This protected the virus during the freeze drying process. This, a personal initiative by Donald Henderson, was a lapel badge, designed and made by his daughter, formed from the needle shaped to form an "O". This represented "Target Zero", the objective of the campaign. It began as early as 1350 BCE, with cases being found in the study of Egyptian mummies. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus. In 1978, Parker was a medical photographer at Englands Birmingham University Medical School. The attenuated viruses may be replicating or non-replicating. As vaccination spread, some European countries made it compulsory. Whole-genome sequencing has revealed that vaccinia is most closely related to horsepox, and the cowpox strains found in Great Britain are the least closely related to vaccinia. [136], In 1939, Allan Watt Downie showed that the vaccinia virus was serologically distinct from the "spontaneous" cowpox virus. [130] These were deployed by the Public Health Agency of Canada for targeted vaccination in response to the 2022 monkeypox outbreak. Saving Lives, Protecting People, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP), Community-Based Planning for a Smallpox Emergency, Help People with Functional, Language, or Cognitive Needs, Sample Alert Messages for Healthcare Providers, Comparison of Reactions for First-Time Vaccinees and Revaccinees, Examples of Major or Take Reactions to Smallpox Vaccination, Administering ACAM2000 Smallpox Vaccine Videos, Specimen Collection and Transport Guidelines for Suspect Smallpox Cases, Specimen Collection and Transport Guidelines for Suspect Smallpox Vaccine Adverse Events, Negative Staining Electron Microscope Protocol for Rash Illness, Packaging and Transporting Infectious Substances, Chart 1: Acute, Generalized Vesicular or Pustular Rash Illness Protocol, Chart 2: Laboratory Testing for Acute, Generalized Vesicular or Pustular Rash Illness, Chart 3: Laboratory Testing for Suspect Smallpox Vaccine Adverse Event (Vaccinia), Chart 4: Laboratory Testing for Environmental Sample, U.S. Department of Health & Human Services. The children or young patients play together all the rest of the day and are in perfect health till the eighth. Jenner assumed a causal connection but the idea was not taken up at that time. [90][91] The first smallpox vaccine in the United States was administered in 1799. Variolation (in the form of inoculation) was introduced in Europe by Lady Mary Wortley Montagu 300 years ago in 1721, after she had observed the practice in the Ottoman Empire, where her husband was stationed as ambassador to Turkey. After 3000 years of suffering and death from the disease, there hasnt been a recorded case of smallpox in almost half a century. In 1980, WHO declared smallpox officially eradicated: The world and all its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness and disfigurement in its wake. Unfortunately, this global eradication campaign suffered from a lack of funds, personnel, and commitment from countries, and a shortage of vaccine donations. The resulting variant was designated LC16m8 (Lister clone 16, medium pocks, clone 8). Over a five year period, you tested the effectiveness of the vaccine to monkeys and then challenging the monkeys with meningitis bacteria. Jenner had sent the paper informally to Sir Joseph Banks, the Society's president, who asked Everard Home for his views. They ranged from simple needles to multi-pointed and multi-bladed spring-operated instruments specifically designed for the purpose. People who wear contact lenses, or touch their eyes frequently throughout the day can get the smallpox vaccine, but they must be especially . A History Of Vaccine Rollouts, From Smallpox To COVID-19 - NPR You will be subject to the destination website's privacy policy when you follow the link. 1520% of children receiving the vaccine for the first time develop fevers of over 102F (39C). Unlike replicating vaccines, MVA-BN is administered by injection via the subcutaneous route and does not result in a vaccine "take. The End of Routine Smallpox Vaccination in The United States . Mandatory smallpox vaccination came into effect in Britain and parts of the United States of America in the 1840s and 1850s, as well as in other parts of the world, leading to the establishment of the smallpox vaccination certificates required for travel. Prevention and Treatment | Smallpox | CDC 1971 was the year in which the Surgeon General of the United States Public Health Service, the Redbook Committee of the American Academy of Pediatrics, and the Territorial Health Officers agreed that the time had come to discontinue routine primary smallpox vaccination for American children. However, due to the high rate of serious adverse effects, the vaccine will only be made available to the CDC for the