Folks of a certain vintage have the tell-tale crater on their upper arms: The discolored, shallow scars from the smallpox vaccine.
This ceased being a rite of passage in 1972, when the disease was eradicated from the U.S. The smallpox vaccine was also protective against monkeypox, though, and the question now arises: Do folks who got a smallpox vaccine — largely Baby Boomers more than 50 years ago — still have some protection against the latest scourge?
How lovely that would be! And those prone to confirmation bias might find some evidence to bolster that hope: In California, more than 90% of cases have been in people younger than 55.
But UC Irvine epidemiologist Andrew Noymer and coauthor Andrew Lover, an epidemiologist at the University of Massachusetts-Amherst, burst that bubble in an op-ed published in the Tampa Bay Times.
“It’s true that we haven’t seen as many cases in older people, but I don’t attribute that to the magic of the smallpox vaccine,” said Noymer. “We have seen cases in mostly gay men, but I expect that to change over time. The epidemiology is going to look different.”
So far, 98% of cases have been reported in men, according to the California Department of Public Health.
Outbreak
In Orange County, there have been 58 suspected or confirmed monkeypox cases. In Los Angeles County, 901; Riverside County, 76; and San Bernardino County, 20, according to county public health departments.
In California as a whole, we’re talking 1,945 cases. In the U.S., about 12,000; and worldwide, more than 36,000, according to the CDPH and the U.S. Centers for Disease Control.
About 3.5% of those infected have had to be hospitalized, according to the CDPH. There are effective vaccines, but they’re in short supply and people are lining up to get them.
“Can Americans — baby boomers, mostly — relax if they were vaccinated against smallpox as kids? Maybe, but we are health scientists who have been observing the epidemiology of monkeypox for years, and we are concerned about complacency,” Noymer and Lover write.
Unproven
“The first thing to understand is that the smallpox vaccine is made of the vaccinia virus, which offers cross-immunity to many viruses related to smallpox, including monkeypox,” they continue.
“Vaccinia-based vaccines will protect against monkeypox, but exactly how much is unknown. There has never been a randomized clinical trial measuring the effectiveness of the vaccine against monkeypox. The figure that has been making the rounds (85% effectiveness) is estimated from a single historical study from the 1980s.”
Before smallpox was eradicated, health officials advised revaccination every five years, and every three years for lab workers handling pox viruses. “We simply cannot assume that any 50-year-old vaccinations are still protective,” they wrote.
“As we age, our immune systems work less well, and most Americans vaccinated against smallpox as children are now in retirement or rapidly approaching it. This is another factor that should give us pause about assuming older Americans should rest easy with a decades-old smallpox vaccine scar.”
Officials agree. Smallpox vaccination can protect for about 3 to 5 years, said Dr. Christopher Zimmerman, deputy medical director with the Orange County Health Care Agency. After that time, its ability to protect wanes.
Mount a fight
Monkeypox is spread by skin-to-skin contact, not just by sex, and the epidemiologists expect the painful pustule-forming disease will eventually move into wider circulation.
“In time, we expect to see more monkeypox cases in the broader population, including children and young adults,” they wrote. “Monkeypox is a disease to avoid; though mortality is very low, the symptoms include fever, and a rash that is temporarily extremely painful with the potential for permanent scarring.”
A more comprehensive public vaccination push will likely be needed to counter monkeypox, they said. The CDC may eventually need to order enough Jynneos vaccine — the newest and most side effect-free vaccine — to jab everyone, including senior citizens.
Right now, public health officials are vaccinating high-risk groups with the vaccine they have on hand. In O.C., the nonprofit Families Together of Orange County became the first community health center in the county to provide vaccinations. Contact your county health department for more information if you believe you’re eligible.
Protect yourself
The experts offer some tips to help us stay out of monkeypox’s way. The CDC says:
• Avoid close, skin-to-skin contact with people who have a rash that’s blistering.
• Don’t touch another person’s rash or scabs.
• Don’t kiss, hug, cuddle or have sex with someone infected with monkeypox.
• Avoid contact with objects and materials that an infected person has used.
• Don’t share eating utensils or cups with an infected person.
• Don’t handle or touch the bedding, towels, or clothes of an infected person.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially before eating or touching your face and after using the bathroom.
It’s never a bad idea to mask. Noymer doesn’t think trying on clothing in the store is a major route of transmission, but he probably won’t be brick-and-mortar swimsuit shopping any time soon. He’s avoiding packed indoor concerts and such, where people cram in close together, and suggests that younger folk might want to avoid the mosh pit for a while.
“This is not going to take off like COVID did,” he said. “But now we have cases in dogs, and it’s going to be hard to stamp it out.”
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