Bioterror: All the Rules Change

Quarantine has been practiced ever since the days of the Black Death, and has often been met with resistance and controversy. Through the 19th and early 20th centuries, city dwellers were routinely subjected to quarantines, but in the past 80 years, no large-scale quarantines have been implemented in the US.

In 1892, cholera is detected in a number of immigrants. The New York City Port Authority quarantines ships arriving from Europe. Poorer passengers are sequestered below deck on many ships in unsanitary conditions. On one ship, 58 die.

an 1893 smallpox outbreak in Muncie, Ind., turns violent as armed guards try to keep neighborhoods under quarantine. Several health officials are shot.

In 1900, Plague breaks out in San Francisco's Chinatown district. Officials impose a quarantine but are charged with ethnic bias after only Chinese homes and businesses are included. A federal court finds the quarantine unconstitutional.

As the aids epidemic emerges in the 1980s, health officials try to close down public bathhouses and are charged with discrimination by gay activists. Many states pass laws weakening quarantine powers after some AIDS patients are unnecessarily isolated.

A Rise in drug-resistant tuberculosis cases in the 1990s prompts New York to allow involuntary hospitalization. A number of individuals are quarantined. Cases decline by more than 90 percent.

The public view of vaccines has long fluctuated between suspicion and enthusiasm - a growing belief in their ability to curb epidemics, combined with some fears about the dangers they can pose to individuals. Below are some examples of both.

the First vaccinations in the US take place in Boston in 1721, for smallpox, after clergyman Cotton Mather learns of the procedure from a slave and convinces a local doctor to try it. Most townspeople react furiously, believing that it will simply spread the disease, and one man tries to burn down Mather's house.

antivaccination leagues spring up during the 1800s, charging that the procedure is dangerous and ineffective. When New York officials forcibly detain those refusing to be vaccinated during an 1893 smallpox outbreak, an antivaccination group sues Brooklyn's health department. The suit is overthrown on appeal.

During a smallpox outbreak in 1901, Henning Jacobson of Cambridge, Mass., refuses to be vaccinated, out of concern over possible side effects. The case eventually goes to the US Supreme Court, which rules that states can mandate vaccinations.

Jonas Salk in 1954 conducts a national trial of his new polio vaccine, and it is deemed largely effective. Some 1.8 million children are inoculated, and public confidence in vaccines soars. After about 200 children are paralyzed by a faulty batch, the government begins recommending that only infants and young children, not all Americans, get the vaccine.

In 1976, concern about "swine flu" (believed to be similar to the influenza that killed 600,000 Americans in 1918) leads the government to launch a nationwide vaccination campaign. The outbreak never materializes, but thousands of people suffer adverse effects from the vaccine, and lawsuits force the government to pay damages.

Smallpox is declared eradicated in 1980 after a worldwide vaccination campaign lasting more than a decade. The US government stopped inoculating Americans for the disease in 1972.

IN 1998, a scientific paper suggests a connection between one vaccine and autism. Congress holds hearings on the issue, which show a lack of scientific evidence supporting the theory. Still, the controversy gives rise to new concerns about the safety of vaccines.

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