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September 25, 1972

Discontinuance of Routine Smallpox Vaccination

JAMA. 1972;221(13):1521. doi:10.1001/jama.1972.03200260055032

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.