Um, isn't smallpox gone?

[autumn1971]

So my wife works at a hospital clinic, and tonight, as happens once in a while, she and other staff members were treated to a dinner where medical things were discussed, and needs to purchase items pursuant to whatever was being talked about came up. My wife is not a physician, but she mentioned to me that the general discussion tonight was about vaccines and such. We talked about the apparent resurgence of pertussis, which is pretty disturbing, and then she mentioned that a physician there said that the entire clinic should be vaccinated for smallpox because new cases were being seen.
This surprised me.

I asked my wife (gently and non-judgementally) if she was sure that this guy wasn't just talking about possible biological terrorism, because I was fairly certain that smallpox in its natural state was extinct. I asked (again, not implying that she was not well informed or a bad listener) if she had heard correctly that new cases of smallpox had been reported.

After being chewed out quite thoroughly for being such a know-it-all bastard, I found that our phone connection had somehow been compromised (darn cell phones).

My question, for those here who know much more than I about epidemilogical matters (read: everyone) is, does the smallpox virus exist in nature, or only in labs like the CDC and secret installations devoted to biological weapons? I seem to even recall a controversy about destroying lab stocks, as this would be a deliberate extinction event.

[LostAngeles]

A toddler and his mother got sick reportedly from the father's smallpox vaccination. http://www.edmontonsun.com/News/World/2007/03/18/3775663-sun.html

... Doctors stressed that the boy was not suffering from smallpox, but from the related vaccinia virus which is used to convey immunity to the much deadlier disease.

They said the boy, who seemed to be improving, may lose 20% of his outer skin layer.

The boy and his mother remained in hospital in a specially ventilated room, though there is no infection risk for the general population because the vaccinia virus can be spread only through close physical contact. The family's name was not released at their request.

Doctors said the infection was a rare condition called eczema vaccinatum, which has not been reported since at least 1990, when the U.S. military ended a previous program of smallpox vaccination. Smallpox was declared eradicated in 1980.

The military began smallpox vaccinations again in 2002 because of bioterrorism fears.

I also thought other than a small sample possessed by the CDC and someone else, it was gone.

[Slimething]

...she mentioned that a physician there said that the entire clinic should be vaccinated for smallpox because new cases were being seen.
This surprised me.

My question, for those here who know much more than I about epidemilogical matters (read: everyone) is, does the smallpox virus exist in nature, or only in labs like the CDC and secret installations devoted to biological weapons? I seem to even recall a controversy about destroying lab stocks, as this would be a deliberate extinction event.

I'm with you. I googled smallpox and all I got was a wide variety of health-related sites saying that the last known case was in 1977. I sure hope your wife is wrong and I think the MD she listened to was wrong as this would be fairly important news to all of us. I don't know where the MD expects to find the vaccine as I think it's tightly controlled by the CDC. I don't think it will be distributed unless there is a CDC-confirmed outbreak.

Good luck lying low for a while! :)

[autumn1971]

Thanks for the link, LostAngeles, but the boy's infection is not smallpox, and the article made no link between the infection and smallpox. Except to note that it had not been seen since before the military ended its smallpox vaccination program, there was not a relation between the specific pathogen and the general disorder seen among those unfortunate few with a predisposition to aquire a disorder from those around them who had been vaccinated for any general virus. Note the name of the disease is eczema vaccinatum, a disease of the skin related to vaccination, not to smallpox. I think the "since the military ended its vaccination" bit is a little slice of fear mongering.

[autumn1971]

Slimething, I said the same thing to my wife; did I miss two inch headlines in every major newspaper shouting about the impending doom? Wouldn't a doctor with a new case of smallpox be instantly elevated to celebrity? How would I not know about a case of smallpox?

But my arguments with my wife got me to thinking; is smallpox like polio? Have we in the first world simply forgotten about the rest of the globe? I know I have no concerns that my son will contract polio. I also know that polio is still a fact of life for many on this planet. Is the reported eradication of smallpox simply another example of the first world's egocentric "it no longer affects Us, and is therefore no longer a world health issue" atitude?

[LostAngeles]

Thanks for the link, LostAngeles, but the boy's infection is not smallpox, and the article made no link between the infection and smallpox. Except to note that it had not been seen since before the military ended its smallpox vaccination program, there was not a relation between the specific pathogen and the general disorder seen among those unfortunate few with a predisposition to aquire a disorder from those around them who had been vaccinated for any general virus. Note the name of the disease is eczema vaccinatum, a disease of the skin related to vaccination, not to smallpox. I think the "since the military ended its vaccination" bit is a little slice of fear mongering.

I know, but it's the closest thing I found to what you were talking about. Maybe that's the source of the confusion, though?

[kellyb]

I know, but it's the closest thing I found to what you were talking about. Maybe that's the source of the confusion, though?


I'm sure it is.
If there were cases of smallpox popping up again, it would be all over the news and on the front page of the CDC's site.

[autumn1971]

Still, are any pathologists or epidemiologists out there to prove me right, cough cough, I mean show that my wife may have been just a little bit mistaken?

[kellyb]

It could have been the physician who was mistaken. A lot of people think the smallpox vaccine was/is attenuated smallpox, so the physician could have assumed the complication with the vaccination was mild case of breakthrough smallpox.

[Zep]

Are there not other diseases still out there that look like, produce symptoms similar to, or are related to smallpox? The vaccination one is known, but there may be others. She MAY have mistaken the disease name as chicken pox, for example, which has a number of strains and similar dangerous variants.

[kellyb]

Are there not other diseases still out there that look like, produce symptoms similar to, or are related to smallpox? The vaccination one is known, but there may be others. She MAY have mistaken the disease name as chicken pox, for example, which has a number of strains and similar dangerous variants.

The chickenpox virus, varicella, doesn't have dangerous variants or strains, but it can be deadly when the host factors are all wrong. But the virus itself is one of the most stable known to man.

But yeah...there are a number of other orthopox viruses (varicella isn't an orthopox virus, by the way...it's a member of the alpha herpes family of viruses...smallpox, cowpox, and vaccinia are orthopox viruses, though) that have been known to infect humans, but I still think someone somewhere heard about the vaccinia (smallpox vaccination virus) complication, and assumed that there were cases of smallpox popping up.

[autumn1971]

Are there not other diseases still out there that look like, produce symptoms similar to, or are related to smallpox? The vaccination one is known, but there may be others. She MAY have mistaken the disease name as chicken pox, for example, which has a number of strains and similar dangerous variants.


