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An outbreak of smallpox in Bradford in 1962 first came to attention on 11 January 1962, when a cook from the children's hospital in
Bradford Bradford is a city status in the United Kingdom, city in West Yorkshire, England. It became a municipal borough in 1847, received a city charter in 1897 and, since the Local Government Act 1972, 1974 reform, the city status in the United Kingdo ...
,
West Riding of Yorkshire The West Riding of Yorkshire was one of three historic subdivisions of Yorkshire, England. From 1889 to 1974 the riding was an administrative county named County of York, West Riding. The Lord Lieutenant of the West Riding of Yorkshire, lieu ...
, England, presented with an unexplained fever and was found to have changes in her blood similar to another sick person at the nearby St Luke's Hospital, both samples appearing compatible with
smallpox Smallpox was an infectious disease caused by Variola virus (often called Smallpox virus), which belongs to the genus '' Orthopoxvirus''. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (W ...
. The
index case The index case or patient zero is the first documented patient in a disease epidemic within a population, or the first documented patient included in an epidemiological study. It can also refer to the first case of a condition or syndrome (no ...
was later discovered to be a nine-year old girl who arrived in the UK on 16 December 1961 from Karachi, Pakistan, where there was an ongoing epidemic of smallpox. The outbreak resulted in 14 cases of smallpox and
contact tracing In public health, contact tracing is the process of identifying people who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individua ...
of over 1,400 individuals. Within five days either 250,000 or 285,000 people had been vaccinated. Six deaths were directly due to the disease and the outbreak was officially declared over on 12 February 1962.


Background

Between December 1961 and April 1962, authorities became aware of an ongoing epidemic of
smallpox Smallpox was an infectious disease caused by Variola virus (often called Smallpox virus), which belongs to the genus '' Orthopoxvirus''. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (W ...
in
Karachi Karachi is the capital city of the Administrative units of Pakistan, province of Sindh, Pakistan. It is the List of cities in Pakistan by population, largest city in Pakistan and 12th List of largest cities, largest in the world, with a popul ...
, where people were able to depart via charter flight and arrive in the UK, where surveillance at airports was enhanced only following the first imported case. At the time,
Bradford Bradford is a city status in the United Kingdom, city in West Yorkshire, England. It became a municipal borough in 1847, received a city charter in 1897 and, since the Local Government Act 1972, 1974 reform, the city status in the United Kingdo ...
was a major destination for those seeking work in mills and factories. Of the city's 298,000 people, 1,000 were West Indian, 2,000 from India and 7,500 from Pakistan. In Roberta Bivins' account of the epidemic published in 2015, she described Bradford as having "prided itself on a reputation for tolerance and good intercommunal relations". On 10 January 1962, a case of smallpox was confirmed in a man who had arrived at
Heathrow Airport Heathrow Airport , also colloquially known as London Heathrow Airport and named ''London Airport'' until 1966, is the primary and largest international airport serving London, the capital and most populous city of England and the United Kingdo ...
, London, on Christmas Day. Another suspected case arrived from Pakistan on 19 December 1961. On 1 January 1962, a contact of the first case arrived in Bradford and was immediately isolated. In all, of the five people with smallpox that had arrived at Heathrow from Pakistan, two travelled to
Birmingham Birmingham ( ) is a City status in the United Kingdom, city and metropolitan borough in the metropolitan county of West Midlands (county), West Midlands, within the wider West Midlands (region), West Midlands region, in England. It is the Lis ...
, one to
Cardiff Cardiff (; ) is the capital city, capital and List of urban areas in the United Kingdom, largest city of Wales. Cardiff had a population of in and forms a Principal areas of Wales, principal area officially known as the City and County of Ca ...
, one to
Bradford Bradford is a city status in the United Kingdom, city in West Yorkshire, England. It became a municipal borough in 1847, received a city charter in 1897 and, since the Local Government Act 1972, 1974 reform, the city status in the United Kingdo ...
and one stayed in London. In Bradford's preparedness, a local hospital was designated for further possible cases of smallpox.