Strategic National Stockpile. After 572 serial passages, the vaccinia virus had lost over 14% of its genome and could no longer replicate in human cells. Most people experience normal, usually mild reactions that include a sore arm, fever, and body aches. [71] The success of these variolations assured the British people that the procedure was safe. While some European regions eliminated the disease by 1900, smallpox was still ravaging continents and areas under colonial rule, with over 2 million people dying every year. Allan Watt Downie demonstrated in 1939 that the modern smallpox vaccine was serologically distinct from cowpox,[11] and vaccinia was subsequently recognized as a separate viral species. [69], scarred the wrists, legs, and forehead of the patient, placed a fresh and kindly pock in each incision and bound it there for eight or ten days, after this time the patient was credibly informed. In the absence of a large-scale coordinated international programme, the disease persisted in other areas. Over thousands of years, smallpox killed hundreds of millions of people. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. "[70] In 1718 she had her son, aged five variolated. Also important in the 1970s were vaccine technology transfers allowing countries to become producers of their own freeze-dried vaccine and suppliers within their region. A Look at Each Vaccine: Smallpox Vaccine | Children's Hospital of Vaccinia was first grown in cell culture in 1931 by Thomas Milton Rivers. Smallpox was highly infectious, with no known cure. Instead, following the discovery of Dr Jenners vaccine, eradication was achieved through prevention, as he himself predicted. An investigation suggested that Janet Parker had been infected either via an airborne route through the medical school buildings duct system or by direct contact while visiting the microbiology corridor. As a young child, Jenner was variolated with the other schoolboys through parish funds, but nearly died due to the seriousness of his infection. All three generations of vaccine are available in stockpiles. [11] This work established vaccinia and cowpox as two separate viral species. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. . In response, all available national and international health personnel were dispatched on a week-long house-by-house search of the area, vaccinating everyone Rahima was the last known person to have had naturally acquired smallpox in the world. These cookies may also be used for advertising purposes by these third parties. WHO also maintains a stockpile of vaccines as an emergency reserve in Switzerland and in several other countries. [15]:585 Japan evaluated MVA and rejected it due to its low immunogenicity, deciding to develop its own attenuated vaccine instead. protected against smallpox, Dr Edward Jenner inoculated 8-year-old James Phipps with matter from a cowpox sore on the hand of Sarah Nelmes, a local milkmaid. The first-generation vaccines are manufactured by growing live vaccinia virus in the skin of live animals. "[47], In May 2007, the Vaccines and Related Biological Products Advisory Committee (VRBPAC) of the U.S. Food and Drug Administration (FDA) voted unanimously that a new live virus vaccine produced by Acambis, ACAM2000, is both safe and effective for use in persons at high risk of exposure to smallpox virus. The Ankara strain was taken to West Germany in 1953, where Herrlich and Mayr grew it on chorioallantoic membrane at the University of Munich. [15]:588589 Two other cell culture vaccines were developed from the Lister strain in the 2000s: Elstree-BN (Bavarian Nordic) and VV Lister CEP (Chicken Embryo Primary, Sanofi Pasteur). Every autumn in the month of September, when the great heat is abated, people send to one another to know if any of their family has a mind to have the small-pox. Smallpox epidemics persisted during the nineteenth century, sometimes occurring on a large scale, such as that in 1870-72 with 42,200 deaths suggesting 200,000 or more cases. Proponents of vaccination saw these as evidence of its need, opponents as evidence of its uselessness. From 1958 to 1977, the World Health Organization (WHO) conducted a global vaccination campaign that eradicated smallpox, making it the only human disease to be eradicated. The smallpox vaccine is the best protection you can get if you are exposed to the smallpox virus. Following the eradication of smallpox, scientists and public health officials determined there was still a need to perform researchusing the variola virus. [109], Louis T. Wright,[110] an African-American Harvard Medical School graduate (1915), introduced, while serving in the Army during World War I, intradermal, smallpox vaccination for the soldiers. He concluded that cowpox inoculation was a safe alternative to smallpox