Brief overview
- Description: Vaccine protection against the human smallpox virus variola, but also against the related monkeypox. Today, lower-risk vaccine made from non-replicable live viruses.
- Compulsory smallpox vaccination: First compulsory smallpox vaccination in Bavaria in 1807 against sometimes strong resistance from the population. General compulsory vaccination from the German Empire in 1875 to the Federal Republic of Germany in 1973 (abolished in the course of worldwide eradication).
- Side effects and sequelae: Newer vaccine well tolerated, side effects mainly headache, nausea, muscle and limb pain, fatigue, reactions at the injection site: Older vaccine more risky: 30 permanently injured and 2-3 deaths per million vaccinated.
- Administration: two doses 28 days apart, 1 dose for smallpox vaccinated over age 50, used to be given with a lancet instead of a syringe.
What is smallpox vaccination?
Due to such a close relationship, the British physician Edward Jenner was also able to obtain the first vaccine from infected cows at the end of the 18th century, but also, as more recent investigations have shown, from horses. Their pathogens are largely harmless to humans. The inspiration for the new medical discovery was probably milkmaids who had contracted cowpox and subsequently failed to fall ill during variola outbreaks.
Jenner and colleagues and successors further developed the wild type of these animal viruses into a live vaccine based on the vaccinia virus. This is also the source of today’s modern vaccine called Imvanex, which causes significantly fewer side effects. It contains a modified form of the vaccinia virus: “Ankara.
Read more in the article Monkeypox Vaccination.
Compulsory smallpox vaccination
After several waves of epidemics, King Maximilian I of Bavaria issued a compulsory vaccination against smallpox in 1807. It applied to all children under the age of three who had not previously suffered from smallpox. The effectiveness of the vaccination was tested on the basis of the vaccination reaction. Vaccinated children also received a vaccination certificate, which they had to present again and again throughout their lives, for example at school.
Although one in five children died after infection, fear of vaccination was widespread. Despite severe fines and even prison sentences, many parents did not have their children vaccinated, and pictures made the rounds showing people growing cow ears after being vaccinated with “cowpox”.
Imperial Vaccination Law under Otto von Bismarck
In the GDR, general compulsory vaccination was introduced from 1950 not only against smallpox, but also against tuberculosis, polio, diphtheria, tetanus, whooping cough – and from the 1970s – also against measles.
In the West, compulsory smallpox vaccination was gradually abolished starting in 1976, after the last West German case of smallpox occurred in 1972. Smallpox vaccination was also gradually discontinued in the GDR. In 1979, the WHO officially declared smallpox eradicated.
No renewed smallpox vaccination in sight
In view of the increased incidence of monkeypox, it seems impossible that a new compulsory smallpox vaccination will be introduced. Monkeypox is less contagious and much less dangerous than the smallpox virus, which is adapted to humans.
All cases observed in Europe since May have recovered so far, with few requiring hospitalization for complications. No patient has died so far.
How was smallpox eradicated?
The eradication of smallpox was possible because variola viruses are found only in humans. Accordingly, no virus reservoirs form in animal hosts that could jump over and over again. Officially, only two high-security laboratories worldwide still hold smallpox viruses in their stocks.
Since it cannot be ruled out that there are still reservoirs of the virus in remote regions of the world after all, or that there are clandestine stocks that could be used for attack purposes, large quantities of smallpox vaccine continue to be held worldwide. However, most of this is the old smallpox vaccine.
Side effects and sequelae of smallpox vaccination
The current vaccine, Imvanex, which is also currently used against monkeypox, is considered well tolerated. Common, typical transient vaccine reactions are manifested by headache, nausea, muscle aches, aching limbs, fatigue, and reactions at the injection site.
Vaccination, which was administered until the 1980s, was still associated with comparatively high risks, unlike the modern vaccine. About one in 1,000 vaccinated people required subsequent medical treatment, about 30 in a million vaccinated people suffered permanent smallpox vaccine damage, and one to two vaccinated people per million died.
How is vaccination given?
The newer smallpox vaccine is administered via subcutaneous injection into the upper arm. It is approved for adults 18 years of age and older. Two doses 28 days apart are required for immunization.
It is currently unclear how long the vaccine will last. Therefore, there is no precise information on a booster vaccination. The reason for this is that Imvamex could never be tested “in the wild,” as there have been no human cases of smallpox. The information on efficacy is also based on laboratory tests – so the protective effect in real situations may differ.
Smallpox vaccinations until the 1970s
In the 18th century, vaccinators used fluid taken directly from the pustules of sick patients for vaccination. The risky procedure was later replaced by vaccinations with cowpox or horsepox, which are much milder in humans – or their further breeding.
At that time, immunization was not carried out with an injection. Instead, until the 1970s, children were taught to make small cuts in the upper arm with the help of a lancet that had previously been dipped in vaccine lymph. This technique allowed a significantly solid immune response to be achieved.
A pustule subsequently developed at the vaccination site, which crusted over and then left the characteristic circular vaccination scar.
