1972 Yugoslav smallpox outbreak

Last updated
1972 Yugoslav smallpox outbreak
Smallpox PHIL 3278.tif
Field physicians checking an immunization reaction in a man during a smallpox epidemic, Kosovo, 1972
Disease Smallpox
Virus strainVariola
Location SAP Kosovo and Belgrade, SR Serbia, SFR Yugoslavia
Index case A Muslim pilgrim from SAP Kosovo
Dates16 February - 11 April 1972 [1]
Confirmed cases175 [1]
Deaths
35 [1]

The 1972 Yugoslav smallpox outbreak was the largest outbreak of smallpox in Europe after the Second World War. [1] It was centered in SAP Kosovo, a province of Serbia within Yugoslavia, and the capital city of Belgrade. A Kosovar Albanian Muslim pilgrim had contracted the smallpox virus in the Middle East. Upon returning to his home in Kosovo, he started the epidemic in which 175 people were infected, killing 35. The epidemic was efficiently contained by enforced quarantine and mass vaccination. The 1982 film Variola Vera is based on the event. [2]

Contents

Background

By 1972 the disease was considered to be eradicated in Europe. The population of Yugoslavia had been regularly vaccinated for 50 years, and the last case was reported in 1930. This was the major cause of the initial slow reaction by doctors, who did not promptly recognize the disease. [3]

In October 1970, an Afghan family went on pilgrimage from Afghanistan, where smallpox was endemic, to Mashhad in Iran, triggering an epidemic of smallpox in Iran that would last until September 1972. By late 1971, smallpox-infected pilgrims had carried smallpox from Iran into Syria and Iraq. [4]

Outbreak

Patient with smallpox, Kosovo, Yugoslavia epidemic, March and April 1972. Smallpox PHIL 2003 lores.jpg
Patient with smallpox, Kosovo, Yugoslavia epidemic, March and April 1972.

In early 1972, a 38-year-old Kosovo Albanian Muslim clergyman named Ibrahim Hoti, from Damnjane near Đakovica, Kosovo, undertook the Hajj. [5] He visited holy sites in Iraq, where cases of smallpox were known. He returned home on February 15. [6] The following morning he suffered aches and was tired. After feeling feverish for a couple of days and developing a rash, he recovered, [7] likely because he had been vaccinated two months earlier. [8]

On March 3, Latif Mumdžić, a thirty-year-old teacher, who had just arrived in Đakovica to attend school, fell ill. He had no known direct contact with Hoti. He may have been infected by one of the clergyman's friends or relatives who visited during his illness, or simply by passing the clergyman in the street. When Mumdžić visited the local medical center two days later, doctors attempted to treat his fever with penicillin (smallpox is a virus, so this was ineffective). His condition did not improve, and after a couple of days, his brother took him to the hospital in Čačak, 150 km to the north in Serbia. The doctors there could not help him, so he was transferred by ambulance to the central hospital in Belgrade. On March 9, Mumdžić was shown to medical students and staff as a case of an atypical reaction to penicillin, which was a plausible explanation for his condition. On the following day, Mumdžić suffered massive internal bleeding and, despite efforts to save his life, died that evening. The cause of death was listed as "reaction to penicillin". In fact, he had contracted Hemorrhagic Smallpox , a highly contagious form of smallpox. Before his death, Mumdžić directly infected 38 people (including nine doctors and nurses), eight of whom died. [9] A few days after Mumdžić's death, 140 smallpox cases erupted across Kosovo province. [10]

Reaction

The government's reaction was swift. Martial law was declared on March 16. Measures included cordons sanitaires of villages and neighborhoods, roadblocks, a prohibition of public assembly, closure of borders and prohibition of all non-essential travel. Hotels were requisitioned for quarantines in which 10,000 people who may have been in contact with the virus were held under guard by the Yugoslav People's Army. [11]

