smallpox vaccine effectiveness

[PainRack]

Hi folks, I'm currently debating a vaccine denier and etc with regards to H1N1. Along the way, a topic was brought up with regards to vaccination and its effectiveness at preventing disease, in particular smallpox.

I'm not an epidemologist, so while I can provide the expert responses to the rest of the claims, some of these defeat me.

"How is it that in Germany, the best vaccinated country in the world, there are more deaths in proportion to the population than In England - for example, in 1919, 28 deaths in England, 707 In Germany; In 1920, 30 deaths In England, 354 In Germany In Germany In 1919 There were 5,012 cases of smallpox with 707 deaths; in England In 1925 There were 5,363 cases of smallpox with 6 deaths. What is the explanation?[/b]"


"In the Philippines, prior to US takeover in 1905, case mortality from smallpox was about 10%. In 1905, following the commencement of systematic vaccination enforced by the US Government, an epidemic occurred where the case mortality ranged from 25% to 50% in different parts of the islands. In 1918-1919 with over 95% of the population vaccinated, the worst epidemic in the Philippine's history occurred resulting in a case mortality of 65%. The highest percentage occurred in the capital Manila, the most thoroughly vaccinated place. The lowest percentage occurred in Mindanao, the least vaccinated place owing to religious prejudices. Dr V de Jesus, Director of Health, stated that the 1918-1919 smallpox epidemic resulted in 60,855 deaths. The 1920 Report of the Philippines Health Service contains the following comments:

"From the time in which smallpox was practically eradicated In the city of Manila to the year 1918 (about 9 years) in which the epidemic appears certainly In one of its severest forms, hundreds after hundreds of thousands of people were yearly vaccinated with the most unfortunate result that the 1918 epidemic looks prima facie as a flagrant failure of the classic Immunization towards future epidemics"."

I'm not up to date on the exact epidemics in particular. My counter-point was that incidence rates dropped to zero and became entirely imported cases in North America and Western Europe. This brought up the rebuttals that

1. Increased cases of sanitation/hygiene and other improvements brought about the decline（rebutted with current epidemic rates in Italy, Britain and US).
2. The effectiveness of the vaccine.

I'm looking for some "common sense" stories on how the vaccine effectiveness has been demonstrated. I have brought up the known examples in history, namely cowpox and the use of variolation on British prisoners then exposed to smallpox. Similarly, the American Revolutionary Army variolated vs the German Hessan Army.
However, I'm unable to show a clear causative element. For example, could anyone find any details on Mack, T.M. Smallpox In Europe, 1950-1971. Several papers quoted this article for statistics on imported smallpox infection in Europe, including its rates in unvaccinated vs vaccinated people but I can't find it in Cochrane.
His specific questions is

like i said no pure human experiment has had the proper control and test grps the examples u have and the examples i have all fail to prove causation because of that. Pure human test are preferred if u can find any.

I'm scratching my head to figure out what simple evidence I can dump on him........ I mean, god, everyone would have assumed exposure of prisoners to smallpox, unethical now would have been definitive proof!

[Melchior]

Is this only about the effectiveness of historical vaccines for smallpox?

[PainRack]

Is this only about the effectiveness of historical vaccines for smallpox?

Well, the areas I'm seeking help in, yes.

[Broomstick]

Well, for starters, sanitation has no effect on smallpox. Properly done quarantine can contain an epidemic, but cleanliness has zero effect. It is not a disease of filth but an airborne/contact contagion. Likewise, as there is no animal vector whatsoever for smallpox, it being a solely human disease (even our closest ape relatives are not sickened by the virus), vermin control has no effect on it either. So saying "smallpox went away due to better sanitation" is like saying "smallpox went away because people started wearing blue jeans". The two are unrelated to each other.

Another thing to consider is that there are several varieties of smallpox. Mortality rates for various types of smallpox range from 2% (Variola minor, with the resulting infection sometimes called alastrim) to 98% ( the "flat" and "hemorrhagic" subtypes of Variola major. V. major has four main subtypes, the other two have mortality rates around 30-40%). Unless the type of smallpox involved in an epidemic is known arguing about it is somewhat meaningless. It's like arguing about whether or not a dog is overweight or underweight without knowing if it's a fox terrier or a great dane.

Alastrim, being relatively minor, allows for the infected person to be ambulatory and might even be missed, so it tends to spread and infect many more people. As this infection provides equal protection as that acquired by surviving V. major and superior defense to being vaccinated, areas where alatrim became the dominant form of the virus tended to have lower infection and mortality when V. major outbreaks occurred because a significant number of the vaccinated populace were immune due to prior infection by V. minor. Both forms of the virus, and both types of infection, are nonetheless called smallpox.

The area where V. minor became dominant by the early 20th Century were the US, South Africa, and Great Britain. It did NOT become dominant in mainland Europe. Now read again that part comparing the fatality rates in the UK and Germany in the early 20th Century. There is your explanation: the UK had a milder form of the virus with only about 2% fatality rate. Germany had the more typical V. major, with a 30-40% fatality rate.

For the Phillipine cases a meaningful attempt at explanation would need to involved the subtype of the presumed V. major in the outbreak. If most of the deaths involved hemorrhaging, intestinal casts, and flat rather than raised lesions then it involves the most virulent and deadly variant(s) of the virus, which could easily account for a higher mortality rate even in a predominantly vaccinated population. Fewer people overall would catch the disease, but those that did would be more likely to die.

