Instruct: Given a question, retrieve relevant passages that answer the question.
Query: When was the smallpox vaccine discontinued in the U.S.?
Given these risks, as smallpox became effectively eradicated and the number of naturally occurring cases fell below the number of vaccine-induced illnesses and deaths, routine childhood vaccination was discontinued in the United States in 1972, and was abandoned in most European countries in the early 1970s.[10][48] Routine vaccination of health care workers was discontinued in the U.S. in 1976, and among military recruits in 1990 (although military personnel deploying to the Middle East and Korea still receive the vaccination[49]). By 1986, routine vaccination had ceased in all countries.[10] It is now primarily recommended for laboratory workers at risk for occupational exposure.[22]
Smallpox was most likely the first disease people tried to prevent by inoculation and was the first disease for which a vaccine was produced. The smallpox vaccine was invented in 1796 by English physician Edward Jenner and although at least six people had used the same principles years earlier he was the first to publish evidence that it was effective and to provide advice on its production. Louis Pasteur furthered the concept through his work in microbiology. The immunization was called "vaccination" because it was derived from a virus affecting cows ( 'cow'). Smallpox was a contagious and deadly disease, causing the deaths of 20–60% of infected adults and over 80% of infected children. When smallpox was finally eradicated in 1979, it had already killed an estimated 300–500 million people in the 20th century.
The Smallpox Vaccine Injury Compensation Program is a secondary payer of medical and lost employment income benefits to individuals who sustained a medical injury after receiving a smallpox vaccine under an HHS-approved smallpox emergency response plan. Funds also may be made available to individuals who contracted vaccinia (the virus in the smallpox vaccine) through accidental contact with a smallpox vaccine recipient.
Sydney Arthur Monckton Copeman, an English Government bacteriologist interested in smallpox vaccine investigated the effects on the bacteria in it of various treatments, including glycerine. Glycerine was sometimes used simply as a diluent by some continental vaccine producers. However, Copeman found that vaccine suspended in 50% chemically-pure glycerine and stored under controlled conditions contained very few "extraneous" bacteria and produced satisfactory vaccinations. He later reported that glycerine killed the causative organisms of erysipelas and tuberculosis when they were added to the vaccine in "considerable quantity", and that his method was widely used on the continent. In 1896, Copeman was asked to supply "extra good calf vaccine" to vaccinate the future Edward VIII.
Smallpox vaccine has been reported to reduce the risk of monkeypox among previously vaccinated persons in Africa. The decrease in immunity to poxviruses in exposed populations is a factor in the prevalence of monkeypox. It is attributed both to waning cross-protective immunity among those vaccinated before 1980 when mass smallpox vaccinations were discontinued, and to the gradually increasing proportion of unvaccinated individuals. The United States Centers for Disease Control and Prevention (CDC) recommends that persons investigating monkeypox outbreaks and involved in caring for infected individuals or animals should receive a smallpox vaccination to protect against monkeypox. Persons who have had close or intimate contact with individuals or animals confirmed to have monkeypox should also be vaccinated.
The next phase of eradication started in 1803 when Francisco Javier Balmis started the vaccination campaign in New Spain. This vaccine was used until 1951 when smallpox was declared officially eradicated in Mexico.
In addition, he became part of a smallpox commission set up in March 1850. Both variolation and vaccination against smallpox were used in India until 1850, when vaccination became the approved method by the smallpox commission. Gupta stated that an initial prejudice against vaccination had been overcome over the years and commended the Native vaccinators.
The terms inoculation, vaccination, and immunization are often used synonymously to refer to artificial induction of immunity against various infectious diseases. However, there are some important historical and current differences. In English medicine, inoculation referred only to the practice of variolation until the very early 1800s. When Edward Jenner introduced smallpox vaccine in 1798, this was initially called cowpox inoculation or vaccine inoculation. Soon, to avoid confusion, smallpox inoculation continued to be referred to as variolation (from "variola" = smallpox) and cowpox inoculation was referred to as vaccination (from Jenner's use of "variolae vaccinae" = smallpox of the cow). Then, in 1891, Louis Pasteur proposed that the terms vaccine and vaccination should be extended to include the new protective procedures being developed. Immunization refers to the use of all vaccines but also extends to the use of antitoxin, which contains preformed antibody such as to diphtheria or tetanus exotoxins. Inoculation is now more or less synonymous in nontechnical usage with injection and the like, and questions along the lines of "Have you had your flu injection/vaccination/inoculation/immunization?" should not cause confusion. The focus is on what is being given and why, not the literal meaning of the technique used.