Outbreak

On 11 January 1962, shortly after being appointed consultant pathologist at St Luke's Hospital in Bradford, pathologist Derrick Tovey received two almost identical severely abnormal blood samples from two unrelated people who had been admitted with unexplained fevers to two different hospitals, unusually on the same day. One case was Hettie Whetlock, a 49 year old cook from Bradford Children's Hospital, who was under observation at the Leeds Road Fever Hospital. The other was Jack Crossley, a 40-year-old
abattoir In livestock agriculture and the meat industry, a slaughterhouse, also called an abattoir (), is a facility where livestock animals are slaughtered to provide food. Slaughterhouses supply meat, which then becomes the responsibility of a meat ...
worker who had been admitted to Tovey's own hospital, St Luke's, and who died shortly after the blood was taken. Tovey described the samples as showing "a mild anaemia,
leucopenia Leukopenia () is a decrease in the number of white blood cells (leukocytes). It places individuals at increased risk of infection as white blood cells are the body's primary defense against infections. Signs and symptoms Symptoms may include: * sk ...
,
thrombocytopenia In hematology, thrombocytopenia is a condition characterized by abnormally low levels of platelets (also known as thrombocytes) in the blood. Low levels of platelets in turn may lead to prolonged or excessive bleeding. It is the most common coag ...
and a striking blood film with nucleated red cells,
myelocyte A myelocyte is a young cell of the granulocytic series, occurring normally in bone marrow (can be found in circulating blood when caused by certain diseases). Structure When stained with the usual dyes, the cytoplasm is distinctly basophili ...
s, fragmenting
granulocyte Granulocytes are cells in the innate immune system characterized by the presence of specific granules in their cytoplasm. Such granules distinguish them from the various agranulocytes. All myeloblastic granulocytes are polymorphonuclear, that i ...
s and vacuolation of the protoplasm, condensed
nuclear bodies Nuclear bodies (also known as nuclear domains or nuclear dots) are biomolecular condensates, membraneless structures found in the Cell nucleus, cell nuclei of eukaryote, eukaryotic cell (biology), cells. Nuclear bodies include Cajal body, Cajal b ...
and atypical
plasma cells Plasma cells, also called plasma B cells or effector B cells, are white blood cells that originate in the lymphoid organs as B cells and secrete large quantities of proteins called antibodies in response to being presented specific substances c ...
and some Türck cells". The findings were similar to a description of smallpox made by Kano Ikeda in 1925. After examining the man in the mortuary and without waiting for laboratory confirmation, the diagnosis was assumed and the regional medical officer convened a committee. One nurse and five children from A1 ward at the Bradford Children's Hospital were shortly suspected of having smallpox. One of these children had already been transferred to
Wharfedale Hospital Wharfedale Hospital (formerly known as Wharfedale General Hospital) is located in the market town of Otley, West Yorkshire, England, and is managed by the Leeds Teaching Hospitals NHS Trust. History The facility has its origins in an infirmary b ...
for observation. The result was that four hospitals were initially quarantined. All cases were transferred to Oakwell Hospital, the designated isolation hospital in Birstall. The following day the
index case The index case or patient zero is the first documented patient in a disease epidemic within a population, or the first documented patient included in an epidemiological study. It can also refer to the first case of a condition or syndrome (no ...
was discovered to be a nine-year old girl who arrived in the UK on 16 December 1961 from Karachi. Her international vaccination certificates were up-to-date and when she was admitted to A1 ward at Bradford's Children's Hospital, her diagnosis and treatment of
malaria Malaria is a Mosquito-borne disease, mosquito-borne infectious disease that affects vertebrates and ''Anopheles'' mosquitoes. Human malaria causes Signs and symptoms, symptoms that typically include fever, Fatigue (medical), fatigue, vomitin ...
masked any suspicion of smallpox. She subsequently died on 30 December 1961. During that Christmas period, both Crossby, whose child was an inpatient at the hospital, and Whetlock, visited A1 ward. Norman Ainley, the pathologist who performed the postmortem at the Bradford Royal Infirmary on the nine-year old girl had not been vaccinated, contracted the illness and died within a few days, leaving the Royal Infirmary as the fifth hospital to be quarantined. At Oakwell, two of the five transferred children died. By mid-January, five of the 10 second generation cases died and all of Bradford's hospitals had closed to non-urgent cases.


Hospitals involved

File:Bradford Children's Hospital - St Mary's Road - geograph.org.uk - 515876.jpg, Bradford Children's Hospital File:St. Luke's Hospital 'A' Block - geograph.org.uk - 391910.jpg, St. Luke's Hospital. File:Leeds Road Hospital - Admin Building - geograph.org.uk - 362490.jpg, Leeds Road Fever Hospital. File:Old Wharfedale Hospital 7 July 2009.jpg, Old Wharfedale Hospital. File:Entrance to Bradford Royal Infirmary - Duckworth Lane - geograph.org.uk - 408625.jpg, Bradford Royal Infirmary.


