1972 outbreak of smallpox in Yugoslavia

The 1972 outbreak of smallpox in Yugoslavia was the last major outbreak of smallpox in Europe. It was centred in Kosovo and Belgrade, Serbia (both then part of SFR Yugoslavia). A Muslim pilgrim had contracted the smallpox virus in the Middle East. Upon returning to his home in Kosovo, he started the epidemic in which 175 people were infected, 35 of whom died. The epidemic was efficiently and ruthlessly contained by enforced quarantine and mass vaccination. The 1982 film Variola Vera is based on the event.

Background
By 1972, vaccination for smallpox had long been widely available and the disease was considered to be eradicated in Europe. The population of Yugoslavia had been regularly vaccinated against smallpox for 50 years, and the last case was reported in 1930. This was the major cause for the initial slow reaction by doctors, who did not promptly recognize the symptoms of the disease.

The outbreak
In early 1972, a 38-year-old Muslim clergyman from Damnjan near Đakovica, Kosovo, undertook the pilgrimage to Mecca. He also visited holy sites in Iraq, where there were known cases of smallpox. He returned home on February 15. The following morning he felt achy and tired, but attributed this to the long bus journey. He soon realised that he had some kind of infection, but, after feeling feverish for a couple of days and developing a rash, he recovered - probably because he had been vaccinated two months earlier.

On March 3, Latif Musa, a thirty-year-old schoolteacher, who had just arrived in Djakovica to enroll at the local higher institute of education, fell ill. He had no known direct contacts with the clergyman, so he might have been infected by one of the clergyman's friends or relatives who visited him during his illness, or by passing the clergyman in the street.

When Musa visited the local medical center two days later, the doctors tried to treat his fever with penicillin (smallpox is a virus, so this was ineffective). His condition didn't improve, and after a couple of days his brother took him to the hospital in Čačak, 150 km to the north in Serbia. The doctors there could not help him, so he was transferred by ambulance to the central hospital in Belgrade.

On March 9, Musa was shown to medical students and staff as a case of an atypical reaction to penicillin, which was a plausible explanation for his condition. On the following day, Musa suffered massive internal bleeding and, despite efforts to save his life, died in the evening.

The cause of death was listed as "reaction to penicillin". In fact he had contracted black pox, a highly contagious form of smallpox. Before his death, Musa directly infected 38 people (including nine doctors and nurses), eight of whom would consequently die.

Reaction
By March 22, medical authorities realised that Musa had died of smallpox. The government's reaction was swift. Martial law was declared. Measures included blockades of villages and neighbourhoods, roadblocks, prohibition of public meetings, closure of borders and prohibition of all non-essential travel. Hotels were requisitioned for quarantines in which 10,000 people who may have been in contact with the virus were held under guard by the army. The authorities undertook a massive revaccination of the population, helped by the World Health Organization. Donald Henderson, the world's foremost authority on smallpox, was flown in to help the effort.

Within two weeks, almost the entire population had been revaccinated. By mid-May the spread of the disease was stopped and the country returned to normal life. During the epidemic, 175 people contracted smallpox and 35 of them died.

Legacy
The Yugoslav government received international praise for the successful containment of the epidemic, which was also one of the finest hours for Donald Henderson and the WHO, as well as one of crucial steps in the eradication of smallpox.

Two months of martial law, the fear and the helplessness during of the epidemic left a lasting mark on an entire generation. Another, more tangible mark, was left in the shape of the small scars on millions of arms, left by the vaccination.

In 1982, Serbian director Goran Marković made the film Variola Vera about a hospital under quarantine during the epidemic. In 2002, the BBC screened a television drama called Smallpox 2002, which was partly inspired by the events.

Timeline

 * February 15, 1972 - A clergyman returns from pilgrimage to Mecca infected with the smallpox virus.
 * February 16 - The clergyman feels unwell.
 * February 21 - Ljatif Muzza, a thirty-year old school teacher, arrives in Djakovica to continue his studies.
 * March 3 - Muzza falls ill with a highly contagious form of smallpox.
 * Between March 3 and March 9 Muzza is misdiagnosed and moved to hospitals in Čačak and then Belgrade. During this time, he directly infects 38 people.
 * March 9 - Muzza is shown to medical students in the Belgrade hospital as a case of reaction to penicillin.
 * March 10 - Muzza develops massive internal bleeding and dies.
 * March 22 - Doctors correctly diagnose the cause of Muzza's death and government begins measures to contain the epidemic.
 * Early April - Mass revaccination begins. Donald Henderson arrives.
 * Late May - The epidemic is over. 175 people were infected, 35 died.