inoculation, but rashly claimed that the protective effect was lifelong. Janet Parker was the last person to die of smallpox. [22] The Texas Department of Health began producing egg-based vaccine in 1939 and started using it in vaccination campaigns in 1948. [68], Variolation was also practiced throughout the latter half of the 17th century by physicians in Turkey, Persia, and Africa. The last naturally occurring case of smallpox occurred in. Maalin died of malaria on July 22, 2013, while working in the polio eradication campaign. Compulsory infant vaccination was introduced in England by the 1853. Charles Creighton believed that uncontaminated vaccine itself was a cause of syphilis. It was organised and co-ordinated by a World Health Organization (WHO) unit, set up and headed by Donald Henderson. Smallpox is an infection of the variola virus. [46] A woman planning on conceiving should not receive smallpox immunization. identified as a contact of a recent case. Smallpox vaccination can protect you from smallpox for about 3 to 5 years. [144], The word "vaccine" is derived from Variolae vaccinae (i.e. Expanding trade routes over the centuriesalso led to the spread of the disease. use in response to a 1721 outbreak of smallpox in Massachusetts. The Vaccination Act made it compulsory for all children born after August 1st 1853 to have a smallpox vaccine in the first three months of their life. Bolstered by efforts united around the world, Jenners concept survived to defeat a historic scourge. Almost two centuries after Jenner hoped that vaccination could annihilate smallpox, the 33rd World Health Assembly declared the world free of this disease on May 8, 1980. This consisted of transferring to healthy people small amounts of material from smallpox sores, resulting in milder forms of illness and much lower mortality than natural infection. Around the same time, it came to public attention in the American colonies. While his deputy, Jos Salvany, took vaccine to the west and east coasts of Spanish South America, Balmis sailed to Manila in the Philippines and on to Canton and Macao on the Chinese coast. In December 1979 they concluded that smallpox had been eradicated; a conclusion endorsed by the WHO General Assembly in May 1980. In January 1929, Dr. L.E. The ancient practice of variolation (named for smallpox, also known as variola or la variole) was widely used in Asia and some parts of Africa. Cases were still occurring in South America, Asia, and Africa (smallpox was never widespread in Australia). Other vaccine material was not reliably derived from cowpox, but from other skin eruptions of cattle. [106] It seems clear that the idea of using cowpox instead of smallpox for inoculation was considered, and actually tried in the late 18th century, and not just by the medical profession. [67] According to Voltaire (1742), the Turks derived their use of inoculation from neighbouring Circassia. [15]:47273,56872 Rubin estimated that it was used to do 200 million vaccinations per year during the last years of the campaign. These smallpox vaccinations are the first in the U.S. 1855 Massachusetts is the first state to require that children have a smallpox vaccine before going to school to prevent the spread of smallpox in schools. Other symptoms include fever, headache, fatigue, and vomiting. The finding of smallpox-like rashes on Egyptian mummies suggests that smallpox has existed for at least 3,000 years. The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977). The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed. early as 200 BCE. The 1947 Smallpox Vaccination Campaign in New York City, Revisited In Pox: An American History, Willrich details how the smallpox epidemic of 1898-1904 had far-reaching implications for public health officials as well as Americans concerned about their own. The invention is also directed to a vaccine comprising a nucleic acid encoding such proteins. History of smallpox: Outbreaks and vaccine timeline - Mayo Clinic However, a single-nucleotide deletion truncates membrane protein B5R from a residue length of 317 to 92. She worked one floor above the Medical Microbiology Department where staff and students conducted smallpox research. [13] However, Sanofi dropped its own vaccine after it acquired Acambis in 2008. It was an unprecedented demonstration of global unity in the face of a common threat. Accelerated by two cases of smallpox in 1978, one fatal (Janet Parker), caused by an accidental and unexplained containment breach at a laboratory at the University of Birmingham Medical School, the WHO ensured that known stocks of smallpox virus were either destroyed or moved to safer laboratories. [87] Vaccination, the term which soon replaced cowpox inoculation and vaccine inoculation, was first used in print by Jenner's friend, Richard Dunning in 