The Vaccine-Seekers : Part 1 : The Past
Image © Guilhem Vellut by VASUDEVA IYER , MD
This year we celebrate the 200th birthday of Louis Pasteur , perhaps the greatest among the vaccine-seekers , most revered for the discovery of the human rabies vaccine . I still vividly remember my first patient with rabies . I was an intern several decades ago in a teaching hospital and was doing my rotation in internal medicine . In the middle of the night came a call from the emergency room regarding a 40-year-old man . He was experiencing severe painful paresthesia starting in his right leg and going up to the lumbar spine of two week ’ s duration . He appeared extremely anxious and was more concerned about a more recent symptom : painful spasms in his throat making it difficult to drink liquids . I was worried about a neurological disorder affecting the brainstem and sought help from the internist on call . After a thorough examination , the attending physician appeared to have come to a diagnosis ; he asked the patient casually whether he has had any injury to the right leg such as a dog bite . After a few minutes the patient nodded his head and said , “ Yes , three months ago by a stray dog ” and added that the wound healed within a week , and he did not seek medical attention . It was too late for him to receive post-exposure prophylaxis vaccine and sadly , the hydrophobic patient died within weeks from the ravages of rabies . As of 2019 , around 60,000 people die each year worldwide from rabies – but only two per year in America . 5
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By the time Pasteur started his research into vaccines , the success of the smallpox vaccine was already widely recognized . Edward Jenner 226 years ago inoculated 8-year-old James Phipps with material from a cow pox lesion of a dairy maid ’ s finger ; the boy was later inoculated with material from smallpox lesion and miraculously did not develop smallpox . The “ speckled monster ” smallpox was eradicated by 1980 . The latest ( JYNNEOS ) version of the smallpox vaccine contains non-replicable vaccinia virus and has come back to the limelight as it is also effective for prevention of monkeypox , which is emerging as another potential public health threat .
Pasteur started as a chemist and his initial studies were on crystals and not in vaccines . He helped the wine and food industry by the technique of initial heating and then cooling to destroy microbes that cause souring of wine . This pasteurization process is named after him and is extensively used in the food industry . His interest in microbes led to his being credited with the germ theory of diseases , which eventually paved the way for development of many vaccines . The initial use of attenuated microorganism for vaccines by Pasteur came from a serendipitous discovery : chicken accidentally injected with one month old culture of chicken cholera developed only mild disease and did not get the serious illness when challenged later with a virulent strain . Paul de Kruif in his marvelous book , Microbe Hunters 1 describes Pasteur pompously declaring in a talk to the Academy of Medicine : “ In this case I have demonstrated a thing that Jenner never could do in smallpox-and that is that the microbe that kills is the same one that guards the animal from death .” This remark apparently belittling Jenner offended some of the medical men in the audience and led almost to a “ Will Smith vs . Chris Rock ” confrontation between Pasteur and Dr . Julius Guerin , a highly regarded surgeon . The next big moment for Pasteur came from a