Instruct: Given a question, retrieve relevant documents that can help answer the question.
Query: When was the last smallpox outbreak?
The last cases of smallpox in the world occurred in an outbreak of two cases (one of which was fatal) in Birmingham, United Kingdom, in 1978.[94] A medical photographer, Janet Parker, contracted the disease at the University of Birmingham Medical School and died on 11 September 1978. Professor Henry Bedson, the scientist responsible for smallpox research at the university, killed himself.[94][95] All known stocks of smallpox were subsequently destroyed or transferred to two WHO-designated reference laboratories with BSL-4 facilities– the United States' Centers for Disease Control and Prevention and Russia's State Research Center of Virology and Biotechnology VECTOR.[96]
Smallpox is an infectious disease unique to humans, caused by either of two virus variants named "Variola major" and "Variola minor". The last naturally occurring infection was of "Variola minor" in Somalia in 1977. At the time of Parker's death, a laboratory at University of Birmingham Medical School was conducting research on variants of smallpox virus known as "whitepox viruses", which were considered to be a threat to the success of the World Health Organization's smallpox eradication programme.
France was the last European country to embrace variolation. It was not until an outbreak of smallpox in Paris in 1752 nearly killed the heir to the French throne that the public embraced the practice after seeing the prince variolated. Similarly in Japan, Chinese merchant Li Jen-Shan proposed the method of traditional Chinese intranasal variolation after a severe smallpox outbreak in Nagasaki in 1744. This led Japanese physician to variolate children using a human smallpox vaccination method during an outbreak in Chikuzen Province from 1789 to 1790. There were no deaths among the children, and they all appeared to be protected.
After joining the National Health Service as Little Bromwich Hospital in 1948, it became a general hospital in 1953. It was renamed East Birmingham Hospital in 1963 and saw considerable expansion in the 1970s. The world's last smallpox patient, Janet Parker, was treated at the hospital during the smallpox outbreak in 1978. It became Heartlands Hospital in 1993.
In 1966, an outbreak of smallpox originated at University of Birmingham Medical School. In 1978, Janet Parker contracted the disease while working as medical photographer in the anatomy department. She was the last person to die of smallpox in the world.
The Manchus feared smallpox more than any other disease because they had no immunity to it and almost always died when they contracted it. By 1622 at the latest, they had already established an agency to investigate smallpox cases and isolate sufferers to avoid contagion. During outbreaks, royal family members were routinely sent to "smallpox avoidance centers" ("bidousuo" 避痘所) to protect themselves from infection. The Shunzhi Emperor was particularly fearful of the disease, because he was young and lived in a large city, near sources of contagion. Indeed, during his reign at least nine outbreaks of smallpox were recorded in Beijing, each time forcing the emperor to move to a protected area such as the "Southern Park" (Nanyuan 南苑), a hunting ground south of Beijing where Dorgon had built a "smallpox avoidance center" in the 1640s. Despite this and other precautions—such as rules forcing Chinese residents to move out of the city when they contracted smallpox—the young monarch still succumbed to that illness.
Historians differ as to whether the illness of the 1520s was smallpox; a minority of scholars claim that the epidemic was due to an indigenous illness called Carrion's disease. In any case, a 1981 study by N. D. Cook the shows that the Andes suffered from three separate population declines during colonization. The first was of 30–50 percent during the first outbreak of smallpox. When a measles outbreak occurred, there was another decline of 25–30 percent. Finally, when smallpox and measles epidemics occurred together, which occurred from 1585 to 1591, a decline of 30–60 percent occurred. Collectively these declines amounted to a decline of 93 percent from the pre-contact population in the Andes region. Mortality was particularly high among children, ensuring that the impact of the epidemics would extend to the next generation.
The indigenous populations were devastated by epidemics of infectious diseases, especially smallpox, brought in by European explorers and traders. Prior to European colonization, various reports from European explorers describe the tribes in the area bearing signs of smallpox. Nathaniel Portlock, a British ship's captain, described as having "expected to have seen a numerous tribe" but instead found "only of three men, three women" as well as the oldest of the men "marked with the small-pox", when referring to the Tlingit people in the North West Coast. Oral traditions of various tribes in the Pacific Northwest also refer to an epidemic of smallpox on the populations. There are many theories to how smallpox arrived in the Pacific Northwest. One theory is that an outbreak in central Mexico in 1779 spread north and infected the Shoshone in 1781, allowing the disease to spread into the lower Columbia River and Georgia Strait via trade between the Flathead, Nez Perce, Walla Walla, and other various tribes. Spanish expeditions to the Northwest Coast from Mexico in 1774, 1775, and 1779 are also attributed to spreading smallpox to the local tribes in the area, with many documented outbreaks correlating to where the Spanish made landfall. Another theory describes the outbreak originating in the Kamchatka Peninsula in 1769 and spreading via Russian explorers to South Alaska and the Aleutians, thus through the Alaska panhandle and down the Pacific Coast.
