data, but there are other studies.
Approximately 38 per 100,000 children vaccinated against chickenpox developed shingles per year, compared with 170 per 100,000 unvaccinated children, researchers found. Furthermore, shingles infection rates were lower in children who received both recommended doses of the chickenpox vaccine compared with those who only got the first dose.
