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NY faced last U.S. smallpox outbreak

From Garrick Utley and Sanjay Gupta

The 1947 smallpox cases led to doctors' immunizing residents at a rate of eight injections per minute - 500,000 in one day.

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NEW YORK (CNN) -- It was 1947 when the United States last fought a war against the biological enemy smallpox.

A businessman from Mexico visiting New York City was found to be infected with the disease. He was hospitalized, but his smallpox was not diagnosed until two other patients in the hospital contracted the disease.

The city faced a crisis.

Smallpox spreads rapidly through the air so a vaccination program began immediately. The first shots were given to adults who had not been vaccinated since childhood.

No one panicked and the media seemed to care little. The first news of the smallpox appeared in the Daily News on page eight. A day later, the inoculation campaign was reported on page two. On the third day, as more cases were reported, the news appeared under a comic strip on page 12.

David Rosner, history professor at Columbia University, says the city reacted with calm because of its recent history.

"This is right after World War II," he said. "People had faith in government."

Health officials decided quickly to vaccinate everyone. New Yorkers lined up at police stations and fire houses, which had been turned into vaccination centers. Children were inoculated at school.

And just as President Bush announced Friday that he too will be vaccinated and ordered U.S. military personnel to receive vaccinations, President Truman was inoculated in 1947 before visiting the city.

By April 15, nine cases of smallpox had been confirmed. And when supplies ran short, the military brought in a million doses. Drug companies stepped up production.

Doctors immunized residents at a rate of eight injections per minute 500,000 in one day. The feared smallpox epidemic was averted.

Rosner suggests one reason for the success.

"The infrastructure has to be there, the actual system of delivering services has to be there," Rosner said.

In less than a month, nearly 6.4 million New Yorkers had been immunized. Two people died of smallpox. It is estimated that eight or nine more died from the effects of the inoculations.

At the time, smallpox was perceived as a deadly disease. Today it is seen as a potential weapon for terrorists.

A global vaccination program has eradicated smallpox from the planet, except in controlled forms. The last known natural case of smallpox occurred in Somalia in 1977. Eradication was declared official by the World Health Organization in 1979.

But the issue of a smallpox outbreak is once again on the minds of health experts after September 11 and as America prepares for possible war with Iraq.

The results of a smallpox attack would be undetectable -- at first.

"You couldn't smell it, you couldn't see it, you wouldn't know it was there," says Dr. D.A. Henderson, who headed the 1977 efforts to eradicate smallpox. "But soon enough, the results would show up. In the case of a smallpox or anthrax attack, the first symptoms would be similar: flu-like fever, aches, and weakness."

In smallpox, a rash would develop about three days later. The rash is painful, usually leading to scarring for life. Some people go blind and about 30 percent of the people who contract smallpox will die.

Once a rash forms, smallpox can spread to people within 6 feet away.

The vaccine is effective if given within three to five days of being exposed.

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