TNX-801 is a new potential vaccine for smallpox. TNX-801 is a synthetic form of horsepox, which is an otherwise extinct virus. Evolutionary analysis of modern vaccines indicates that the vaccine isolated and used by Edward Jenner to vaccinate against smallpox was either horsepox or something quite similar. A 1902 sample of vaccinia smallpox vaccine was characterized and found to be 99.7% similar to horsepox, further supporting the connection with Jenner's vaccine. The synthesis of horsepox was a collaboration with David Evans and Ryan Noyce at the University of Alberta in Edmonton, Alberta, Canada. TNX-801 or horsepox is the first poxvirus, or poxviridae, to be synthesized and provides a platform for developing new vaccines against infectious disease and cancer. The finding that a horsepox vaccine was in clinical use in the U.S. in 1902 to protect against smallpox provides strong support for the efficacy of TNX-801 horsepox vaccine to protect against smallpox.
Pastor Henning Jacobson already lived through an era of mandatory vaccinations back in his original home in Sweden. The national law made vaccination mandatory and when he was a child, he was vaccinated for smallpox. Although the efforts to eradicate smallpox were successful in Sweden, he did not agree with the methods. He said vaccination caused him "great and extreme suffering" that he would have to endure for the rest of his life. One of his sons "suffered adverse effects" after being vaccinated as a child. Jacobson and his wife were thus resistant when it came to mandatory vaccinations in Massachusetts. 
When smallpox vaccine was introduced in the early 19s century, there were anecdotal descriptions of non-specific beneficial effects. In the second half of the 20th century the potential for beneficial non-specific effects of smallpox vaccine was reviewed, and new evidence on "para-immune effects" was added. More recent studies have focused on the phasing out of smallpox vaccine in the 1970s and compared vaccinated and unvaccinated cohorts.
Smallpox vaccine leaves a very characteristic scar. In low-income countries, having a smallpox vaccine scar has been associated with reductions of more than 40% in overall mortality among adults; in high-income countries smallpox vaccination has been associated with a tendency for reduced risk of asthma, and significantly reduced risk of malignant melanoma and infectious disease hospitalizations. There are no studies that contradict these observations. However it should be noted that no randomized trials testing the effect of smallpox vaccine on overall mortality and morbidity have been conducted.
The original vaccine for smallpox, and the origin of the idea of vaccination, was Cowpox, described by Edward Jenner in 1798. The Latin term used for Cowpox was "Variolae vaccinae", Jenner's own translation of "smallpox of the cow". That term lent its name to the whole idea of vaccination. When it was realized that the virus used in smallpox vaccination was not, or was no longer, the same as cowpox virus, the name 'vaccinia' was used for the virus in smallpox vaccine. (See OED.) Vaccine potency and efficacy prior to the invention of refrigerated methods of transportation was unreliable. The vaccine would be rendered impotent by heat and sunlight, and the method of drying samples on quills and shipping them to countries in need often resulted in an inactive vaccine. Another method employed was the "arm to arm" method. This involved vaccinating an individual then transferring it to another as soon as the infectious pustule forms, then to another, etc. This method was used as a form of living transportation of the vaccine, and usually employed orphans as carriers. However, this method was problematic due to the possibility of spreading other blood diseases, such as hepatitis and syphilis. In 1861, 41 Italian children contracted syphilis after being vaccinated by the arm to arm method.
Calf lymph was the name given to a type of smallpox vaccine used in the 19th century, and which was still manufactured up to the 1970s. Calf lymph was known as early as 1805 in Italy, but it was the Lyon Medical Conference of 1864 which made the technique known to the wider world. In 1898 calf lymph became the standard method of vaccination for smallpox in the United Kingdom, when arm to arm vaccination was eventually banned (due to complications such as the simultaneous transmission of syphilis).
In 1900, the smallpox vaccine was the only one administered to children. By the early 1950s, children routinely received three vaccines, for protection against diphtheria, pertussis, tetanus and smallpox, and as many as five shots by two years of age. Since the mid-1980s, many vaccines have been added to the schedule. In 2009 the US Centers for Disease Control and Prevention (CDC) recommended vaccination against at least fourteen diseases. By two years of age, U.S. children receive as many as 24 vaccine injections, and might receive up to five shots during one visit to the doctor. The use of combination vaccine products means that, , the United Kingdom's immunization program consists of 9 injections by the age of two, rather than 22 if vaccination for each disease was given as a separate injection.
