#smallpox outbreak

(…) 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.” 

‘My wife’s father worked as a stoker in Glanryhd hospital in Bridgend. The reason the smallpox was diagnosed there in one of the old dears is because one of the doctors had worked abroad and because of that he diagnosed it immediately. The other doctors didn’t know. This doctor had to burn all his clothes.’

- Malcolm G John

‘I was a patient in the then East Glamorgan Hospital awaiting the birth of my second child. Mr Hodkinson was due a ward round on a morning and I had been told he would be likely to examine me.  However, the visit never took place and we learnt later that he had been taken ill.  Within a few days – by which time my child had been born – all patients were confined to their beds with visits to the television room banned.

‘Later it became apparent that something serious was going on and we learnt that it had to do with smallpox. No visiting was allowed and we were informed we would have to remain in the hospital in isolation for some time.  By now we knew that Mr Hodkinson had died.

‘Some months before I had had a smallpox vaccination, so I was not particularly concerned, but some of the other mums were very nervous. (I received a vaccination because I was a nurse in another hospital.)  My baby and otheres were given an injection – as a precaution we were told.

(...) ‘We were able to see our families through the windows and parcels could be left for us at the main entrance.  I already had a young child at home and that was upsetting only to see her through a window.

On one occasion we saw a body being removed outside with accompanying staff dressed all over in white suits.  I believe a young child had died of smallpox.

‘After three weeks and one day we were allowed to leave.’

-Mary Alleyne

‘I was nine at the time and remember having the inoculation at Cowbridge. I vaguely remember the children’s “joke”. ‘What is the Rhondda Valley famous for? – Smallpox’. As an adult I have come to realise what an insidious disease Smallpox is and thank medical science that it now only exists in a very few laboratories.’

-Paul Anderson

‘My father’s full name was Dr Richard Thomas Bevan. He was involved with the smallpox outbreak for a variety of reasons. (...) At the time of the outbreak In 1962 he held the post of  Deputy Medical Officer of Health, Glamorgan.

‘I was 13 years old when the smallpox outbreak occurred. My father was a very calm placid man who never showed agitation but I could sense at the time that this was something more serious than usual.

‘Having the vaccination done in the kitchen was not a totally unusual event for me as I also remember that was the way I received polio injections etc so I didn’t really feel any sense of urgency about the need to vaccinate us all. It was just the way of life in our family!

-Cath Arnold

In 1962 I was16. My mother had been a nurse and had a medical book with a picture of a patient with smallpox. It had scared me so I went to Dr Spector and had the vaccination.

Anyway, my mother and I were caught up in the events in Cardiff and were monitored for a few weeks. A bit like the Ebola crisis now! We lived in Ystrad and the Isolation Hospital was on Penrhys. I remember the ambulances coming with the staff all gowned up. I also remember the smoke from the chimney at the hospital. I think it meant that someone had died.

It also made people comment that the Pope had been elected!

-Sandra Jones

I lived in Aberaman at that time – I was 7 years old. My father, Les Thomas, was a physiotherapist and chiropodist. He had his practice at home at number 1 Margaret Street, Aberaman but worked in the mornings at East Glamorgan hospital as the resident physiotherapist.

I remember him being in contact with one of our local GP’s, Dr Moffatt who had his practice in Glamorgan Street, Aberaman. The vaccinations were being done by Dr Moffatt and my father. I remember long queues of people out from our front door, and along Cynon Street. I remember asking my father to vaccinate me and he did it.

Being so very young at the time, I obviously didn’t realise the enormity of the problem but I do remember feeling very afraid.

-Lyn du Plessis nee Thomas

I knew Wayne Mansfield when I was an infant and it’s strange how you remember things. The family was still living in 12 Tegfan at the time – we must have been about 6 years old.

I remember when he came to call for me my aunt was a bit reticent for me to go out to play. I realize now how strong the stigma attached to this was – and we are talking about 2 to 3 years later. Not long after, the family moved from Tegfan, I don’t know where to.

-Stuart Jenkins

I was born and brought up on the main road in Tonyrefail. In the village, the husband of the children’s clinic nurse died in the outbreak. My mother was pregnant and narrowly missed, through providential circumstances, a consultation with the gynaecologist who died, during a time he was incubating but before he had developed the disease. I recall vividly the ambulances from Blackmill passing our home with a police escort, carrying corpses to be cremated in Glyntaff or Thornhill Crematoria.

- Ieuan Davies

My father was the chemist in Cilfynydd and we were given the vaccination before anyone else by our doctor because he didn’t have enough vaccine to go round. We were told not to tell anyone and not to have a bath for 6 weeks or go swimming. My school was next to the cemetery and I remember being sent home from school one lunchtime because they were cremating one of the victims of the outbreak and, apparently, they were still contagious even after death. It was feared we would breathe in the infectious spores.

- Glynys Hono

I was six years old in 1962. I had been admitted to East Glamorgan Hospital and examined by Dr Hodkinson just a few days before he became ill. The hospital was closed and I was put into ward 2. (The childrens’ ward had been closed due to an outbreak, I think.) Being the only child on a womens’ ward resulted in my long hair being brushed, combed, curled, plaited, put into rags – you name it! I remember standing on the radiators in the day room to be able to wave to my parents in the car park. It seemed like ages until I could go home. I was one of the lucky ones. It is only now that I realise how worried my parents must have been.

-Kath Malpas

I was at Porth Grammar Technical School at the time of the outbreak, aged 16. I remember the tension and panic. I was sent by my parents for the injection at Dr. Maxwell’s tiny surgery in Ynyshir. The room was packed with very worried patient. I remember realising that this surgery was the perfect place for the infection to spread. One of my class mates had been in contact with family members in Swansea, he and his family were placed in a form of “quarantine.”

My injection had no reaction, I needed a second one. At school our whole class refused to do P.E. as they had sore arms, this was seen as a dangerous rebellion. The class was caned – apart from me as the second injection was so recent. A highlight was an International football match between Wales and England was switched from Swansea to Ninian Park. It must have been one of the last games for Johnny Haynes and John Charles.