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In Britain in the early 1890s, a smallpox epidemic spread across the country and infected thousands. While the death rate was just a fraction of the level observed during the Great Pandemic of the 1870s, the overall death rate increased from 16 deaths in 1890 to 1,456 deaths in 1893. Among all outbreaks shown here, there were more cases among those who were vaccinated and over the age of ten than in any other group, however the death rate of the infected ranged from just one to ten percent. To put this into context, the death rates among the unvaccinated over the age of ten reached as high as forty percent in Gloucester. Unvaccinated children below ten years of age had the highest death rate among infected cases, and in the second outbreak in London, there were 148 deaths in 205 cases among unvaccinated children, whereas there were no deaths in 72 cases among vaccinated children. Another development in this pandemic was that the number of cases in children below the age of ten years was much lower than those above the age of ten; this trend that did not exist in previous centuries.

A century of change

In the pre-vaccination era, smallpox cases among adults were rare, as the majority of adults had contracted smallpox as children and had therefore built up a tolerance to the disease. In the early nineteenth century, the number of cases among children decreased, thanks to the protection granted to them through vaccination; however vaccination did not guarantee lifelong protection, which meant that the share of smallpox cases in young adults rose until revaccination then brought this trend back down. As we can see during these epidemics in England in the 1890s, the distribution of smallpox cases was much more representative of the population's age distribution, showing the impact and development of vaccination in its first century.