In 1871, there was an outbreak of smallpox at Akropong. Peter Hall's parents and two brothers were afflicted by the infectious disease. Unfortunately, one brother, James Hall, who had a wife and a daughter, was died from the smallpox outbreak.
The last major European outbreak of smallpox was in 1972 in Yugoslavia, after a pilgrim from Kosovo returned from the Middle East, where he had contracted the virus. The epidemic infected 175 people, causing 35 deaths. Authorities declared martial law, enforced quarantine, and undertook widespread re-vaccination of the population, enlisting the help of the WHO. In two months, the outbreak was over.[89] Prior to this, there had been a smallpox outbreak in May–July 1963 in Stockholm, Sweden, brought from the Far East by a Swedish sailor; this had been dealt with by quarantine measures and vaccination of the local population.[90]
There are no credible descriptions of smallpox-like disease in the Americas before the westward exploration by Europeans in the 15th century CE.[30] Smallpox was introduced into the Caribbean island of Hispaniola in 1509, and into the mainland in 1520, when Spanish settlers from Hispaniola arrived in Mexico bringing smallpox with them. Smallpox devastated the native Amerindian population and was an important factor in the conquest of the Aztecs and the Incas by the Spaniards.[27] Settlement of the east coast of North America in 1633 in Plymouth, Massachusetts was also accompanied by devastating outbreaks of smallpox among Native American populations,[66] and subsequently among the native-born colonists.[67] Case fatality rates during outbreaks in Native American populations were as high as 80–90%.[68] Smallpox was introduced into Australia in 1789 and again in 1829.[27] Although the disease was never endemic on the continent,[27] it was the principal cause of death in Aboriginal populations between 1780 and 1870.[69]
The smallpox outbreaks from 1837–1840 had a 90% death rate among the Mandan. The two Mandan villages that had been in contact with Lewis and Clark suffered the horrific effects of the virus. The smallpox outbreak lasted from 1837–1838 and, out of 1,600 Mandan villagers, 31 survived. The smallpox epidemic was largely spread through the trading business. Despite warnings of outbreaks, Native Americans still visited trading posts and became exposed to the virus. Once the infected Mandan villages were empty, neighboring peoples raided the village for goods, but suffered after carrying back the virus via blankets, horses, and household tools.
In 2018, Pallen wrote a book on the 1978 smallpox outbreak in the United Kingdom, "The Last Days of Smallpox: Tragedy in Birmingham",
The containment efforts proved effective and, on 17 April 1978, WHO's Nairobi office sent a telegram stating: "Search complete. No cases discovered. Ali Maow Maalin is the world's last known smallpox case." Although there was one further smallpox outbreak in 1978 acquired from a laboratory in Birmingham, UK, Maalin remains the last case of naturally acquired smallpox in the world. On 26 October 1979, two years after the day when Maalin's rash appeared, WHO declared that smallpox had been eradicated globally.
The 1972 Yugoslav smallpox outbreak was the last major outbreak of smallpox in Europe. It was centred in Kosovo and Belgrade (both then part of the Socialist Federal Republic of Yugoslavia). A Muslim pilgrim had contracted the smallpox virus in the Middle East. Upon returning to his home in Kosovo, he started the epidemic in which 175 people were infected, 35 of whom died. The epidemic was efficiently contained by enforced quarantine and mass vaccination. The 1982 film "Variola Vera" is based on the event.
The last cases of smallpox occurred in an outbreak of two cases, one of which was fatal, in Birmingham, UK, in 1978. A medical photographer, Janet Parker, contracted the disease at the University of Birmingham Medical School and died on September 11, 1978. In light of this incident, all known stocks of smallpox were destroyed or transferred to one of two WHO reference laboratories which had BSL-4 facilities—the Centers for Disease Control and Prevention (CDC) in the United States and the State Research Center of Virology and Biotechnology VECTOR in Koltsovo, Russia. Since 1984, these two labs have been the only ones authorized by the WHO to hold stocks of live smallpox virus.