No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.

[kellyb]

No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.

Well, they do have a shingles vaccine now. But I'd still go rub any chickenpox infested kids on me if I got the chance.
In defense of the varicella vaccine, they didn't know until a couple of years ago that the vaccine viruses ability to infect the dorsal root ganglia (and thus re-emerge as shingles) wasn't actually attenuated at all. And childhood mortality from varicella, while low to begin with, is now down to almost nothing.

[LostAngeles]

No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.

Well, if you'd like help with the hypochondria, might I refer you to WebMD.com where every little symptom means you're dying a horrible, horrible death.

[Beady]

Well, if you'd like help with the hypochondria, might I refer you to WebMD.com where every little symptom means you're dying a horrible, horrible death.

I'll be 57 in a few days (jeez, I was going to say "a couple of weeks," but I just looked at the calendar), and I had thought I was on death's door; there was an almost constant pain in my legs when I walked, I couldn't get to the top of the stairs without running out of breath, and I wheezed in bed. My GP had diagnosed asthsma, and is considering COPD, as well as Peripheral Artery Disease. I quite literally made out my will.

Then I got referred to a urologist, who decided my prostate has to come out, and he told me to lose some tonnage before surgery. After just two weeks on a treadmill (one mile per day, 2.5 mph, 2.5% incline), and a 1500-calorie diet, I'm down two pounds (not much, but it's a start), the pain in the legs is gone, and I no longer wheeze or gasp.

I'm a confirmed lazy slob, but the best cure I've found for hypochondria is to get up off your ass. And I would like to extend my fondest thanks to my GP for all the ennabling.

[ponderingturtle]

Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. The last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention
Link (http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp)

So the CDC does not think there have been any recent cases of it. I am amazed that the doctors did not call BS when someone mentioned it.

[patnray]

Smallpox was the first disease targeted for world wide elimination precisely because the vaccine was cheap, stable, easily administered, and there are no non-human vectors. Any such effort also requires a large PR campaign to convince everyone to participate. The first round of smallpox eradication appeared to succeed, but then new cases began popping up. Turns out that some rural chieftains were told of the importance of the campaign, but took it to mean that their villages would be seen in an unfavorable light if they reported cases of smallpox. So they stoppped reporting them. Workers had to go back and convince them that they would be seen as heros for reporting cases and for encouraging everyone to get vaccinated. With that second effort smallpox was finally eliminated, although, because of the first experience, it took a few years to be confident.

[autumn1971]

Thanks, all.


But my wife is still ticked-off at me.

[skeptigirl]

No, we talked at length about the shingles vaccine, and the chicken pox vaccine, and whether the two were at any point connected, and whether shingles would not be a problem in the future, since children now don't get chicken pox. As she explained to me (I am not in the health care field, and my ignorance was known to her before her scathing criticisms), the vaccine, being a not entirely attenuated version of the virus, still puts the actual pathogen into your nervous system, possibly to explode later as shingles. This is a rather disturbing bit of knowledge, and I look forward to my future hypochondria.There is a big misconception that shingles is more dangerous than chicken pox or that the vaccine for chicken pox causes a worse problem than it prevents.

The initial infection EVERYONE has if infected with chicken pox is chicken pox. About 90% of people have had the infection by age 19 and close to 100% have had it by the age of 40. But a good number of cases have no accompanying rash so not everyone knows they have had it.

After being infected, the virus is not cleared from your body and instead remains dormant in specific nerve cells. Some people later develop shingles when they virus is reactivated. This typically occurs once in people unless they have a seriously weakened immune system. Only then is shingles life threatening.

Shingles and chicken pox can both be treated with acyclovir and the newer versions of the drug.

However, for chicken pox, the vaccine is still safer than waiting for the roulette wheel of wild virus infection. Chicken pox kills a small number of people every year including some children. Some people also end up with permanent lung damage from chicken pox and secondary infection of the pox is common. There have been outbreaks of rapidly invasive streptococcal disease (flesh eating bacteria) in children with pox rashes.

The vaccine does not increase your risk of shingles and the chances you are not going to get chicken pox is close to nil if you are not vaccinated so you will be at risk for shingles anyway.

The shingles vaccine is too new to say with any certainty whether in people with normal immune systems the vaccine is better than anti-viral drugs during an outbreak. I have not read up on who should be getting the vaccine. Once it has been in use for a while, we'll know if everyone should get it or not.

[Zep]

Thanks, all.


But my wife is still ticked-off at me.There's no vaccine for that... :boxedin:

[skeptigirl]

....

But my arguments with my wife got me to thinking; is smallpox like polio? Have we in the first world simply forgotten about the rest of the globe? I know I have no concerns that my son will contract polio. I also know that polio is still a fact of life for many on this planet. Is the reported eradication of smallpox simply another example of the first world's egocentric "it no longer affects Us, and is therefore no longer a world health issue" atitude?This has been stated but let me add a tiny bit to the story.

The reason we were able to eradicate smallpox was because there are no animal or environmental reservoirs (http://www.cdc.gov/ncidod/eid/vol9no11/03-0088.htm). Vector (http://www.medterms.com/script/main/art.asp?articlekey=5968) is the wrong word. It does mean something which carries and transmits disease. However, a reservoir is where a disease resides when out of circulation so to speak, but is still in existence. A vector more often refers to something which carries and transmits the disease. So a vector is always a reservoir but a reservoir is not always a vector.

The wild bird population is a reservoir for bird flu but it isn't referred to as a vector of disease though technically when poultry end up being direct sources of human infection they are then considered vectors. Ponds and lakes have been found to be reservoirs of influenza viruses. A lake is not a vector.

Anyway, back to the story. We were able to eradicate smallpox because the WHO undertook an aggressive campaign in 1967 to do so, and because all cases were tracked down, isolated and all their contacts were isolated until no new cases occurred.

Virus samples had been held by the US, Great Britain and Russia but in 1978 after a lab accident in Great Britain (http://www.who.int/mediacentre/factsheets/smallpox/en/) led to a fatal infection only the US and Russia are now known to still hold specimens. That was the last known case of smallpox on Earth.

Vaccinia virus is not an attenuated smallpox virus. According to the Stanford web site (http://www.stanford.edu/group/virus/pox/2000/vaccinia_virus.html)Vaccinia virus is a big mystery in virology. It is not known whether vaccinia virus is the product of genetic recombination, or if it is a species derived from cowpox virus or variola virus by prolonged serial passage, or if it is the living representative of a now extinct virus.

