The state of Arizona is celebrating its 100th anniversary this year and a little known nugget from its past makes for a fascinating tale and warning for our future. Arizona Department of Health Services Director Will Humble recounts that:
“Smallpox broke out in southeast Arizona almost exactly 100 years ago today (co-incident with the Statehood activities). The first cases were in Tucson and Douglas with a few dozen cases and several deaths… and there were a few additional cases in Nogales and Globe. Of course, all the cases were among folks that hadn’t been vaccinated. The public health interventions of the time were much like what we would do today- case contact follow up with targeted vaccinations of folks that had contact with cases.
For example, Dr. Chenoweth (Santa Cruz County Superintendent of Health) implemented an aggressive targeted vaccination effort following the Nogales case. From the 1912 records, we know that Dr. Chenoweth immediately began a “house-to-house vaccination campaign, vaccinating every person within a radius of six or seven miles of the case under quarantine, except one person who secreted herself and escaped vaccination, but developed smallpox instead.” These two cases were the only ones reported from Santa Cruz County.
As the outbreak progressed in the following months, the State Board of Health weighed in on the public health response that had been undertaken in the various counties. The 1912 State Board of Health minutes stated that: “In our opinion this (contact and ring vaccination campaigns) is not sufficient, as there is no one to keep check on the patient or guardian to see that vaccination is done. Our public health law should be amended to read: In addition to the above stated section, no principal, teacher or superintendent shall permit any person to attend school, unless they have been vaccinated. A large per cent of the children of Arizona have not been vaccinated and will not as long as they are allowed to attend school without first having been vaccinated.
So, the February 1912 Smallpox outbreak in southeastern Arizona was that spark that triggered the debate about whether and how to require vaccination as a prerequisite for attending school.”
Have we learned anything in the ensuing 100 years? Not as well as one might suspect. It would seem that this battle is still being fought in the state where this movement took hold. There is a bill pending in the state House to remove any immunization requirements for admission to any state college or university. Given that measles vaccination is a requirement for entrance into all the Arizona state institutions of higher learning, I would fully expect to see measles outbreaks in the state if the bill passes. The state has already had its share of outbreaks in the recent past with the attendant morbidity and costs of investigation and containment activities. The lesson of 100 years ago was to use the public health tools at society’s disposal to combat the scourge of infectious disease. It seems we may have to re-invent the wheel all over again…