Smallpox is exogenous to Australia. The first recorded outbreak, in 1789, devastated the Aboriginal population; while the extent of this outbreak is disputed, some sources claim that it killed about 50% of coastal Aboriginal populations on the east coast. There is an ongoing historical debate concerning two rival and irreconcilable theories about how the disease first entered the continent. The central hypotheses of these theories suggest that smallpox was transmitted to indigenous Australians by either:
The 1978 smallpox outbreak in the United Kingdom resulted in the death of Janet Parker, a British medical photographer, who became the last recorded person to die from smallpox. Her illness and death, which was connected to the deaths of two other people, led to an official government inquiry and triggered radical changes in how dangerous pathogens were studied in the UK. The government inquiry into Parker's death by R.A. Shooter found that while working at the University of Birmingham Medical School, she was accidentally exposed to a strain of smallpox virus that had been grown in a research laboratory on the floor below her workplace, and that the virus had most likely spread from that laboratory through ducting. Shooter's conclusion on how the virus had spread was challenged in court when the University of Birmingham was unsuccessfully prosecuted by the Health and Safety Executive for breach of Health and Safety legislation.
A similar outbreak had occurred at the University of Birmingham Medical School in 1966, when Tony McLennan, who was also a medical photographer and worked in the same laboratory later used by Parker, contracted smallpox. He had a milder form of the disease, which was not diagnosed for eight weeks. He was not quarantined and there were at least twelve further cases in the West Midlands, five of whom were quarantined in Witton Isolation Hospital in Birmingham. There are no records of any formal enquiries on the source of this earlier outbreak despite concerns expressed by the then head of the laboratory, Peter Wildy.
By 1972, vaccination for smallpox had long been widely available and the disease was considered to be eradicated in Europe. The population of Yugoslavia had been regularly vaccinated against smallpox for 50 years, and the last case was reported in 1930. This was the major cause for the initial slow reaction by doctors, who did not promptly recognize the symptoms of the disease.
One immediate consequence was a series of epidemics of European diseases such as measles, smallpox and tuberculosis. In the 19th century, smallpox was the principal cause of Aboriginal deaths, and vaccinations of the "native inhabitants" had begun in earnest by the 1840s. This smallpox epidemic in 1789 is estimated to have killed up to 90% of the Darug people. The cause of the outbreak is disputed. Some scholars have attributed it to European settlers, but it is also argued that Macassan fishermen from South Sulawesi and nearby islands may have introduced smallpox to Australia before the arrival of Europeans. A third suggestion is that the outbreak was caused by contact with members of the First Fleet. A fourth theory is that the epidemic was of chickenpox, not smallpox, carried by members of the First Fleet, and to which the Aborigines also had no immunity.
The Massachusetts smallpox epidemic or Colonial epidemic was a smallpox outbreak that hit Massachusetts in 1633. Smallpox outbreaks were not confined to 1633 however, and occurred nearly every ten years.
Birmingham was declared officially free of smallpox on 16 October 1978. At the time of the outbreak, the WHO had been about to certify that smallpox had been eradicated globally. It eventually did so in 1980.
At the beginning of the 1780s there was an outbreak of smallpox in the Western Canada, the Northern Great Plains which severely affected the villages and the population reduced drastically in size by about 70-80%. William Tomison is greatly known for the records that he made of this epidemic, he recorded in his diary in great detail concerning this. Giving thorough detail and updates regarding Cree Indians who were struck by smallpox, he also journalled about those that came to him to seek help. His journal contained great detail about this outbreak and it brought clarity about the epidemic. From records and accounts from the time it is clear that the British employees did not suffer from smallpox as they were in contact with it or had smallpox or a similar disease when they were infants. The British employees of HBC did not contract or catch this disease because they had smallpox, cowpox or chicken pox when they were infants. This led to them being immune to the disease when it spread in Western Canada Employees that were Hudson Bay Company and Canadians (despite sexual activity between Indigenous women and employees being banned) were sensitive to the disease, however some individuals did not contract the disease. Unfortunately, there is no concrete evidence to show that the Aboriginal people blamed the British or French traders for this incident.
The 1947 New York City smallpox outbreak occurred in March, 1947 and was declared ended on April 24, 1947. The outbreak marked two milestones for America. First, it was the largest mass vaccination effort ever conducted for smallpox in America, and second, it marked the last outbreak of smallpox in America. Within three weeks of the discovery of the outbreak, the U.S. Public Health Service, in conjunction with New York City health officials, had procured vaccine and inoculated over 6,350,000 adults and children. Of that number, 5,000,000 had been vaccinated within the first two weeks. The rapid response was credited with limiting the outbreak to 12 people, 10 of whom recovered, while 2 died.