Mumdžić's brother developed a smallpox rash on March 20, resulting in medical authorities realizing that Mumdžić had died of smallpox. The authorities undertook massive revaccination of the population, helped by the World Health Organization (WHO), "almost the entire Yugoslavian population of 18 million people was vaccinated". Leading experts on smallpox were flown in to help, including Donald Henderson and Don Francis. [12]

By mid-May, the outbreak was contained and the country returned to normal life. During the epidemic, 175 people contracted smallpox and 35 died. [13]

Legacy

The Yugoslav government received international praise for the successful containment of the epidemic, which was one of the finest hours for Donald Henderson and WHO, as well as one of the crucial steps in the eradication of smallpox. [12]

In 1982, Serbian director Goran Marković made the film Variola Vera about a hospital under quarantine during the epidemic.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">1775–1782 North American smallpox epidemic</span> Disease outbreak in North America

The New World of the Western Hemisphere was devastated by the 1775–1782 North American smallpox epidemic. Estimates based on remnant settlements say at least 130,000 people were estimated to have died in the epidemic that started in 1775.

<span class="mw-page-title-main">1978 smallpox outbreak in the United Kingdom</span> Event resulting in the last known death from smallpox

The 1978 smallpox outbreak in the United Kingdom resulted in the death of Janet Parker, a British medical photographer, who became the last recorded person to die from smallpox. Her illness and death, which was connected to the deaths of two other people, led to the Shooter Inquiry, an official investigation by government-appointed experts triggering radical changes in how dangerous pathogens were studied in the UK and named after the panel's leader.

<i>The Killer That Stalked New York</i> 1950 film by Earl McEvoy

The Killer That Stalked New York is a 1950 American film noir directed by Earl McEvoy and starring Evelyn Keyes, Charles Korvin and William Bishop. The film, shot on location and in a semi-documentary style, is about diamond smugglers who unknowingly start a smallpox outbreak in the New York City of 1947. It is based on the real threat of a smallpox epidemic in the city, as described in a story taken from a 1948 Cosmopolitan magazine article.

Vaccination and religion have interrelations of varying kinds. No major religion prohibits vaccinations, and some consider it an obligation because of the potential to save lives. However, some people cite religious adherence as a basis for opting to forego vaccinating themselves or their children. Many such objections are pretextual: in Australia, anti-vaccinationists founded the Church of Conscious Living, a "fake church", leading to religious exemptions being removed in that country, and one US pastor was reported to offer vaccine exemptions in exchange for online membership of his church.

<span class="mw-page-title-main">Rahima Banu</span> Last known person to have been infected with naturally occurring Variola major smallpox

Rahima Banu Begum is the last known person to have been infected with naturally occurring Variola major smallpox, the more deadly variety of the disease.

<span class="mw-page-title-main">Ali Maow Maalin</span> Hospital worker, last naturally acquired case of smallpox (1954–2013)

Ali Maow Maalin was a Somali hospital cook and health worker from Merca who is the last person known to have been infected with naturally occurring Variola minor smallpox. He was diagnosed with the disease in October 1977 and made a full recovery. Although he had many contacts, none of them developed the disease, and an aggressive containment campaign was successful in preventing an outbreak. Smallpox was declared to have been eradicated globally by the World Health Organization (WHO) two years later. Maalin was subsequently involved in the successful poliomyelitis eradication campaign in Somalia, and he died of malaria while carrying out polio vaccinations after the re-emergence of the poliovirus in 2013.

Globalization, the flow of information, goods, capital, and people across political and geographic boundaries, allows infectious diseases to rapidly spread around the world, while also allowing the alleviation of factors such as hunger and poverty, which are key determinants of global health. The spread of diseases across wide geographic scales has increased through history. Early diseases that spread from Asia to Europe were bubonic plague, influenza of various types, and similar infectious diseases.

<i>Variola Vera</i> 1982 film

Variola Vera is a 1982 Yugoslav film directed by Goran Marković.

Mass vaccination is a public policy effort to vaccinate a large number of people, possibly the entire population of the world or of a country or region, within a short period of time. This policy may be directed during a pandemic, when there is a localized outbreak or scare of a disease for which a vaccine exists, or when a new vaccine is invented.

