Smallpox Vaccine and Resident Responses in Modern Shanghai: Focusing on Regional and Cultural Comparison.

In modern Shanghai, smallpox was one of the most threatening diseases with its mortality rate going up to 30 percent. In response to the disease, Dr. William Lockhart, a medical missionary of the London Missionary Society, introduced vaccination to the Chinese people in Shanghai. He built the first western style hospital in Shanghai, Renji Hospital, in 1843. At this time, native doctors also played a very important role. For example, Huang Chun-pu was in charge of the dispensary in the Chinese City in Shanghai, and he was the one who introduced vaccination under Dr. Lockhart's direction. In 1868, the Health Office of Shanghai Municipal Council began to implement a vaccination program. Around the turn of the 20th century, the Health Office of Shanghai Municipal Council managed several sub-district offices, hospitals, dispensaries, gaol, and even the traditional place like simiao for the free vaccinations. Urban residents benefited from a sanitary system, such as wide and free vaccination, compared to people who lived in rural areas. Moreover, Shanghai possessed the advantage of having the vaccine as a staple product of the Municipal Laboratory. The number of units of the vaccine issued from the Laboratory in sequence of years from 1898 to 1920 has been 115,351 on average. Unlike the International Settlement, where systematic inoculation was conducted under the leadership of the Municipal Council, the Chinese City was still reliant on charity organizations in the early 1900s. The foreign residence in the International Settlement had a strong influence from the foreign governments, and foreign doctors were well-aware of the need for the vaccination. However, the Chinese City was a Chinese enclave that was still under the traditional rule of the Qing Dynasty. In addition, the people of Shanghai had different perceptions of the smallpox vaccination, and this became an obstacle to the establishment of urban sanitation systems. Some Chinese people still relied on the traditional Chinese variolation and Chinese custom. For example, Chinese people still applied for inoculation in the spring and avoided summer and fall following traditional Chinese variolation, even though the best time to get vaccinated was in early winter before the spread of smallpox. In addition, foreigners were often more problematic than Chinese because they often overlooked the importance of vaccines and relied on drugs instead. The municipal authority, therefore, provided a wide range of free vaccinations for the poor and needy people regardless of their nationalities, and with such measures, sought to establish a stable urban sanitation system. This had been the key to the success of hygiene policies.

Preparedness for a smallpox pandemic in Japan: public health perspectives.

Smallpox is an acute, febrile, contagious disease caused by the Variola virus, which is a member of the Poxviridae family. Until the 1970s, smallpox had been a pandemic disease for more than 3000 years, endemic in tropical and developing areas and periodically epidemic worldwide. The World Health Organization declared smallpox to be completely eradicated in 1980 as the result of global vaccination efforts. At that time, all routine vaccination programs were terminated, given the success of thismonumental eradication. Although smallpox remains fully eradicated, uncertainty exists regarding the possibility of recurrent smallpox outbreaks. At the end of the Cold War, concerns regarding unstable international security and the feasibility of terrorism with weapons of mass destruction have been highlighted. The potential threat of intentional release of smallpox has forced regional health authorities to reconsider their political landscape and create preparedness plans to protect the community in the event of biological attacks. Here we present current countermeasures to this biological threat in Japan and discuss methods for strengthening public health preparedness both domestically and internationally. These methods include infection control, vaccination policy, and international partnerships to help deter or contain a contagious smallpox pandemic.

Bioterrorism preparedness--Part II. Smallpox vaccination in a hospital setting.

The threat of using smallpox as an agent for bioterrorism resulted in a directive for the creation of smallpox response teams. In Connecticut, The Commissioner of the Department of Public Health convened public health and hospital leadership to plan for the vaccination of these teams. The purpose of this paper is to provide a description of the vaccination program at Hartford Hospital, a Center of Excellence for Bioterrorism Preparedness, and to report the results of a survey of the vaccinees regarding the vaccination experience. Ninety persons were vaccinated. Six individuals experienced low-grade fever and 10 had axillary node swelling. One individual experienced significant fatigue. A total of six persons lost time from work. Four lost one day and two persons lost between four to five days of work. There was no autoinoculation, transfer inoculation, vaccinia or any other significant complication. Survey results indicate that most vaccinees felt positive about the experience.