According to the CDC (http://www.bt.cdc.gov/agent/smallpox/vaccination/live-virus.asp)The vaccinia virus is the "live virus" used in the smallpox vaccine. It is a "pox"-type virus related to smallpox. When given to humans as a vaccine, it helps the body to develop immunity to smallpox. The smallpox vaccine does not contain the smallpox virus and it cannot cause smallpox.

This differs considerably from polio. In polio, 95% of cases do not involve paralytic disease. So it is very hard to track down every last case. However, there still are no animal reservoirs. So after maintaining a high percentage of vaccination in the population of Western countries, we have nonetheless managed to eliminate all wild virus infection except that which is occasionally imported.

The polio vaccine which is an attenuated vaccine can very rarely cause paralytic disease usually after it passes through the gut of the vaccinated person and infects an unvaccinated person. A couple years ago the few cases of polio found in the Americas were all identified as vaccine strains and none were wild virus strains. The decision was made that because the wild virus was eliminated (except for imported cases) it was no longer true that the vaccine was safer than the disease. However, the killed vaccine is still safer than the disease risk. So the ACIP (Advisory Committee for Immunization Practices) changed the recommendation to killed vaccine in the USA. Other countries in the Western Hemisphere I believe followed suit but I am not positive of that.

However, in countries where wild polio virus infection is still occurring, the live vaccine is more effective, only requires one dose instead of three, and doesn't require the use of injections, a problem that has resulted in blood borne infections like HIV and hepatitis B in poverty stricken countries tempted to reuse disposable syringes. Live polio vaccine is still recommended in third world countries outside of the Western Hemisphere and the WHO is trying to wage an aggressive campaign against polio like they did against smallpox.

[skeptigirl]

More smallpox trivia:

Routine vaccinations in the USA ended in 1972. If you were born in the US before that you were likely vaccinated. After 1972 the military continued to vaccinate soldiers until the 1980s when that was also stopped.

After the anthrax incident and 911, the US tried to implement a voluntary smallpox vaccine program for key health care workers who would then be able to respond to a bioterrorism incident. But a few cases of cardiac infection with the vaccinia virus resulted in the campaign being halted. You can be vaccinated at the time of an exposure (you have about 48 hours) and still be protected or at least have milder disease.

The military resumed vaccinations after 911 and apparently are still giving the vaccine. The sad thing about this infected child in the news is that it was preventable either by better screening of the servicemen and women vaccinated (you don't vaccinate people with eczema or with household members with eczema) or with proper education of the vacinee in how to care for the vaccine site and keep the vaccinia virus from being transmitted to others.

Regarding whether having had a smallpox vaccine 30+ years ago is still protecting you, two studies which looked at two different outcomes came to the opposite conclusions. (Reminds me I could use this example in the thread where we are discussing when evidence does and does not actually apply to one's hypothesis.)

[skeptigirl]

Still, are any pathologists or epidemiologists out there to prove me right, cough cough, I mean show that my wife may have been just a little bit mistaken?

You can quote me, infectious disease is my field and I've been practicing in it for 16 years.

[skeptigirl]

It could have been the physician who was mistaken. A lot of people think the smallpox vaccine was/is attenuated smallpox, so the physician could have assumed the complication with the vaccination was mild case of breakthrough smallpox.Definite possibility.

[skeptigirl]

Are there not other diseases still out there that look like, produce symptoms similar to, or are related to smallpox? The vaccination one is known, but there may be others. She MAY have mistaken the disease name as chicken pox, for example, which has a number of strains and similar dangerous variants.
While there are related diseases (vaccinia, monkeypox and cowpox are related - orthopoxviruses), and there are 'pox' diseases, (chicken pox - not related, it is in the herpes virus family), smallpox has unique symptoms and other infections are not easily mistaken for small pox.

Poxviridae (http://www.ncbi.nlm.nih.gov/ICTVdb/Images/em_poxvi.htm)
Poxviridae (http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/58000000.htm)
Orthopoxvirus (http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/58110000.htm)
Herpesviridae (http://www.ncbi.nlm.nih.gov/ICTVdb/Ictv/fs_herpe.htm)

[skeptigirl]

The chickenpox virus, varicella, doesn't have dangerous variants or strains, but it can be deadly when the host factors are all wrong. But the virus itself is one of the most stable known to man.

But yeah...there are a number of other orthopox viruses (varicella isn't an orthopox virus, by the way...it's a member of the alpha herpes family of viruses...smallpox, cowpox, and vaccinia are orthopox viruses, though) that have been known to infect humans, but I still think someone somewhere heard about the vaccinia (smallpox vaccination virus) complication, and assumed that there were cases of smallpox popping up.Ooops, you beat me to it.

I think you are correct about someone mistaking what they heard/read in the news.

[skeptigirl]

Well, they do have a shingles vaccine now. But I'd still go rub any chickenpox infested kids on me if I got the chance.
In defense of the varicella vaccine, they didn't know until a couple of years ago that the vaccine viruses ability to infect the dorsal root ganglia (and thus re-emerge as shingles) wasn't actually attenuated at all. And childhood mortality from varicella, while low to begin with, is now down to almost nothing.I'm confused about this post. I sure as he11 wouldn't go out and try to get a varicella infection were I not immune. And what do you mean not attenuated at all? Think you might want to update your varicella vaccine knowledge with more accurate information.

Do you have any cases of fatal disseminated shingles in a person who has a normal immune system? Know of any fatalities related to varicella vaccine? Know of any cases of fatalities from varcella vaccine shingles?

Because I can find you the fatal cases from wild varicella infection.

[timhau]

A little-known fact about smallpox:

The last person to catch smallpox was Chuck Norris. This was in 1977; today, smallpox lives in a crummy low-rent apartment in Central LA under an assumed name, goes to therapy twice a week, and still has nightmares about Chuck.

:boxedin:

[skeptigirl]

I found one reference to a fatality (http://jama.ama-assn.org/cgi/content/full/284/10/1271) from the varcella vaccine in a child with asthma but to read the details requires a subscription so I have no idea what the circumstances were. The Google entry reads,Varicella Vaccine Fatality Reports. Patient A. Shortly before her eighth birthday, a girl with history of chronic severe asthma received a tuberculosis ...

Chicken pox, OTOH, causes a number of hospitalizations, deaths and permanent brain and respiratory sequelae in some cases every year.

Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59681)On average, 25 people a year die from chickenpox. Overall case fatality was 9.22 per 100 000 consultations for chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths were twice as common in men as in women. More of those who died were born outside United Kingdom than expected (12% v 4%).

Conclusions
Chickenpox is not a mild disease. Deaths in adults are increasing, both in number and proportion.

Severe Complications of Varicella in Previously Healthy Children in Germany: A 1-Year Survey (http://pediatrics.aappublications.org/cgi/content/abstract/108/5/e79)The most frequent complications were neurologic, which were reported in 73 children (61.3%); cerebellitis was the leading diagnosis (n = 48), followed by encephalitis (n = 22), meningitis (n = 2), and central facial palsy (n = 1). A total of 46 (38.6%) infectious complications were identified. Superinfections of the skin were present in 31 (26.0%), pyogenic arthritis was present in 5 (4.2%), osteomyelitis was present in 4 (3.3%), necrotizing fasciitis was present in 3 (2.5%), orbital cellulitis was present in 2 (1.6%), and pneumonia was present in 1 (0.8%). Streptococcus pyogenes was the leading cause of bacterial infections (18 cases [15.1%]), with invasive disease in 6 patients (8.4%) and linked to 4 of 8 cases with defect healing. Infectious complications were reported in the majority in younger children up to 4 years of age, whereas neurologic complications occurred more frequently in an older age range. Five children experienced thrombocytopenia or severe anemia. There was no bleeding disorder, no fatality, and no case of Reye syndrome reported during the 1-year observation period. In total, 8 (6.7%) of 119 patients reported having long-term sequelae, 6 attributable to infectious complications and 2 to persistent deficits after neurologic complications.

Conclusion. This is the first prospective nationwide study of severe complications of varicella in immunologically healthy children. Related to 14 025 867 children up to the age of 16, a crude incidence of severe chickenpox complications of 8.5/100 000 could be calculated. The actual hospitalization rate attributable to complicated chickenpox is probably much higher, because this calculation refers to a population theoretically at risk and not the truly susceptible individuals. The results of this study demonstrate considerable morbidity with a comparatively high rate of encephalitis, osteomyelitis, and pyogenic arthritis.

Varicella-Related Deaths Among Adults — United States, 1997 (3 case descriptions) (http://www.cdc.gov/mmwr/PDF/wk/mm4619.pdf)

The cost-effectiveness of varicella vaccine programs for Australia. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10519929&dopt=Abstract)strategy I (no vaccination) was compared with three different varicella vaccination programs: strategy II - all infants; strategy III - adolescents without a history of varicella; and strategy IV ('catch-up')- all infants plus, for the first 11 years, adolescents without a history.Outcome measures: fatalities and hospitalisations for varicella and its complications (encephalitis, pneumonitis, long-term disability).Results: the average cost per case of chickenpox averted was $64, $530 and $418 in the infant, adolescent and catch-up programs, respectively. The infant program was the most cost-effective of the three. This program could avert 4. 4 million cases, 13,500 hospitalisations and 30 fatalities for chickenpox over a 30-year period. Results were sensitive to the price of the vaccine and the discount rate, but relatively insensitive to changes in vaccine efficacy, coverage rates or vaccine complication rates. Improved accuracy of a negative varicella history in adolescents would substantially reduce the costs of the adolescent and catch-up programs making these programs feasible.Conclusions: the infant vaccine program is the preferred program, but the direct costs of any of the vaccination programs considered here are greater than the direct costs of no vaccination program.

PubMed citations for varicella fatalities including the above citation: (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&db=PubMed&term=varicella+fatalities&tool=QuerySuggestion)lias A, Galanakis E, Raissaki M, Kalmanti M. Related Articles, Links
Abstract Childhood encephalitis in Crete, Greece.
J Child Neurol. 2006 Oct;21(10):910-2.
PMID: 17005114 [PubMed - indexed for MEDLINE]
2: Abuhammour W, Hasan RA, Unuvar E. Related Articles, Links
Free Full Text Group A beta-hemolytic streptococcal bacteremia.
Indian J Pediatr. 2004 Oct;71(10):915-9.
PMID: 15531835 [PubMed - indexed for MEDLINE]
3: Scuffham PA, Lowin AV, Burgess MA. Related Articles, Links
Abstract The cost-effectiveness of varicella vaccine programs for Australia.
Vaccine. 1999 Oct 14;18(5-6):407-15.
PMID: 10519929 [PubMed - indexed for MEDLINE]
4: Gangaram HB, Cheong IK. Related Articles, Links
Abstract Fatal haemorrhagic chickenpox complicating nephrotic syndrome.
Med J Malaysia. 1993 Dec;48(4):446-8.
PMID: 8183171 [PubMed - indexed for MEDLINE]
5: Ceyhan M, Kanra G, Secmeer G, Okuyan K, Kale G. Related Articles, Links
Abstract [Fatal varicella pneumonia unresponsive to acyclovir therapy in a child with a malignancy]
Mikrobiyol Bul. 1992 Jul;26(3):266-70. Turkish.
PMID: 1528147 [PubMed - indexed for MEDLINE]Nothing else came up for vaccine fatalities or varicella zoster fatalities.

[skeptigirl]

Link (http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp)

.... I am amazed that the doctors did not call BS when someone mentioned it.
Sadly, I am not. I'm convinced the chapter on infectious disease in med school is a short one.

[Big Les]

By-the-by really, but archaeologists concern themselves over diseases like smallpox, for example at the excavation of burial vaults (http://ads.ahds.ac.uk/catalogue/adsdata/cbaoccpap/pdf/121/121tl003.pdf) at Christ Church, Spitalfields, London.

The reference to disease risk is fairly brief, but the linked pdf ought to be of interest to anyone of an historical, archaeological, or just plain morbid bent. :)

[ponderingturtle]

Sadly, I am not. I'm convinced the chapter on infectious disease in med school is a short one.

But the point is the so many people with no medical training know that small pox is the one disease that has been effectively eradicated from the world.

[patnray]

Thanks Skeptigirl for all your information and for correcting my misuse of the word "vector". One of the things I love about this site is the way we correct each other's errors.

[skeptigirl]

Thanks Skeptigirl for all your information and for correcting my misuse of the word "vector". One of the things I love about this site is the way we correct each other's errors.
:D

[skeptigirl]

But the point is the so many people with no medical training know that small pox is the one disease that has been effectively eradicated from the world.I bet less of them know that than you estimate.

