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In the eighteenth century, before vaccination was introduced to Sweden, smallpox epidemics were much more severe and regular than in the nineteenth century. Between 1774 and 1802, epidemics in Sweden peaked roughly every five years, with the toll reaching over seven thousand deaths per million people in some years. When vaccination was introduced to Sweden in the early 1800s, it greatly decreased the total number of smallpox deaths per million people, with the number never exceeding one thousand deaths per million people in any year after 1809. In actual numbers, there were roughly two thousand smallpox deaths per year in Sweden during the pre-vaccination era; optional vaccination helped bring this average down to 623 deaths between 1802 and 1811, while the number dropped to 176 between 1857 and 1866 when compulsory vaccination was introduced. Vaccination in Sweden became enforced in 1880, where parents were punished with fines or imprisonment for failing to immunize their child, and this helped bring the average number of smallpox deaths to just two deaths per year over the next two decades. Although there were some cases and fatalities recorded in the late 1890s, naturally occurring cases of smallpox were eliminated in Sweden in 1895, which made Sweden the second country in the world (after Iceland in 1872) to successfully eradicate the disease.