1800. In 1981, the four countries that either served as a WHO collaborating center or were actively working with variola virus were the United States, England, Russia, and South Africa. The patients would then develop a mild case of the disease and from then on were immune to it. [126], In 2002, the United States government started a program to vaccinate 500,000 volunteer health care professionals throughout the country. [129] On May 6, the contract was awarded to Bavarian Nordic for their Imvamune vaccine. The U.S. stockpile of WetVax was manufactured in 19561957 and maintained since then at 4F (20C),[54] and it was still effective when tested in 2004. Modern research suggests Jenner was trying to distinguish between effects caused by what would now[when?] When the virus was eradicated in the. The disease had been all but eradicated, and had ceased to be endemic in the United Kingdom since the 1930s. "[35] A "take" or "major cutaneous reaction" is a pustular lesion or an area of definite induration or congestion surrounding a central lesion, which can be a scab or an ulcer. Third-generation vaccines are based on attenuated strains of vaccinia and saw limited use prior to the eradication of smallpox.[13]. Known stockpiles of the virus are stored for research in one lab in the United States and one in Russia. While vaccine research continued, new vaccines were not introduced during the 1970s. The History of Vaccines, From Smallpox to COVID-19 | Time [124], Smallpox was eradicated by a massive international search for outbreaks, backed up with a vaccination program, starting in 1967. 3. Epidemiologists from the Soviet Union and the United States of America worked side by side in the middle of a cold war. The chief reason for the end of smallpox vaccination was fairly obvious. [119][120] Collier added 0.5% phenol to the vaccine to reduce the number of bacterial contaminants but the key stage was to add 5% peptone to the liquid vaccine before it was dispensed into ampoules. It was one of the deadliest diseases known to humans, and to date (2016) the only human disease to have been eradicated by vaccination. At first healthcare workers diagnosed him with malaria, and then chickenpox. Jenner believed that both cowpox and smallpox were viruses that originated in the horse and passed to the cow,[134]:5253 and some doctors followed his reasoning by inoculating their patients directly with horsepox. However, he was the first to publish his evidence and distribute vaccine freely, provide information on selection of suitable material, and maintain it by arm-to-arm transfer. When there is NO smallpox outbreak, you should get the smallpox vaccine if you: Are a lab worker who works with virus that causes smallpox or other viruses that are similar to it. [111], Until the end of the 19th century, vaccination was performed either directly with vaccine produced on the skin of calves or, particularly in England, with vaccine obtained from the calf but then maintained by arm-to-arm transfer;[112] initially in both cases vaccine could be dried on ivory points for short-term storage or transport but increasing use was made of glass capillary tubes for this purpose towards the end of the century. A house-to-house vaccination campaign within a 1.5-mile radius of her home began immediately. Unlike the severely-damaged MVA, LC16m8 contains every gene that is present in the ancestral vaccinia. paravaccinia/milker's nodes), or contaminating bacterial pathogens. Although now mythological, a review of the events of April 1947, from copies of The New York Times (1,2), tells of a more recognizably human response: pushing, jawing, deceit, shortages, surpluses, and perhaps a . Some healthcare systems refused to participate, worried about becoming a destination for smallpox patients in the event of an epidemic. Answered: 3. You are a medical researcher working | bartleby Such certificates were not always easily obtained and a further Act in 1907 allowed exemption by a statutory declaration which could not be refused. [105] John Fewster, a surgeon friend of Jenner's from nearby Thornbury, discussed the possibility of cowpox inoculation at meetings as early as 1765. Smallpox Vaccination | CDC - Centers for Disease Control and Prevention [73] This practice was widely criticized at first. A Cochrane review which explored the factors that influence caregivers' views and practices around routine childhood vaccines worldwide was conducted by Cooper and colleagues. Some sources suggest practices of variolation were taking place as This encouraged the British Royal Family to take an interest and a trial of variolation was carried out on prisoners in Newgate Prison. The Soviet Union provided freeze-dried CDC twenty four seven. Thanks to the combined efforts of national health agencies, WHO and scientists