<span class="mw-page-title-main">Smallpox</span> Eradicated viral disease

Smallpox was an infectious disease caused by variola virus, which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) certified the global eradication of the disease in 1980, making smallpox the only human disease to have been eradicated to date.

<span class="mw-page-title-main">1974 smallpox epidemic in India</span> Disease outbreak in India

The 1974 smallpox epidemic in India infected 188,000 people, leading to the deaths of 31,000 Indians.

The history of smallpox extends into pre-history. Genetic evidence suggests that the smallpox virus emerged 3,000 to 4,000 years ago. Prior to that, similar ancestral viruses circulated, but possibly only in other mammals, and possibly with different symptoms. Only a few written reports dating from about 500 AD to 1000 AD are considered reliable historical descriptions of smallpox, so understanding of the disease prior to that has relied on genetics and archaeology. However, during the 2nd millennium AD, especially starting in the 16th century, reliable written reports become more common. The earliest physical evidence of smallpox is found in the Egyptian mummies of people who died some 3,000 years ago. Smallpox has had a major impact on world history, not least because indigenous populations of regions where smallpox was non-native, such as the Americas and Australia, were rapidly and greatly reduced by smallpox during periods of initial foreign contact, which helped pave the way for conquest and colonization. During the 18th century the disease killed an estimated 400,000 Europeans each year, including five reigning monarchs, and was responsible for a third of all blindness. Between 20 and 60% of all those infected—and over 80% of infected children—died from the disease.

The Aral smallpox incident was a 30 July 1971 outbreak of the viral disease which occurred as a result of a field test at a Soviet biological weapons (BW) facility on an island in the Aral Sea. The incident sickened ten people, of whom three died, and came to widespread public notice only in 2002.

The Massachusetts smallpox epidemic or colonial epidemic was a smallpox outbreak that hit Massachusetts in 1633. Smallpox outbreaks were not confined to 1633 however, and occurred nearly every ten years. Smallpox was caused by two different types of variola viruses: variola major and variola minor. The disease was hypothesized to be transmitted due to an increase in the immigration of European settlers to the region who brought Old World smallpox aboard their ships.

<span class="mw-page-title-main">Ring vaccination</span> Strategy to inhibit the spread of a disease by vaccinating those most likely to be infected

Ring vaccination is a strategy to inhibit the spread of a disease by vaccinating those who are most likely to be infected.

<span class="mw-page-title-main">1721 Boston smallpox outbreak</span> Disease outbreak in Boston, USA

In 1721, Boston experienced its worst outbreak of smallpox. 5,759 people out of around 10,600 in Boston were infected and 844 were recorded to have died between April 1721 and February 1722. The outbreak motivated Puritan minister Cotton Mather and physician Zabdiel Boylston to variolate hundreds of Bostonians as part of the Thirteen Colonies' earliest experiment with public inoculation. Their efforts would inspire further research for immunizing people from smallpox, placing the Massachusetts Bay Colony at the epicenter of the Colonies' first inoculation debate and changing Western society's medical treatment of the disease. The outbreak also altered social and religious public discourse about disease, as Boston's newspapers published various pamphlets opposing and supporting the inoculation efforts.

The 1924–1925 Minnesota smallpox epidemic was the deadliest outbreak of smallpox in the U.S. state of Minnesota. 500 people died—400 of them in the Minneapolis–Saint Paul metropolitan area. Almost 90 percent of the Twin Cities deaths took place in Minneapolis.

The 1862 Pacific Northwest smallpox epidemic was a smallpox outbreak that started in Victoria on Vancouver Island and spread among the indigenous peoples of the Pacific Northwest Coast and into the indigenous peoples of the Northwest Plateau, killing a large portion of natives from the Puget Sound region to Southeast Alaska. Two-thirds of British Columbia natives died—around 20,000 people. The death rate was highest in southeast Alaska and Haida Gwaii—over 70% among the Haida and 60% among the Tlingit. Almost all native nations along the coast, and many in the interior, were devastated, with a death rate of over 50% for the entire coast from Puget Sound to Sitka, Alaska, part of Russian America at the time. In some areas the native population fell by as much as 90%. The disease was controlled among colonists in 1862 but it continued to spread among natives through 1863.