Ever watch Jay Leno's Jaywalking? Have you seen the Harvard grad interviews where the majority of graduates couldn't explain why we see Moon phases or what causes the seasons?

We had local Pertussis epidemics 3-4 years in a row when I called to follow up on a patient taken to the ED to see if Pertussis was being ruled out. The ED doctor told me, "adults don't get pertussis." 60% of the local annual cases which numbered in the hundreds were in adults. Here was an ED doctor who was oblivious to a current ongoing epidemic in the same county he worked in. And Pertussis is a life threatening infection.

Then there was the orthopedic surgeon whose wife was the director of nurses at a moderate size hospital I worked at at the time. The doctor got a needlestick and while he had had many before, this was the first one since we implemented a policy of offering employee health services to the doctors for exposures.

Turned out he wasn't vaccinated for hepatitis B. Orthopedic doctors have one of the highest exposure rates because they are working with carpenter's tools and it's very bloody. Of course, without the vaccine 200 health care workers were dying of hepatitis B every year in the US alone. And a few surgeons who contracted hepatitis B from their patients have gone on to infect more patients before realizing they had it.

But it wasn't so much a surprise he wasn't vaccinated as he didn't know the difference between HBIG and vaccine. He had no clue about the different types of hepatitis and no clue he was in danger of contracting the infection from blood. Most unvaccinated health care workers underestimate the risk, but they at least know there is one. And a nurse wife might want to know her husband wasn't going to bring the infection home to her.

I have many of these anecdotes.

[LostAngeles]

I honestly have trouble doing moon phases without making a fist in front of my face. It sounds stupid, but I have trouble visualizing it so I can explain it to someone else unless I do that.

The seasons are easy. Winter is cause the vegetation god was born and then Spring comes when he dies and ressurects again.

...

...wait...

:D

[skeptigirl]

I like the one I read from another member,

"Earth's rotation on the axis is the reason for the season."

[andyandy]

in other news, the black death (http://www.guardian.co.uk/science/story/0,,2038722,00.html) is back

A multiple drug-resistant form of the plague, one of the oldest and most lethal diseases in human history, has been identified by scientists, prompting fears of devastating future outbreaks that cannot be contained by antibiotics.

Tests on a strain of the disease-causing bacterium, Yersinia pestis, taken from a 16-year-old boy in Madagascar revealed the organism has developed resistance to eight antibiotics used to treat the infection, including streptomycin and tetracyclin.

The bacterium is believed to have become resistant to drugs after swapping genes with common food bacteria such as salmonella, E coli and klebsiella, probably while being carried in the guts of fleas, which spread the disease by biting infected rodents.


snip

The plague first emerged several thousand years ago and swept across Asia and Europe during the Black Death pandemic between the 14th and 17th centuries. Successive pandemics are estimated to have claimed some 200m lives. Antibiotics brought the disease under control, but in recent decades the World Health Organisation has recorded outbreaks in 25 countries, most recently in the Democratic Republic of Congo, which last year reported 1,174 suspected cases and 50 deaths

yikes - lock up your fleas!

[LostAngeles]

There's a plush black death somewhere in the pile o' crap next to me...

[elgarak]

I bet less of them know that than you estimate.

Ever watch Jay Leno's Jaywalking? Have you seen the Harvard grad interviews where the majority of graduates couldn't explain why we see Moon phases or what causes the seasons?

We had local Pertussis epidemics 3-4 years in a row when I called to follow up on a patient taken to the ED to see if Pertussis was being ruled out. The ED doctor told me, "adults don't get pertussis." 60% of the local annual cases which numbered in the hundreds were in adults. Here was an ED doctor who was oblivious to a current ongoing epidemic in the same county he worked in. And Pertussis is a life threatening infection.

Then there was the orthopedic surgeon whose wife was the director of nurses at a moderate size hospital I worked at at the time. The doctor got a needlestick and while he had had many before, this was the first one since we implemented a policy of offering employee health services to the doctors for exposures.

Turned out he wasn't vaccinated for hepatitis B. Orthopedic doctors have one of the highest exposure rates because they are working with carpenter's tools and it's very bloody. Of course, without the vaccine 200 health care workers were dying of hepatitis B every year in the US alone. And a few surgeons who contracted hepatitis B from their patients have gone on to infect more patients before realizing they had it.

But it wasn't so much a surprise he wasn't vaccinated as he didn't know the difference between HBIG and vaccine. He had no clue about the different types of hepatitis and no clue he was in danger of contracting the infection from blood. Most unvaccinated health care workers underestimate the risk, but they at least know there is one. And a nurse wife might want to know her husband wasn't going to bring the infection home to her.

I have many of these anecdotes.

Yup. I knew a doctor (internist, family doctor) once whose wife got pregnant while she was still breastfeeding the first child. Cause you can't impregnate a breastfeeding woman, as any doctor knows ;) .

On topic stupidity: Guy stops flight with smallpox scare (http://www.guardian.co.uk/worldlatest/story/0,,-6504033,00.html). Forum rules do not allow me do use words I would like to describe this 'person'.

[skeptigirl]

in other news, the black death (http://www.guardian.co.uk/science/story/0,,2038722,00.html) is back



yikes - lock up your fleas!Wow, it was 5, now it's up to 8 antibiotics. Those pesky yersinias exchanging all those biological fluids.

No more squirrel hunting (http://www.dhs.ca.gov/ps/dcdc/cm/951101cm.htm).

[autumn1971]

My wife has plenty of anecdotes about the unbelievable ignorance of the doctors she works with. To be fair, it seems that anyone actively studying a field is not expecting to be more conversant with the ideas of that field than those who hae gone before, but it seems that all too often the elders have literally forgotten more than the neophytes know.

[kellyb]

I'm confused about this post. I sure as he11 wouldn't go out and try to get a varicella infection were I not immune. And what do you mean not attenuated at all? Think you might want to update your varicella vaccine knowledge with more accurate information.

Do you have any cases of fatal disseminated shingles in a person who has a normal immune system? Know of any fatalities related to varicella vaccine? Know of any cases of fatalities from varcella vaccine shingles?

Because I can find you the fatal cases from wild varicella infection.

I promised myself I wasn't going to engage in this subject here anymore, because I joined this forum because I'm a skeptic...not because I want to argue a pet controversy.

But I'm just too argumentative. I apparently can't help myself.