around the world, smallpox was eliminated from South America in 1971, Asia in 1975 and Africa in 1977. Posted BY: | NwoReport At least three prominent Fox News stars are set to be axed from the embattled news network to help Rupert Murdoch save face amid the ongoing $1.6 billion defamation lawsuit against him and his company, RadarOnline.com has learned.. [81] At the age of 13, he was apprenticed to apothecary Daniel Ludlow and later surgeon George Hardwick in nearby Sodbury. Two reports on the Chinese practice of inoculation were received by the Royal Society in London in 1700; one by Dr. Martin Lister who received a report by an employee of the East India Company stationed in China and another by Clopton Havers. However, the Faculty favoured variolation and took no action. infertility. We take your privacy seriously. [28], MVA stimulates the production of fewer antibodies than replicating vaccines. [135] The situation was further muddied when Louis Pasteur developed techniques for creating vaccines in the laboratory in the late 19th century. Like other vaccines, once reconstituted it became ineffective after 12 days at ambient temperatures. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Although routine smallpox vaccination is no longer performed on the general public, the vaccine is still being produced to guard against bioterrorism, biological warfare, and monkeypox. [114] Smallpox vaccine was the only vaccine available during this period, and so the determined opposition to it initiated a number of vaccine controversies that spread to other vaccines and into the 21st century. Thank you for taking the time to confirm your preferences. [107]:20213 This intensified opposition, and the 1898 Vaccination Act introduced a conscience clause. For example, if you had a prolonged face-to-face contact with someone who has smallpox. [79][80], Edward Jenner was born in Berkeley, England as an orphan. [12], As the oldest vaccine, the smallpox vaccine has gone through several generations of medical technology. Many believe this achievement to be the most significant milestone in global public health. In a 2006 predictive analysis of casualties if there were a mass vaccination of the populations of Germany and the Netherlands, it was estimated that a total of 9.8 people in the Netherlands and 46.2 people in Germany would die from uncontrolled vaccinia infection after being vaccinated with the New York City Board of Health strain. The physician Valentine Seaman gave his children a smallpox vaccination using a serum acquired from Jenner. To stay protected from smallpox, you should get booster vaccinations every 3 years. (2003), "A case of severe monkeypox virus disease in an American child: emerging infections and changing professional values"; Michael J. Bennett, War against Smallpox: Edward Jenner and the Global Spread of Vaccination (Cambridge, United Kingdom: Cambridge University Press, 2020), 32. At the first sign of any fever after exposure to smallpox, a person needs to be isolated until it is clear that they do not have smallpox. The authors of the official World Health Organization (WHO) account Smallpox and its Eradication assessing Jenner's role wrote:[15]:264. Many people consider smallpox eradication to be the biggest achievement in international public health. investment every 26 days in money not spent on administering further vaccinations and treating new cases. It took another 50 years to achieve global solidarity in the fight against the disease. She became ill on August 11 and developed a rash on August 15 but was not diagnosed with smallpox until 9 days later. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. [66] In China, powdered smallpox scabs were blown up the noses of the healthy. Three-year-old Rahima Banu with her mother in Bangladesh. Within 4 to 7 days of being exposed to the virus, the vaccine likely gives you some protection from the disease. The rich, the poor, the young, the old. [15]:588. immunization of these groups didn't effectively stop transmission of hepatitis B virus. After drying the ampoules were sealed under nitrogen. [144] One of the 18591873 vaccines was identified as a novel strain of horsepox, containing a complete gene from the 1976 horsepox sample that has deletions in vaccinia. By 1930 Arizona, Utah, North Dakota and Minnesota prohibited compulsory vaccination, 35 states allowed regulation by local authorities, or had no legislation affecting vaccination, whilst in ten states, including Washington, D.C. and Massachusetts, infant vaccination was compulsory. [43][44][45], LC16m8 is a replicating attenuated strain of vaccinia that is manufactured by Kaketsuken in Japan. Vaccines that only contain attenuated vaccinia viruses (an attenuated virus is one in which the pathogenicity has been decreased through serial