In 1796, the discovery of vaccination—the use of the related cowpox virus to immunize against smallpox—by Edward Jenner revolutionized the ability of medicine to deal with smallpox. Vaccination reached Vienna around 1800, when yet another local epidemic created impetus for its adoption. One of the doctors trained in the Vienna campaign, named Doutrepout, then brought vaccination to Mozart's native city of Salzburg. According to Halliwell, "popular resistance was fierce," and both the government and the Roman Catholic Church (previously an opponent) took stern measures to promote vaccination. The first relative of Mozart's known to have been vaccinated was Johanna Berchtold von Sonnenberg, called "Jeannette" (1789–1805), Nannerl's youngest child; she was vaccinated during the 1802 campaign in Salzburg.
The introduction of the vaccine to the New World took place in Trinity, Newfoundland, in 1798 by Dr. John Clinch, boyhood friend and medical colleague of Jenner. The first smallpox vaccine in the United States was administered in 1799. The physician Valentine Seaman gave his children a smallpox vaccination using a serum acquired from Jenner. By 1800, Jenner's work had been published in all the major European languages and had reached Benjamin Waterhouse in the United States — an indication of rapid spread and deep interest. Despite some concern about the safety of vaccination the mortality using carefully selected vaccine was close to zero, and it was soon in use all over Europe and the United States. 
In 1804 the Balmis Expedition, an official Spanish mission commanded by Francisco Javier de Balmis, sailed to spread the vaccine throughout the Spanish Empire, first to the Canary Islands and on to Spanish Central America. While his deputy, José Salvany, took vaccine to the west and east coasts of Spanish South America, Balmis sailed to Manila in the Philippines and on to Canton and Macao on the Chinese coast. He returned to Spain in 1806.
The question of who first tried cowpox inoculation/vaccination cannot be answered with certainty. Most, but still limited, information is available for Benjamin Jesty, Peter Plett and John Fewster. In 1774 Jesty, a farmer of Yetminster in Dorset, observing that the two milkmaids living with his family were immune to smallpox, inoculated his family with cowpox to protect them from smallpox. He attracted a certain amount of local criticism and ridicule at the time then interest waned. Attention was later drawn to Jesty, and he was brought to London in 1802 by critics jealous of Jenner's prominence at a time when he was applying to Parliament for financial reward. During 1790–92 Peter Plett, a teacher from Holstein, reported limited results of cowpox inoculation to the Medical Faculty of the University of Kiel. However, the Faculty favoured variolation and took no action. John Fewster, a surgeon friend of Jenner's from nearby Thornbury, discussed the possibility of cowpox inoculation at meetings as early as 1765. He may have done some cowpox inoculations in 1796 at about the same time that Jenner vaccinated Phipps. However Fewster, who had a flourishing variolation practice, may have considered this option but used smallpox instead. He thought vaccination offered no advantage over variolation, but maintained friendly contact with Jenner and certainly made no claim of priority for vaccination when critics attacked Jenner's reputation. It seems clear that the idea of using cowpox instead of smallpox for inoculation was considered, and actually tried in the late 18th century, and not just by the medical profession. Therefore, Jenner was not the first to try cowpox inoculation. However, he was the first to publish his evidence and distribute vaccine freely, provide information on selection of suitable material, and maintain it by arm-to-arm transfer. The authors of the official World Health Organization (WHO) account "Smallpox and its Eradication" assessing Jenner's role wrote:
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.