[PainRack]

Well, for starters, sanitation has no effect on smallpox. Properly done quarantine can contain an epidemic, but cleanliness has zero effect. It is not a disease of filth but an airborne/contact contagion. Likewise, as there is no animal vector whatsoever for smallpox, it being a solely human disease (even our closest ape relatives are not sickened by the virus), vermin control has no effect on it either. So saying "smallpox went away due to better sanitation" is like saying "smallpox went away because people started wearing blue jeans". The two are unrelated to each other.

Unfortunately, his sanitation theory was not based entirely on smallpox but similarly refers to measles and tyhpoid. The last in particular has sanitation being an important component of control.

The area where V. minor became dominant by the early 20th Century were the US, South Africa, and Great Britain. It did NOT become dominant in mainland Europe. Now read again that part comparing the fatality rates in the UK and Germany in the early 20th Century. There is your explanation: the UK had a milder form of the virus with only about 2% fatality rate. Germany had the more typical V. major, with a 30-40% fatality rate.

Would you offer any explaination for the difference in infection rates vis a vis vaccination? From what I do know, the UK had a more lax attitude towards vaccination when compared to Germany, which enforced mandatory vaccination earlier and more aggressively.

I would think this is due to herd immunity not being achieved but I'm simply not aware of the specifics.

lol. Meanwhile, we see how my studies in patient teaching and the adoption of a "holistic" approach comes about in a real life setting:D

[Broomstick]

The area where V. minor became dominant by the early 20th Century were the US, South Africa, and Great Britain. It did NOT become dominant in mainland Europe. Now read again that part comparing the fatality rates in the UK and Germany in the early 20th Century. There is your explanation: the UK had a milder form of the virus with only about 2% fatality rate. Germany had the more typical V. major, with a 30-40% fatality rate.

Would you offer any explaination for the difference in infection rates vis a vis vaccination? From what I do know, the UK had a more lax attitude towards vaccination when compared to Germany, which enforced mandatory vaccination earlier and more aggressively.

I would think this is due to herd immunity not being achieved but I'm simply not aware of the specifics.

Are you referring to this? I used color coding to match information from the different years mentioned:

"How is it that in Germany, the best vaccinated country in the world, there are more deaths in proportion to the population than In England - for example, in 1919, 28 deaths in England, 707 In Germany; In 1920, 30 deaths In England, 354 In Germany In Germany In 1919 There were 5,012 cases of smallpox with 707 deaths; in England In 1925 There were 5,363 cases of smallpox with 6 deaths. What is the explanation?"

For the year 1919 you have total deaths in both England and Germany, total cases in Germany, but no mention of total cases in England.

Only raw numbers of death are mentioned for 1920, which isn't terribly informative unless you have the numbers of infections as well.

Only England is mentioned for 1925

Therefore, the information presented only allows us to discuss 1919 with any real meaning, and in that case only the actual numbers of deaths, not the the number of infections. In other words, this is cherry-picking and false comparison of raw data with no means to really make a comparison. For example, for England for 1919 we don't know if you had 30 cases where 28 died (a horrific mortality) or 10,000 cases were 28 died (much less of a crisis). As England is on an island there is some geographical isolation. This is, for example, the reason rabies is largely unheard of in the UK while it is still endemic in Europe. Unless we have meaningful data, such as the number of infections in England for those years, no meaningful conclusion can be drawn here.

[Mayabird]

1918-1919 was at the end of and right after the biggest war of all time (up to that point) and there was a goddamn flu plague killing tens of millions then! Why the fuck are they cherry-picking those years?

Expanding on Broomstick's point. They don't have enough data points to even pretend to have correlation, and there were some pretty big factors skewing the results.

[PainRack]

I don't really want to do this as the debate doesn't really reflect well on me, but would it help if I post the link?
****://forums.hardwarezone.com.sg/showthread.php?t=2555062&page=9

[anybody_mcc]

Ask him how does he explain that eradication of smallpox in the entire world "coincided" with the vaccination campaign, and he definitely cannot invoke sanitation (Broomstick's reasons should be enough for rational person, but since he is vaccination denier facts probably won't work with him that well), because sanitation did not improve in many places in the 3rd world, yet disease was eradicated.

[PeZook]

I noticed he only cites mortality rates for the Phillipino epidemic ; I know next to nothing about it, but you should've probably demanded more meaningful numbers, like total numbers of infections and death as compared with epidemics prior to variolation. Because if vaccination somehow raised the mortality to 65%, but only 5% of the population is in danger, that's a big improvement, rather than an argument against vaccination.

[PainRack]

I noticed he only cites mortality rates for the Phillipino epidemic ; I know next to nothing about it, but you should've probably demanded more meaningful numbers, like total numbers of infections and death as compared with epidemics prior to variolation. Because if vaccination somehow raised the mortality to 65%, but only 5% of the population is in danger, that's a big improvement, rather than an argument against vaccination.

He's simply not in a position to understand or dig out data.
Furthermore..... I'm trying to achieve a non confrontational attitude because I'm treating this as a real life health problem as opposed to a debate. Find out their concerns, empathy etc etc, then overwhelm them with various counselling techniques so as to enforce a change in health behaviour...... Sadly, this means in terms of my goals, it would be better for me to dig out the relevent information rather than confront him on his shortfalls.

Solidghost just blew my fuses though so.......