Response


Contact tracing, vaccination and surveillance

The responsibility for tracing contacts, vaccination and surveillance of hospital staff and patients was designated to one medical officer at each hospital. Tovey became the “control of infection” for St. Luke's. Bradford's
medical officer of health A medical officer of health, also known as a medical health officer, chief health officer, chief public health officer or district medical officer, is the title commonly used for the senior government official of a health department, usually at a m ...
at the time was John Douglas. Neighbouring authorities were notified within 48 hours. Authorities carried out
contact tracing In public health, contact tracing is the process of identifying people who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individua ...
of over 1,400 individuals and public demand led to the vaccination of either 250,000 or 285,000 people over five days, despite as Douglas confirmed in 1962, that "mass vaccination was at no stage recommended". A number of people experienced minor symptoms as side effects from the vaccine; at least six had severe symptoms and one man with pre-existing medical conditions died. One death occurred in a child who had not been vaccinated, but had contracted smallpox after having been in a bath with her recently vaccinated sister.


Business

The outbreak resulted in the closing of shops with a consequent drop in earnings. Cafes, cinemas and theatres closed and football was postponed.


Media

On 12 January 1962, the ''
Telegraph & Argus The ''Telegraph & Argus'' is the daily newspaper for Bradford, West Yorkshire, England. It is published six times each week, from Monday to Saturday inclusive. The newspaper has offices in Newhall Way, Bradford, from where its journalists work ...
'', Bradford's local daily newspaper, reported "Smallpox Fear: 2 Die". The following day after a child had died from smallpox in hospital, the paper reported "Panic measures not needed". Bivins' described that the ''Argus'' was "careful not to exaggerate the role of immigration", noted the paper to frequently quote medical authorities, acknowledged that it reported that Pakistani residents were just as vulnerable and that Pakistan itself had been implementing its own vaccination measures. In contrast, papers such as ''
The Yorkshire Post ''The Yorkshire Post'' is a daily broadsheet newspaper, published in Leeds, Yorkshire, England. It primarily covers stories from Yorkshire, although its masthead carries the slogan "Yorkshire's National Newspaper". It was previously owned by ...
'' alleged that "most Bradfordians were angry", a claim the ''Argus'' denied. The epidemic was covered by Pathé newsreels. With media attention on health checks for immigrants, the outbreak became a focus of discussion in the months leading to the
Commonwealth Immigrants Act 1962 The Commonwealth Immigrants Act 1962 ( 10 & 11 Eliz. 2. c. 21) was an Act of the Parliament of the United Kingdom. The Act entailed stringent restrictions on the entry of Commonwealth citizens into the United Kingdom. Only those with work permits ...
.


Outcome

Of the 11 cases treated in hospital, one 77 year old man had been vaccinated as a child; the others were unvaccinated. In all, the outbreak resulted in 14 cases of smallpox and six deaths directly due to the disease. It was officially declared over on 12 February 1962. After including the cases in the rest of England and Wales during this time, it was reported that there were 62 local cases of smallpox, 16 in England and 46 in Wales. 40 cases were in hospitals and there were 24 deaths.


Recollections

In 2014, in a letter published in ''The Telegraph'', the person who nursed the girl from Pakistan, recalled that due to it being Christmas "contact between child patients was unusually high because they were carried around the wards to look at Christmas trees and decorations" and upon recognising the outbreak "Everyone in the hospital was immediately quarantined".


References


Further reading

* {{cite journal, last=Bivins, first=Roberta, date=1 November 2007, title="The People Have No More Love Left for the Commonwealth": Media, Migration and Identity in the 1961–62 British Smallpox Outbreak, journal=Immigrants & Minorities, volume=25, issue=3, pages=263–289, doi=10.1080/02619280802407376, issn=0261-9288, pmc=2899858, pmid=20622927


External links


Smallpox outbreak in Bradford (1962)

Secure against smallpox
Granada TV footage (Director: Geoffrey Warnes) 1967 1962 disasters in the United Kingdom 1962 in England 1962 disease outbreaks 1960s in West Yorkshire January 1962 in the United Kingdom February 1962 in the United Kingdom Smallpox epidemics History of Bradford Disease outbreaks in England