The English physician Edward Jenner demonstrated the effectiveness of cowpox to protect humans from smallpox in 1796, after which various attempts were made to eliminate smallpox on a regional scale. In Russia in 1796, the first child to receive this treatment was bestowed the name "Vaccinov" by Catherine the Great, and was educated at the expense of the nation.[75] The introduction of the vaccine to the New World took place in Trinity, Newfoundland in 1800 by Dr. John Clinch, boyhood friend and medical colleague of Jenner.[76] As early as 1803, the Spanish Crown organized the Balmis expedition to transport the vaccine to the Spanish colonies in the Americas and the Philippines, and establish mass vaccination programs there.[77] The U.S. Congress passed the Vaccine Act of 1813 to ensure that safe smallpox vaccine would be available to the American public. By about 1817, a very solid state vaccination program existed in the Dutch East Indies.[78] In British India a program was launched to propagate smallpox vaccination, through Indian vaccinators, under the supervision of European officials.[79] Nevertheless, British vaccination efforts in India, and in Burma in particular, were hampered by stubborn indigenous preference for inoculation and distrust of vaccination, despite tough legislation, improvements in the local efficacy of the vaccine and vaccine preservative, and education efforts.[80] By 1832, the federal government of the United States established a smallpox vaccination program for Native Americans.[81] In 1842, the United Kingdom banned inoculation, later progressing to mandatory vaccination. The British government introduced compulsory smallpox vaccination by an Act of Parliament in 1853.[82] In the United States, from 1843 to 1855 first Massachusetts, and then other states required smallpox vaccination. Although some disliked these measures,[58] coordinated efforts against smallpox went on, and the disease continued to diminish in the wealthy countries. In Northern Europe a number of countries had eliminated smallpox by 1900, and by 1914, the incidence in most industrialized countries had decreased to comparatively low levels. Vaccination continued in industrialized countries, until the mid to late 1970s as protection against reintroduction. Australia and New Zealand are two notable exceptions; neither experienced endemic smallpox and never vaccinated widely, relying instead on protection by distance and strict quarantines.[83]
The were three major vaccination attempts to stop the spread of smallpox at the onset of the epidemic. The first by the American Fur Company was largely unsuccessful. Many traders tried to obtain vaccines but the AFC was unwilling to heed their requests. The second was by the American government. Here efforts were made under the Indian Vaccination Act of 1832. Some areas did receive vaccines for smallpox, typically ones that were in contact with Americans, usually in the southern United States. Still the Office of Indian Affairs did not have the network or information needed to vaccinate the plains people quickly, nor did they try establish the needed network. While the damage of the epidemic could have been reduced if preemptive measures had been taken, the HBC still had the best response of the three actors. Rumours of the disease spreading prompted traders to act quickly as a reduction in the indigenous population meant a reduction in profit from the furs they brought in. A good information network, a supply of vaccines at posts, and a willingness among all for vaccination resulted in efforts being much more successful than those by their American counterparts. Vaccination performed by HBC workers and trained Indigenous people were critical to limiting the spread of smallpox in Canada. After the epidemic the HBC implemented a territory wide vaccination program which further reduced smallpox deaths. Unfortunately, as people entered communities with the intention of vaccinating against smallpox, they brought with them additional diseases that worked to keep mortality rates high.
The antibodies induced by vaccinia vaccine are cross-protective for other orthopoxviruses, such as monkeypox, cowpox, and variola (smallpox) viruses. Neutralizing antibodies are detectable 10 days after first-time vaccination, and seven days after revaccination. Historically, the vaccine has been effective in preventing smallpox infection in 95 percent of those vaccinated.[46] Smallpox vaccination provides a high level of immunity for three to five years and decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts even longer. Studies of smallpox cases in Europe in the 1950s and 1960s demonstrated that the fatality rate among persons vaccinated less than 10 years before exposure was 1.3 percent; it was 7 percent among those vaccinated 11 to 20 years prior, and 11 percent among those vaccinated 20 or more years prior to infection. By contrast, 52 percent of unvaccinated persons died.[47]
In the late 1940s and early 1950s, Leslie Collier, an English microbiologist working at the Lister Institute of Preventive Medicine, developed a method for producing a heat-stable freeze-dried vaccine in powdered form. Collier added 0.5% phenol to the vaccine to reduce the number of bacterial contaminants but the key stage was to add 5% peptone to the liquid vaccine before it was dispensed into ampoules. This protected the virus during the freeze drying process. After drying the ampoules were sealed under nitrogen. Like other vaccines, once reconstituted it became ineffective after 1–2 days at ambient temperatures. However, the dried vaccine was 100% effective when reconstituted after 6 months storage at allowing it to be transported to, and stored in, remote tropical areas. Collier's method was increasingly used and, with minor modifications, became the standard for vaccine production adopted by the WHO Smallpox Eradication Unit when it initiated its global smallpox eradication campaign in 1967, at which time 23 of 59 manufacturers were using the Lister strain.
