A Question of Health: Am I immune?

In the 1930s I developed cowpox after being inoculated for smallpox. Recently, I met a first cousin and he also developed cowpox after inoculation. Obviously, we would be very reluctant to receive the smallpox vaccine again and wonder if having cowpox has given us immunity against the human form of the disease smallpox. What is your opinion?

In the 1930s I developed cowpox after being inoculated for smallpox. Recently, I met a first cousin and he also developed cowpox after inoculation. Obviously, we would be very reluctant to receive the smallpox vaccine again and wonder if having cowpox has given us immunity against the human form of the disease smallpox. What is your opinion?

The last case of naturally acquired smallpox occurred in Somalia 25 years ago. Routine vaccination against smallpox stopped in the UK in the early 1970s. The eradication of smallpox is one of the great success stories of the World Health Organisation. But recently the risk of a terrorist attack using the smallpox virus has raised the question of whether anyone who was vaccinated as a child will still be protected against the disease. The vaccine against smallpox contains a virus called vaccinia, which is very like the virus that causes cowpox. Back in the Thirties, if you developed cowpox from the vaccine, that is a sign that you acquired protection against smallpox. If you were vaccinated only once, your immunity will have waned over the years. The American Centers for Disease Control and Prevention says that protection against disease following primary vaccination begins to fade after five years and is probably negligible after 20 years. But people who have been successfully revaccinated one or more times may remain protected for 30 years or longer. Although such immunity may protect against death from smallpox, it may not protect against the development of a milder form of smallpox. I sincerely hope that none of us will need to be revaccinated against smallpox, but if there is a programme of mass vaccination, you would be wise not to rely on your cowpox infection 70 years ago.

A weighty question

I am a 39-year-old man, 6ft tall, and weigh 13st. I was told recently by my doctor that I was overweight and should lose a stone. I don't eat too much. No, honestly, I really don't! I avoid sugar, processed foods and excess fat. I eat fresh fruit, salads and vegetables, seldom snack between meals, hardly ever eat cakes, biscuits and chocolate bars, and drink wine (usually) in moderation. I would estimate my daily calorie intake to be around 2,000. I also cycle to work every day (5 miles each way). Yet I have a double chin, flabby middle and boy-breasts. What am I doing wrong?

It sounds to me that you are doing nearly everything right, and hardly anything wrong. If you are 6ft tall and your weight is 13st, you are not overweight. Your BMI (body mass index) is 24.7, which is within the normal range. If you were to follow your doctor's advice and lose a stone, this would bring your BMI down to 22.8, which is still within the normal range. BMI is a measurement that takes both your height and weight into consideration. A BMI between 18.5 and 25 is normal. Up to 30 is considered "overweight", and above 30 is "obese". There is a simple BMI calculator on the web at www.nhlbisupport.com/bmi. If you are too flabby, you should think about increasing your range of physical exercise. Cycling is good for your cardiovascular system and leg muscles, but it probably won't do much to tone up your middle. Think about some exercises to tighten up your abdominal and chest muscles. Your double chin might become single if you lose more weight, but this is a cosmetic problem, not a health problem.

Arthritis 'cure'

I recently heard about a new cure for arthritis called CMO. I've heard claims that one course of this product would cure arthritis forever. Do these claims have any substance? I have already spent a great deal on various products which didn't work.

CMO stands for cetyl myristoleate, which is a fatty acid that is currently being promoted heavily in the United States as a "cure" for arthritis. There has been one published study looking at how well it works for people with arthritis of the knee. This study found that CMO (in the form of tablets called Celadin) was more effective than tablets containing vegetable oil. People who took the CMO could bend their knees more easily than those who did not. The study involved only 64 people (half took Celadin and half took vegetable oil), and it was partly financed by the manufacturers of Celadin. Nevertheless, it was published in The Journal of Rheumatology, which is a reputable scientific journal. Only time will tell if CMO turns out to be a useful treatment for arthritis. The suggestion that one course of the product will "cure arthritis forever" is preposterous.

Have your say

The postbag has been weighed down this week with suggested ways of curing phlegm and catarrh. FS, a physiotherapist, writes:

You should ask your GP for a referral to a respiratory physiotherapist, or seek a chartered physiotherapist privately, who can treat respiratory problems. He/she will teach you a regime of postural drainage and breathing exercises.

RS has a condition, bronchiectasis, which causes similar symptoms:

Several things have helped me, including reducing my intake of dehydrating substances (alcohol and caffeine) and taking prescribed medication to open up airways. Physiotherapy also helps to clear the lungs. This involves using gravity and tapping the chest to shift the mucus. This can be done at home, using pillows under your stomach to elevate the lower part of your lungs. Breathing deeply is the key. I have found exercise to be of great benefit.

Send questions and answers to A Question of Health, 'The Independent', 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets he is unable to respond personally to questions