passage) have been proposed, but some researchers[who?] Early written descriptions also appeared in India in the 7th century and in Asia Minor in the 10th century. Smallpox and monkeypox vaccine: Canadian Immunization Guide [89]:16578, The introduction of the vaccine to the New World took place in Trinity, Newfoundland, in 1798 by Dr. John Clinch, boyhood friend and medical colleague of Jenner. Centers for Disease Control and Prevention. WHO poster commemorating the eradication of smallpox in October 1979, which was officially endorsed by the 33rd World Health Assembly on May 8, 1980. This was successful and in 1722 Caroline of Ansbach, the Princess of Wales, allowed Maitland to vaccinate her children. Smallpox is spread by droplets from the respiratory tract or by direct or indirect contact with the virus shed from skin lesions. [50], Stockpiles of newer vaccines must be repurchased periodically since they carry expiration dates. After sampling 154 studies that met their inclusion criteria, the authors included 27 studies in their synthesis, of which 6 were from Africa. [100][101] In Lutheran Sweden, the Protestant clergy played a pioneering role in voluntary smallpox vaccination as early as 1800. Accounts from the 18th century suggest this technique dates back hundreds of years. [18][19] Many countries have stockpiled first generation smallpox vaccines. All information these cookies collect is aggregated and therefore anonymous. Compositions, methods and kits relating to poxvirus subunit vaccines [97] The vaccine was not carried in the form of flasks, but in the form of 22 orphaned boys, who were 'carriers' of the live cowpox virus. [12], Horsepox is extinct in the wild, and the only known sample was collected in 1976. [8][9], The term vaccine derives from the Latin word for cow, reflecting the origins of smallpox vaccination. [141] However, as more smallpox vaccines were sequenced, older vaccines were found to be more similar to horsepox than modern vaccinia strains. On October 12, 1977, he rode with two smallpox patients in a vehicle from the hospital to the local smallpox office. In 1958, the World Health Assembly called for the global eradication of smallpox the permanent reduction to zero cases without risk of reintroduction. [102] The first vaccination was carried out in Liechtenstein in 1801, and from 1812 it was mandatory to vaccinate. In the early part of the 18th century, Boston, a city of 10,000 people, suffered an epidemic of smallpox 5,000 people were infected and 800 died from the disease. She was isolated at home with house guards posted 24 hours a day until she was no longer infectious. That's . The United States ordered over 200 million doses of ACAM2000 in 19992001 for its stockpile, and production is ongoing to replace expired vaccine. Smallpox vaccine - Wikipedia ", "Compulsory smallpox vaccination; the University City, Missouri, case", "A Brief Biography of Dr. Louis T. Wright", "Spotlight on Black Inventors, Scientists, and Engineers", "The Milroy Lectures on the Natural History of Vaccina: Delivered at the Royal College of Physicians", "Development of Smallpox Vaccine in England in the Eighteenth and Nineteenth Centuries", "The development of a stable smallpox vaccine", "Development of a stable smallpox vaccine: Collier L. J Hyg 1955; 53: 76101", "US smallpox vaccination plan grinds to a halt", "Third Generation Smallpox Vaccine (6D024-215700/A)", "Canada considering smallpox vaccine for monkeypox cases, says Dr. Theresa Tam", "Statement from the Minister of Health on Canada's Response to Monkeypox", "Incongruencies in Vaccinia Virus Phylogenetic Trees", "Equination (inoculation of horsepox): An early alternative to vaccination (inoculation of cowpox) and the potential role of horsepox virus in the origin of the smallpox vaccine", "The origins and genomic diversity of American Civil War Era smallpox vaccine strains", "Revisiting Jenner's mysteries, the role of the Beaugency lymph in the evolutionary path of ancient smallpox vaccines", "Re-assembly of nineteenth-century smallpox vaccine genomes reveals the contemporaneous use of horsepox and horsepox-related viruses in the USA", "Early smallpox vaccine manufacturing in the United States: Introduction of the "animal vaccine" in 1870, establishment of "vaccine farms", and the beginnings of the vaccine industry", "Edward Jenner's inquiry after 200 years", "Smallpox/Monkeypox Vaccine Information Statement", "Medication Guide Smallpox (Vaccinia) Vaccine, Live ACAM2000", "Monkeypox Update: FDA Authorizes Emergency Use of Jynneos Vaccine to Increase Vaccine Supply", https://en.wikipedia.org/w/index.php?title=Smallpox_vaccine&oldid=1141059245, This page was last edited on 23 February 2023, at 04:03.
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when did they stop giving the smallpox vaccine