<span class="mw-page-title-main">1963 smallpox epidemic in Wrocław</span> Disease outbreak in Poland

An outbreak of smallpox occurred in the city of Wrocław in Poland in the summer of 1963. The disease was brought to Poland by an officer in the Ministry of Public Security who had returned from India. The epidemic lasted for two months, causing 99 people to fall ill and seven to die. It caused Wrocław to close and quarantine itself.

Mahendra Dutta was an Indian public health official, best known for his efforts to eradicate smallpox in India as the appraisal officer for smallpox in Bihar during the 1974 epidemic. He later served as Health Commissioner of New Delhi, Chief Epidemiologist of the National Centre for Disease Control, and Deputy Director General of the Ministry of Health and Family Welfare's public health operations. Additionally, he was a founding member of the Indian Public Health Association, serving as its president in 1987. Dutta's career is featured in an episode of Céline Gounder's 2023 podcast series Epidemic: Eradicating Smallpox.

References

  1. 1 2 3 4 Ilic, Irena; Ilic, Milena (11 April 2022). "Historical review: Towards the 50th anniversary of the last major smallpox outbreak (Yugoslavia, 1972)". Travel Medicine and Infectious Disease. 48: 102327. doi:10.1016/j.tmaid.2022.102327. ISSN   1873-0442. PMID   35421599.
  2. Markovic, Goran (1982-07-09), Variola Vera, Rade Serbedzija, Erland Josephson, Dusica Zegarac, retrieved 2017-12-18
  3. Ferhadbegović, Sabina. "Cultures of History Forum : Past and Present Health Crises: How Yugoslavia Managed the Smallpox Epidemic of 1972". www.cultures-of-history.uni-jena.de. Retrieved 2021-07-06.
  4. "SMALLPOX SURVEILLANCE — Worldwide". Morbidity and Mortality. 21 (16): 137–139. 1972. ISSN   0091-0031.
  5. MATIC, Katarina SUBASIC and Jovan. "Memories Of Smallpox Outbreak Stir Nostalgia For Tito's Time". www.barrons.com. Retrieved 2021-07-06.
  6. "Smallpox in Yugoslavia" (PDF). The Climate Change and Public Health Law Site. 1972-09-22. Retrieved 2022-09-01.
  7. Bliss, Dominic (2020-04-16). "What will be the psychological legacy of quarantine? History may have answers". National Geographic . Retrieved 2022-09-01.
  8. Billauer, Barbara P. (2016). "Weapons of Mass Hysteria (WMH), Faulty Bio-Threat Predictions and its Impact on National (In)Security" . Health Matrix: The Journal of Law-Medicine. doi:10.2139/ssrn.2749658. ISSN   1556-5068.
  9. "BBC - History - British History in depth: Smallpox: Eradicating the Scourge". www.bbc.co.uk. Retrieved 2021-07-06.
  10. Litvinjenko, S.; Arsic, B.; Borjanovic, S. (1972-11-24). "Epidemiological Aspects of Smallpox in Yugoslavia in 1972" (PDF). World Health Organization . Retrieved 2022-09-01.
  11. "Football Lockdowns: Smallpox outbreak in 1972". Football Makes History. 2020-04-29. Archived from the original on 2021-07-09. Retrieved 2021-07-06.
  12. 1 2 Herskovitz, Jon (2016-08-22). "D.A. Henderson, who led effort to eradicate smallpox, dies at 87". Reuters . Retrieved 2021-07-06.
  13. "Director of hit Yugoslav film about smallpox epidemic gets COVID jab". Reuters . 2021-01-26. Retrieved 2021-07-06.

Sources