Do a current literature search on attenuated Oka and dorsal root ganglia, and you'll find exactly what I've found. The varicella vaccines contain a spectrum of attenuated viruses. When people develop breakthrough varicella after vaccination, the virus isolated is different from the majority of the vaccine viruses. The vaccine contains unattenuated varicella virons. This, in and of itself, isn't a big deal. What's a bigger deal though is that even the attenuated virons are still quite good at infecting the dorsal root ganglia. And they reactivate just like wild varicella.

Since shingles isn't reportable, no one really knows if this is a problem or not. And even when it's found that shingles is increasing, it's hard to weed out the effects of decreasing varicella circulation from an increase in corticosteroid exposure. And it doesn't help matters that the CDC fired their varicella epidemiologist when he began reporting bad things. On the bright side, his findings were published all throughout Europe, and the European health authorities are watching the American experiment closely.

And yes, kids have died from chickenpox after being vaccinated for chickenpox. Some of the breakthrough cases are lethal. But that's a bit of a non-issue since wild chickenpox is undeniably more lethal. But at least 76 kids have been killed by the varicella vaccine viruses.

[Capsid]

And yes, kids have died from chickenpox after being vaccinated for chickenpox. Some of the breakthrough cases are lethal. But that's a bit of a non-issue since wild chickenpox is undeniably more lethal. But at least 76 kids have been killed by the varicella vaccine viruses.
That's quite alarming. Can you provide the links, please?

[kellyb]

That's quite alarming. Can you provide the links, please?

Any time there's a death it's sad, but 76 over the course of 10 years isn't really all that bad. All of these kids are probably the same kids who would have been killed by wild varicella, probably, too. But even more would have died from wild varicella. This is 76 deaths as opposed to over a thousand that would have died before the vaccine

http://www.medalerts.org/vaersdb/findfield.php?LOWAGE=&HIGHAGE=&SEX=&STATE=&PRIOR_VAX=&VAX_DATE_LOW=&VAX_DATE_HIGH=&CUR_ILL=&VAX=VARCEL&VAXDOSE=&VAXMAN=&VAXROUTE=&VAXLOT=&VAXSITE=&ONSET_DATE_LOW=&ONSET_DATE_HIGH=&REPORT_DATE_LOW=&REPORT_DATE_HIGH=&SYMPTOMS=&HISTORY=&L_THREAT=&ER_VISIT=&DIED=Yes&HOSPITAL=&DEATH_DATE_LOW=&DEATH_DATE_HIGH=&X_STAY=&RECOVD=&LAB_DATA=&DISABLE=&OTHER_MEDS=&V_ADMINBY=&V_FUNDBY=&PAGENO=1&action=Find&PERPAGE=10

I know some goofy stuff makes it into the database sometimes, and I haven't looked through every page, so maybe some of them were coincidences, but here's an example:

Days since Vaccination: 14
Symptoms: DEHYDRAT EMPHYSEMA HEM GI HYPOTENS IMMUNE SYSTEM DIS NECRO SKIN PNEUMONIA PNEUMOTHORAX

That really sounds like breakthrough varicella after vaccination in a kid with a pretty badly compromised immune system.

Here's more on why and how breakthrough varicella happens after vaccination sometimes:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=535228&tools=bot

Varicella virus vaccine strain Oka (V-Oka) has in rare cases caused zoster in vaccinated people. Despite broad usage of V-Oka, little is known about varicella-zoster virus genomic sequence variation of strains in vaccine and isolates from patients with vaccine adverse events.


We demonstrated here that an in vivo-selected virus, V-Oka-zoster, isolated from a vaccinated zoster patient has wild-type ORF 10 and that it emerged from a vaccine preparation containing both vaccine and wild-type gene 10 variants (Table 2). The isolated vaccine variant also displayed the wild-type SNPs for 9A (a structural protein), 21 (capsid assembly protein), 52 (DNA helicase/primase complex, associated protein), and 55 (probable helicase, required for viral replication), any of which might also contribute to differences in pathogenicity.



These findings confirm that both GlaxoSmithKline and Biken varicella vaccines are mixtures of several variants of attenuated VZV, some of which are likely to vary with respect to degree of attenuation. Detailed evaluation of every identified vaccine-specific SNP and their relative proportion in vaccine preparations is outside the range of this report and will require careful investigation. Importantly, V-Oka-zoster represents a single vaccine-related VZV strain, a variant that contained six wild-type (P-Oka) bases at identified vaccine SNPs and otherwise carried only vaccine-associated SNPs. None of these six polymorphisms reliably distinguish VZV Oka vaccine from wild-type VZV, since they represent SNPs that are variably expressed in the V-Oka-GSK mixture.

That's about the European vaccine, but I've never heard that either Merck or GSK did anything special to the V-Oka strain after it was given to them. I suppose if they did, it would be trade secreted, but the vaccine was fairly successful in Japan, so I can't imagine them wanting to mess with perfection.


Another...
http://www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/423210&erFrom=-4287797616546263147Guest

Vaccination against chickenpox causes a varicella-like rash in up to 5% of healthy children and 50% of children with leukemia. The vaccine may establish latency and reactivate to cause herpes zoster, albeit more rarely than wild-type virus. All vaccine preparations are composed of a mixture of varicella-zoster virus strains that show genotypic variation at several loci. We have shown, by DNA sequencing of 40 polymorphic loci, that viruses sampled from vesicles in varicella-like and herpes zoster rashes are single clones. This finding suggests that, between the time of inoculation of the vaccine and development of rash, selection of single strains occurs. The results have general implications for the pathogenesis of varicella-zoster virus.

It is nice to see medical science talking in real scientific terms like "selection", though, isn't it?
I would imagine that it would be almost impossible to be a virologist and not believe in natural selection, though. :)

One more, the most recent:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17182747

Natural selection for rash-forming genotypes of the varicella-zoster vaccine virus detected within immunized human hosts.


The inoculation of >40 million patients has consequently created a highly replicated evolutionary experiment that we have used to assess the competitive ability of these different viral genotypes in a human host.

