Armstrong – Table of Contents

destroyed all their stocks of biological warfare weapons, remains a frightening possibility
if they might have fallen into the wrong hands. Shortly after September 11, 2001 CDC
updated its smallpox-response plan to address the possibility of a bioterrorist attack
involving smallpox. In view of the shortage of available stocks of the standard vaccine
stored since 1982, several groups of investigators (15, 16) studied the immunogenicity
and clinical responses to undiluted and diluted smallpox vaccine in 680 volunteers.
Vaccine diluted 1:5 and 1:10 still produced primary takes in more than 95 per cent of 18-
32-year old volunteers. The usual number of adverse reactions occurred. Of interest
though, especially in view of Charles Armstrong’s previously described observations, the
investigators applied a covering to the vaccination. A few layers of gauze were placed
over the insertion site, and the area was covered with a transparent, semi-permeable
adhesive membrane. The investigators changed the covering every 3-5 days to observe
the development of the vaccination vesicle. The technique of covering the vaccination
was different than the ones among the patients described by Armstrong. The chance of
the volunteers getting tetanus was unlikely for several reasons. The coverings among the
volunteers were not strapped down and the coverings were changed at frequent intervals.
The young volunteers probably had all received childhood tetanus immunizations and
boosters, and the coverings were of a semi-permeable, transparent, self-adhesive material
not available to Armstrong’s contemporaries. The investigators adopted the use of
protective coverings to prevent autoinoculation of the eyes and genitalia of the volunteers
and to avoid inadvertent inoculation of unvaccinated persons.
The whole smallpox vaccination program has become the subject of recent
criticism (17) since there has been no credible evidence that Iraq in the 1990s ever