Smallpox can be prevented through the use of the smallpox vaccine. The World Health Organization (WHO) used smallpox vaccine to eradicate natural smallpox from the planet. About 95% of people are protected within 10 days of getting a single smallpox vaccination.
From 1983 through 2002, most service members did not get vaccinated against smallpox. Those vaccinated before 1983 do not have much immunity left from vaccine given years ago. Until the late 1970s, many billions of people around the globe received smallpox vaccine. Smallpox vaccine is still used routinely to protect a small number of people who work in labs with the smallpox vaccine virus (vaccinia) or similar viruses. Between December 2002 and May 2014, more than 2.4 million service members received smallpox vaccinations.
There is no proven treatment for the smallpox disease, but research to evaluate new antiviral medications is ongoing. Patients infected with smallpox can benefit from supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that occur from all the skin problems smallpox causes.
Research indicates that the first dose of smallpox vaccine offers an increased level of protection from smallpox for 3 years. Immunity decreases thereafter. Substantial, but waning immunity persists for 7-10 years. Subsequent vaccinations increase and extend protection. After 3 doses substantial protection persists for >30 years.
In that European study, about 30% of unvaccinated people infected with smallpox died. About 1.4% of people vaccinated up to 10 years earlier died. Among people vaccinated 11 to 20 years earlier, 7% died. Among people vaccinated 21 or more years earlier, 11% died. These data show that immunity falls off over time and that revaccination is needed to maintain immunity. [Mack TM. Smallpox in Europe, 1950-1971. J Infect Dis 1972; 125:161-169]
As of May 2014, smallpox vaccination is no longer mandatory for those deploying to the U.S. Central Command (CENTCOM) area of operations. Smallpox vaccination is still required for uniformed personnel deploying or assigned to the Korean Peninsula for 15 or more consecutive days. It is also mandatory for certain designated emergency-essential personnel and contractors, uniformed personnel assigned to special units, and comparable U.S. government civilian employees.
For complete information regarding policy, please review the "Policy" section of our website under "Resource Center".
We begin with the assumption that any service member covered by this policy who refuses vaccination may be uninformed about the facts related to the deadly effects of the smallpox virus and the protection afforded by the vaccine. Our first action with those who might refuse the vaccine will be to determine their concern and provide information.
This is a force protection issue. If a service member continues to refuse the vaccine, then a commander will manage the situation as he or she would for any failure to obey a lawful order, including educating the member about the smallpox vaccine as appropriate.