[fls]

Any time there's a death it's sad, but 76 over the course of 10 years isn't really all that bad. All of these kids are probably the same kids who would have been killed by wild varicella, probably, too. But even more would have died from wild varicella. This is 76 deaths as opposed to over a thousand that would have died before the vaccine

http://www.medalerts.org/vaersdb/findfield.php?LOWAGE=&HIGHAGE=&SEX=&STATE=&PRIOR_VAX=&VAX_DATE_LOW=&VAX_DATE_HIGH=&CUR_ILL=&VAX=VARCEL&VAXDOSE=&VAXMAN=&VAXROUTE=&VAXLOT=&VAXSITE=&ONSET_DATE_LOW=&ONSET_DATE_HIGH=&REPORT_DATE_LOW=&REPORT_DATE_HIGH=&SYMPTOMS=&HISTORY=&L_THREAT=&ER_VISIT=&DIED=Yes&HOSPITAL=&DEATH_DATE_LOW=&DEATH_DATE_HIGH=&X_STAY=&RECOVD=&LAB_DATA=&DISABLE=&OTHER_MEDS=&V_ADMINBY=&V_FUNDBY=&PAGENO=1&action=Find&PERPAGE=10

I know some goofy stuff makes it into the database sometimes, and I haven't looked through every page, so maybe some of them were coincidences, but here's an example:

That really sounds like breakthrough varicella after vaccination in a kid with a pretty badly compromised immune system.

I looked the examples on the first page in detail (and skimmed the other pages). They are not examples of deaths from varicella vaccination, but rather deaths in people who had also received varicella vaccine at some point (days to years) prior to their death. There was only one case (on the first page) where it looked like the patient may have become ill and died due to varicella after a varicella vaccination. The example you quoted listed Epstein-Barr Virus as a cause of the illness. Other examples include a woman who had acute leukemia that was discovered after she developed a few vessicles after receiving the vaccine, but her death was due to her chemotherapy and complications, a woman that died of sarcoma (and had received the vaccine 102 days earlier - no mention of any varicella related disease or complications), several babies with SIDS, other viruses (Respiratory synticial virus, echovirus), etc.

Linda

[kellyb]

I looked the examples on the first page in detail (and skimmed the other pages). They are not examples of deaths from varicella vaccination, but rather deaths in people who had also received varicella vaccine at some point (days to years) prior to their death. There was only one case (on the first page) where it looked like the patient may have become ill and died due to varicella after a varicella vaccination. The example you quoted listed Epstein-Barr Virus as a cause of the illness. Other examples include a woman who had acute leukemia that was discovered after she developed a few vessicles after receiving the vaccine, but her death was due to her chemotherapy and complications, a woman that died of sarcoma (and had received the vaccine 102 days earlier - no mention of any varicella related disease or complications), several babies with SIDS, other viruses (Respiratory synticial virus, echovirus), etc.

Linda

I just looked through them more closely, and you're right that some of them couldn't have had anything to do with varicella. But in the case of the one with EBV, varicella rash, and necrotic skin all at the same time, it's sort of hard to say that "X factor" was the reason for the death, isn't it? It seem like if any of the factors hadn't been there at that moment in time, the outcome would have probably been different?

[HeyLeroy]

This is from an article later fleshed out into a book:
The Demon In The Freezer (http://cryptome.org/smallpox-wmd.htm)(Excerpt)
THE smallpox virus first became entangled with the human species somewhere between three thousand and twelve thousand years ago -- possibly in Egypt at the time of the Pharaohs. Somewhere on earth at roughly that time, the virus jumped out of an unknown animal into its first human victim, and began to spread. Viruses are parasites that multiply inside the cells of their hosts, and they are the smallest life forms. Smallpox developed a deep affinity for human beings. It is thought to have killed more people than any other infectious disease, including the Black Death of the Middle Ages. It was declared eradicated from the human species in 1979, after a twelve-year effort by a team of doctors and health workers from the World Health Organization. Smallpox now exists only in laboratories.

Smallpox is explosively contagious, and it travels through the air. Virus particles in the mouth become airborne when the host talks. If you inhale a single particle of smallpox, you can come down with the disease. After you've been infected, there is a typical incubation period of ten days. During that time, you feel normal. Then the illness hits with a spike of fever, a backache, and vomiting, and a bit later tiny red spots appear all over the body. The spots turn into blisters, called pustules, and the pustules enlarge, filling with pressurized opalescent pus. The eruption of pustules is sometimes called the splitting of the dermis. The skin doesn't break, but splits horizontally, tearing away from its underlayers. The pustules become hard, bloated sacs the size of peas, encasing the body with pus, and the skin resembles a cobbled stone street.

The pain of the splitting is extraordinary. People lose the ability to speak, and their eyes can squeeze shut with pustules, but they remain alert. Death comes with a breathing arrest or a heart attack or shock or an immune-system storm, though exactly how smallpox kills a person is not known. There are many mysteries about the smallpox virus. Since the seventeenth century, doctors have understood that if the pustules merge into sheets across the body the victim will usually die: the virus has split the whole skin. If the victim survives, the pustules turn into scabs and fall off, leaving scars. This is known as ordinary smallpox.

Some people develop extreme smallpox, which is loosely called black pox. Doctors separate black pox into two forms -- flat smallpox and hemorrhagic smallpox. In a case of flat smallpox, the skin remains smooth and doesn't pustulate, but it darkens until it looks charred, and it can slip off the body in sheets. In hemorrhagic smallpox, black, unclotted blood oozes or runs from the mouth and other body orifices. Black pox is close to a hundred per cent fatal. If any sign of it appears in the body, the victim will almost certainly die. In the bloody cases, the virus destroys the linings of the throat, the stomach, the intestines, the rectum, and the vagina, and these membranes disintegrate. Fatal smallpox can destroy the body's entire skin -- both the exterior skin and the interior skin that lines the passages of the body.

Smallpox virus's scientific name is variola. It means "spotted" in Latin, and it was given to the disease by a medieval bishop. The virus, as a life form, comes in two subspecies: Variola minor and Variola major. Minor is a weak mutant, and was first described in 1863 by doctors in Jamaica. People usually survive it. Classic major kills one out of three people if they haven't been vaccinated or if they've lost their immunity. The death rate with major can go higher -- how much higher no one knows. Variola major killed half of its victims in an outbreak in Canada in 1924, and presumably many of them developed black pox. Smallpox is less contagious than measles but more contagious than mumps. It tends to go around until it has infected nearly everyone.