From the 1760s, a number of individuals, including John Fewster, Peter Plett, Benjamin Jesty, and particularly Edward Jenner, were interested in the use of material from cowpox, an animal infection, to protect against smallpox. In 1796, Jenner vaccinated James Phipps, did more vaccinations in 1798, and was the first to publish evidence that cowpox protected against smallpox, was safer than variolation, and that his vaccine could be maintained by arm-to-arm transfer. The use of variolation soon began to decline as the smallpox vaccine became widely used and its benefits appreciated. Various countries made variolation illegal, starting with Russia in 1805. Variolation served as a natural precursor to the discovery of vaccination. The major differences between the two were that in vaccination, material from cowpox, an animal disease, was used, but particularly that it was safe to those vaccinated and was not transmitted to their contacts. Vaccination offered the public a less-harmful method of preventing smallpox. Vaccination would revolutionize the control of smallpox, leading to its eventual eradication. The extension of the principle of vaccination by Pasteur and his successors would lead to the development of vaccines for diseases such as diphtheria, measles, mumps, rubella, and influenza, and make the eradication of infectious diseases, particularly poliomyelitis, a realistic prospect.
The terminology used to describe the prevention of smallpox can cause confusion. In 18th-century medical terminology, "inoculation" refers to "smallpox inoculation". Confusion is caused by writers who interchange "variolation" and "vaccination" through either mistranslation or misinterpretation. The term "variolation" refers solely to inoculation with smallpox virus and is not interchangeable with "vaccination". The latter term was first used in 1800 soon after Edward Jenner introduced smallpox vaccine derived from cowpox, an animal disease distinct from smallpox. The term "variolation" was then used from the 19th century to avoid confusion with vaccination. Most modern writers tend to refer to smallpox inoculation as variolation throughout without regard for chronology, as is used here. Further confusion was caused when, in 1891, Louis Pasteur honoured Jenner by widening the terms "vaccine/vaccination" to refer to the artificial induction of immunity against any infectious disease. "Inoculation" is used synonymously with "injection" in connection with the use of vaccines or other biopharmaceuticals, but has other meanings in e.g. laboratory work.
Pearson was a very early advocate of smallpox vaccination and supporter of Edward Jenner and published his early observations within months of the publication of Jenner's "Inquiry". Early in 1799 he helped to set up the Original Vaccine Pock Institute in London and started to distribute vaccine, some samples of which were contaminated with smallpox virus. This caused a rift with Jenner who thought his own work was being overshadowed. In turn, Pearson became envious of Jenner's growing reputation. When Jenner petitioned Parliament for a financial reward in 1802, he published a detailed account of his own contribution, together with evidence that Jenner did not "discover", vaccination bringing attention to farmer Benjamin Jesty and others who he maintained had prior claims. When Jenner sought a further Parliamentary grant in 1805 Pearson brought Jesty to London to visit the Original Vaccine Pock Institute to further his claim with no success. By this time, although there was opposition to vaccination as such, Jenner's role in its introduction was firmly established and Pearson played little further part. However, his role in the introduction of smallpox vaccine was examined in detail much later when controversy arose over the origin of vaccinia virus, the active constituent of smallpox vaccine. 
In the years from 1770 to 1790, at least six people who had contact with a cow had independently tested the possibility of using the cowpox vaccine as an immunization for smallpox in humans. Amongst them were the English farmer Benjamin Jesty, in Dorset in 1774 and the German teacher Peter Plett in 1791. Jesty inoculated his wife and two young sons with cowpox, in a successful effort to immunize them to smallpox, an epidemic of which had arisen in their town. His patients who had contracted and recovered from the similar but milder cowpox (mainly milkmaids), seemed to be immune not only to further cases of cowpox, but also to smallpox. By scratching the fluid from cowpox lesions into the skin of healthy individuals, he was able to immunize those people against smallpox. Reportedly, farmers and people working regularly with cattle and horses were often spared during smallpox outbreaks. Investigations by the British Army in 1790 showed that horse-mounted troops were less infected by smallpox than infantry, due to probable exposure to the similar horse pox virus ("Variola equina"). By the early 19th century, more than 100,000 people in Great Britain had been vaccinated. The arm-to-arm method of transfer of the cowpox vaccine was also used to distribute Jenner's vaccine throughout the Spanish Empire. Spanish king Charles IV's daughter had been stricken with smallpox in 1798, and after she recovered, he arranged for the rest of his family to be vaccinated. In 1803, the king, convinced of the benefits of the vaccine, ordered his personal physician Francis Xavier de Balmis, to deliver it to the Spanish dominions in North and South America. To maintain the vaccine in an available state during the voyage, the physician recruited 22 young boys who had never had cowpox or smallpox before, aged three to nine years, from the orphanages of Spain. During the trip across the Atlantic, de Balmis vaccinated the orphans in a living chain. Two children were vaccinated immediately before departure, and when cowpox pustules had appeared on their arms, material from these lesions was used to vaccinate two more children.