To the Editor.—
The ink didn't dry well on the reply by the Center for Disease Control (CDC) to my inquiry (219:908, 1972) and a smallpox epidemic broke out in Yugoslavia. It resulted in 173 cases there, another case in Hamburg, Germany, and ended with 34 fatalities (220:1254,1972). The mortality for this importation epidemic was almost 20%. The contention by the CDC that a range of mortality prevails in smallpox is irrelevant to the main issue for the United States. What is the mortality during an imported epidemic in a developed country? Would the avoidance of a few cases of postvaccinal encephalitis (their number could be decreased in part by having raised the age of primary vaccination to two or three) outweigh the risk of a tragedy such as the one that occurred in Yugoslavia? After all, the Yugoslavian epidemic was the first such outbreak during the last 42 years.
Tizes R. Discontinuance of Routine Smallpox Vaccination. JAMA. 1972;221(13):1521. doi:10.1001/jama.1972.03200260055032