Most people today have no immunity to smallpox. The vaccine begins to wear off in many people after ten years. Mass vaccination for smallpox came to a worldwide halt around twenty-five years ago. There is now very little smallpox vaccine on hand in the United States or anywhere else in the world. The World Health Organization once had ten million doses of the vaccine in storage in Geneva, Switzerland, but in 1990 an advisory committee recommended that most of it be destroyed, feeling that smallpox was longer a threat. Nine and a half million doses are assumed to have been cooked in an oven, leaving the W.H.O. with a total supply of half a million doses -- one dose of smallpox vaccine for every twelve thousand people on earth. A recent survey by the W.H.O. revealed that there is only one factory in the world that has recently made even a small quantity of the vaccine, and there may be no factory capable of making sizable amounts. The vaccine was discovered in the age of Thomas Jefferson, and making a lot of it would seem simple, but so far the United States government has been unable to get any made at all. Variola virus is now classified as a Biosafety Level 4 hot agent -- the most dangerous kind of virus -- because it is lethal, airborne, and highly contagious, and is now exotic to the human species, and there is not enough vaccine to stop an outbreak. Experts feel that the appearance of a single case of smallpox anywhere on earth would be a global medical emergency.

At the present time, smallpox lives officially in only two repositories on the planet. One repository is in the United States, in a freezer at the headquarters of the federal Centers for Disease Control and Prevention, in Atlanta -- the C.D.C. The other official smallpox repository is in a freezer at a Russian virology institute called Vector, also known as the State Research Institute of Virology and Biotechnology, which is situated outside the city of Novosibirsk, in Siberia. Vector is a huge, financially troubled former virus-weapons-development facility -- a kind of decayed Los Alamos of viruses -- which is trying to convert to peaceful enterprises.

There is a growing suspicion among experts that the smallpox virus may also live unofficially in clandestine biowarfare laboratories in a number of countries around the world, including labs on military bases in Russia that are closed to outside observers. The Central Intelligence Agency has become deeply alarmed about smallpox. Since 1995, a number of leading American biologists and public-health doctors have been given classified national-security briefings on smallpox. They have been shown classified evidence that as recently as 1992 Russia had the apparent capability of launching strategic-weapons-grade smallpox in special biological warheads on giant SS-18 intercontinental missiles that were targeted on the major cities of the United States. In the summer of last year, North Korea fired a ballistic missile over Japan in a test, and the missile fell into the sea. Some knowledgeable observers thought that the missile could have been designed to carry a biologic warhead. If it had carried smallpox and landed in Japan, it could have devastated Japan's population: Japan has almost no smallpox vaccine on hand and its government seems to have no ability to deal with a biological attack. The United States government keeps a list of nations and groups that it suspects either have clandestine stocks of smallpox or seem to be trying to buy or steal the virus. The list is classified, but it is said to include Russia, China, India, Pakistan, Israel, North Korea, Iraq, Iran, Cuba, and Serbia. The list may also include the terrorist organization of Osama bin Laden and, possibly, the Aum Shinrikyo sect of Japan -- a quasi-religious group that had Ph.D. biologists as members and a belief that an apocalyptic war will bring them worldwide power. Aum members released nerve gas in the Tokyo subway in 1995, and, as the year 2000 approaches, the group is still active in Japan and in Russia. In any case, the idea that smallpox lives in only two freezers was never anything more than a comfortable fiction. No one knows exactly who has smallpox today, or where they keep the virus, or what they intend to do with it.

Strange; I've read it before but I just checked this book out of the library two days ago before seeing this thread.

http://www.amazon.com/Demon-Freezer-True-Story/dp/0375508562

[fls]

I just looked through them more closely, and you're right that some of them couldn't have had anything to do with varicella. But in the case of the one with EBV, varicella rash, and necrotic skin all at the same time, it's sort of hard to say that "X factor" was the reason for the death, isn't it? It seem like if any of the factors hadn't been there at that moment in time, the outcome would have probably been different?

The case you quoted did not have a "varicella rash". That it was diagnosed as Gianotti Crosti syndrome tells you that the rash was not the type seen with varicella.

Also, it isn't that the presence of all these things led to death, but rather that the underlying illness is severe enough to affect multiple systems.

Linda

[skeptigirl]

I promised myself I wasn't going to engage in this subject here anymore, because I joined this forum because I'm a skeptic...not because I want to argue a pet controversy.

But I'm just too argumentative. I apparently can't help myself.

Do a current literature search on attenuated Oka and dorsal root ganglia, and you'll find exactly what I've found. The varicella vaccines contain a spectrum of attenuated viruses. When people develop breakthrough varicella after vaccination, the virus isolated is different from the majority of the vaccine viruses. The vaccine contains unattenuated varicella virons. This, in and of itself, isn't a big deal. What's a bigger deal though is that even the attenuated virons are still quite good at infecting the dorsal root ganglia. And they reactivate just like wild varicella.I'm not disagreeing with this much.

Since shingles isn't reportable, no one really knows if this is a problem or not. And even when it's found that shingles is increasing, it's hard to weed out the effects of decreasing varicella circulation from an increase in corticosteroid exposure. And it doesn't help matters that the CDC fired their varicella epidemiologist when he began reporting bad things. On the bright side, his findings were published all throughout Europe, and the European health authorities are watching the American experiment closely.This is simply wrong by a bit of common sense. If shingles were killing people, it would be reportable. And not being reportable doesn't mean there are no epidemiology studies.

Disseminated shingles is serious and can be fatal with immunocompromised individuals. Shingles involving the cornea (very rare) can cause blindness in one eye. The cornea can be replaced with a transplant. And post-herpetic neuralgia is a very painful months long condition. Shingles in all these forms is treatable with anti-viral drugs.

But, there is no evidence shingles post varicella vaccine is any more dangerous than shingles post wild varicella infection. So what is your point or issue with attenuated vaccine which prevents fatalities from wild varicella?

And yes, kids have died from chickenpox after being vaccinated for chickenpox. Some of the breakthrough cases are lethal. But that's a bit of a non-issue since wild chickenpox is undeniably more lethal. But at least 76 kids have been killed by the varicella vaccine viruses.Kelly, that's quite a claim to make without a citation.

[skeptigirl]

I just looked through them more closely, and you're right that some of them couldn't have had anything to do with varicella. But in the case of the one with EBV, varicella rash, and necrotic skin all at the same time, it's sort of hard to say that "X factor" was the reason for the death, isn't it? It seem like if any of the factors hadn't been there at that moment in time, the outcome would have probably been different?VAERS is raw data. For Pete's sake, if you got hit by a car on the way home from the clinic it might be in there.

People die and they die after vaccinations. To go around making absurd claims like the vaccine killed 76 people is reckless. It is the disease that kills people and the vaccine is safer than the disease.