#aralsk

(…) The 1971 smallpox outbreak in Aralsk was unusual because the Soviet Union had eradicated endemic smallpox from its territory in 1936. (…) Soviet health authorities kept the Aralsk outbreak secret and did not report it to the World Health Organization (WHO), as required under international agreement. (…) In this case, however, there may have been another reason for keeping the smallpox outbreak under wraps—the Aralsk outbreak could have originated in a field test of weaponized smallpox virus at the nearby Soviet biological warfare (BW) testing grounds on Vozrozhdeniye Island in the Aral Sea. 

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(…) The other four infected adults (ages 24, 36, 38, and 60) contracted smallpox despite having been vaccinated. Three were described as having “varioloid smallpox” with only a few scattered lesions evident on physical examination, and one with a classical “discrete” rash. In short, three people, all unvaccinated, developed the hemorrhagic form of the disease and died. Six others also contracted smallpox in either a modified or typical discrete form. 

(…) Nearly 50,000 residents of Aralsk were vaccinated in less than two weeks, and many hundreds were placed in isolation in a makeshift facility on the outskirts of town. Transportation into and out of Aralsk was almost completely halted, and more than 5,000 square meters (54,000 square feet) of living space in the homes of local residents were disinfected, along with 18 metric tons of household goods. 

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(…) Although the overall mortality in the two outbreaks was similar (three out of ten cases in Aralsk, 35 out of 175 cases in Kosovo, p>.43 by Fisher’s exact test), critical differences between the two outbreaks are also evident. There were three patients with hemorrhagic smallpox (all fatal) in Aralsk, but five such cases in Kosovo, where the total number of smallpox cases was much larger (p<.005 by Fisher’s exact test). This observation suggests that the clinical manifestations were somewhat more severe in the Aralsk epidemic.

Hemorrhagic smallpox was rare in most outbreaks and was almost universally fatal. (…) Although the Aralsk outbreak data are insufficient to support a firm conclusion, the seemingly high percentage of hemorrhagic cases and the skewing of the distribution to very young children suggest that either unusual “host factors” (e.g., nutritional status, genetic resistance), or an unusual strain of the virus, were responsible for this distinctive feature of the Aralsk outbreak. 

(…) Further, of the six adults with confirmed smallpox in Aralsk, five had been vaccinated. Because it is not known how many of the later- quarantined “contacts” of Patients 1, 2, and 3 were vaccinated, nor how many years had passed since their last vaccination, it is impossible to calculate vaccine effectiveness in the Aralsk outbreak. However, the efficacy of the smallpox vaccine (sometimes also called “rate of protection”) is usually described as being in excess of 90 percent. The official report states that there were approximately 30 direct contacts of Patients 3 and 4 (including Patients 7–9); those contacts that developed clinical disease had all been vaccinated. In addition, the index case (Patient 1) had been vaccinated, but not Patient 3. These data suggest that the variola virus strain involved in the epidemic may have been somewhat vaccine- resistant. 

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(…) How did the index case in the 1971 Aralsk outbreak become infected with smallpox? The official report does not offer a conclusive explanation but presents three hypotheses. According to the first of these: Members of the crew and of the research team went ashore on July 29 in the town of Uyaly in the Kzyl-Orda region (…) According to this scenario, Patient 1 was the source of the disease’s outbreak in the city of Aralsk. She contracted smallpox at the end of July, 1971, either in Uyaly or in Komsomolsk-on-Ustyurt. 

(…) The second hypothesis put forward in the official report is that the infection was introduced directly into the city of Aralsk from the southern borders of the Soviet Union via land or water transportation.  

(...) The third hypothesis presented in the official report: A scenario of infection via the open-air market has also been thoroughly checked. (…) However, no evidence was established that people with smallpox arrived from those regions and visited the home of [the father of Patients 1 and 2] or the market’s director, or that goods such as rugs and other wool artifacts were bought or sold there. 

--- (…) On May 25, 2002, the author (Zelicoff) contacted the index case, Patient 1, by telephone and conducted an extensive interview of about two hours Patient 1 confirms that, as a recent graduate of the Fisheries Institute in Aralsk, she sailed on the Lev Berg in 1971. She disputes, however, several key aspects of the official report. Most significantly: 

      + Patient 1 insists that she did not disembark from the Lev Berg at any of the ports of call along its route, (…) Patient 1 noted that official policy allowed only the male members of the crew to leave the ship, and that this rule was strictly enforced. 


     + The official report states that Patient 1 became ill en route to Aralsk. Yet Patient 1 recalls feeling well on the ship and only becoming ill shortly after arriving home in Aralsk.

     + She states that no one on board the Lev Berg developed illness or fever through August 11, when the ship returned to Aralsk.


(…) If  Patient 1’s recollections are accurate, it is unlikely that she was exposed to smallpox at any of the ship’s ports of call on the Aral Sea. It is also unlikely that she was secondarily infected by any of the male crew members who went ashore, because no one on board became feverish or otherwise sick during the voyage. 

(…) it is most likely that his sister, Patient 1, became ill on or about August 11, roughly thirteen days earlier. This is precisely in line with her oral history and at variance with the official report, where the date of onset of her illness is given as August 6. It is extremely unusual for patients with smallpox to transmit the disease after the first week of clinical illness, further discrediting the official report. It is therefore most likely that she became infected with smallpox during the last days of July 1971. 

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(…) It is now known that beginning in 1936, the Soviet Ministry of Defense used Vozrozhdeniye Island in the Aral Sea as a site for BW field testing.15 The island offered a number of advantages: it was isolated and surrounded by water, making security relatively easy. (…) Finally, the blistering hot temperatures and intense solar radiation insured that microbial pathogens tested in the open environment would die quickly and hence would not inadvertently escape from the island. 

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(…) Referring to the map, the Lev Berg was probably south of Vozrozhdeniye Island on or about July 30. Could an open- air test or a laboratory accident involving a virulent strain of variola virus have resulted in the inadvertent contamination of the research vessel? Dr. Pyotr Burgasov, a former chief sanitary physician of the Soviet Union who is notorious for his now- discredited claim that the Sverdlovsk anthrax outbreak of 1979 resulted from “contaminated meat,” was interviewed in the Russian press in November 2001. He is quoted as having said: 

“On Vozrozhdeniye Island in the Aral Sea, the strongest formulations of smallpox were tested. Suddenly I was informed that there were mysterious cases of disease in Aralsk. A research ship of the Aral fleet came 15 kilometers away from the island (it was forbidden to come any closer than 40 kilometers). The laboratory technician of this ship took samples of plankton twice a day from the top deck. The smallpox formulation—400 grams of which was exploded on the island—“got her” and she became infected. After returning home to Aralsk, she infected several people, including children. All of them died. I suspected the reason for this and called the Chief of the General Staff of the Ministry of Defense and requested that the train from Alma-Ata to Moscow be forbidden to stop at Aralsk. As a result, an epidemic around the country was prevented. I called Andropov, who at that time was chief of the KGB, and informed him of the exclusive recipe of smallpox in use on Vozrozhdeniye Island. He ordered that not another word be said about it. This is a real biological weapon! The minimum radius of contamination was 15 kilometers. One could imagine what would have happened if instead of one laboratory technician, there had been 100 to 200 people.”