Name: Topic: Smallpox Date: 12/2/2013

Smallpox is a contagious disease, caused by the Variola virus. It is a large brick-shaped, double-stranded DNA virus that is a member of the genus Orthopoxvirus. Variola virus infects only humans and does not exist in a carrier state. The name came from the Latin word varius, meaning spotted, or from another Latin word, varus, meaning pimple. Smallpox is caused by two virus variants: Variola minor (V.minor) and Variola major (V.major). V. minor causes a less dangerous disease known as alastrim. V. major has four presentations: ordinary, modified, malignant (or flat), and hemorrhagic. Ordinary Variola cause over 90% of cases. Modified V. major generally is milder and occurre in previously vaccinated individuals. The most severe form of disease is hemorrhagic smallpox, often called black or purpuric smallpox. It is rare and usually fatal (Bray 1996). Most of the diseases victims acquire the virus as a result of face-to- face contact, by handling the clothes or sheets of an infected person and by directly contacting infected bodily fluids (Tucker 2001). When lesion (as pustules) exuding virus appears in the mouth and pharynx and burst, the patient is most infectious (Bray 1996). The disease starts after about 12-14 days of incubation and the first symptoms are flu-like: high fever, muscle pain, fatigue, headache, body ache. The next stage of the disease produces the smallpox rush. It usually starts on the face, then

spread to the chest, the arms, back, and legs. After few days, the smallpox pustules split open and dry up. They form scabs that will fall off and leave the victim with deep scars (Ridgway 2001). A sequel to smallpox is blindness and death can be due to the multiple hemorrhages (Tucker 2001). Diagnosis is made on the clinical appearance and progression of the disease. There is a
checklist which provides a tick box-style question sheet to guide the practitioner. Smallpox can be

confirmed with a viral swab of the pharynx and a series of rapid tests can be performed (electron microscopy which takes about 2 hours or real-time polymerase chain reaction (PCR) testing which takes about 6 hours) to confirm suspicions (Smallpox Disease Overview CDC). According to Center for Disease Control and Prevention (CDC), the clinical definition of smallpox is an illness with acute onset of fever >101F (38.3C) followed by a rash characterized by firm, deep seated vesicles or pustules in the same stage of development without other apparent cause. The origins of smallpox are unknown. It probably first became a common disease in ancient Egypt before 1500 B.C. From there traveled eastward along the trade routes to Persia and India. Many historians believe that smallpox contributed to the downfall of both the Aztecs and the Incan empires and also entire tribes of Amerindians were eradicated because of it. Eventually spread around the world, causing the death of millions of people (Smallpox Wikipedia). Thanks to Edward Jenner work about the usefulness of cowpox vaccination for prevention of smallpox during 1790s (He observed that even though smallpox was widespread, milkmaids never seemed to be infected. Jenner realized this was due to the milkmaids contracting cowpox from the cows.) and to the global vaccination programme led by WHO,

smallpox was officially declared eradicated in 1979. The last case of endemic smallpox occurred in Somalia in 1977, and the last recorded case in humans occurred in England in 1978 (Smallpox -WHO). Smallpox has no known treatment. Research is continuously being conducted to find an effective treatment. Smallpox vaccination within three days can reduce the severity of smallpox disease, or even prevented it in some cases. The World Health Organization (WHO) and its member countries keep an emergency stockpile of the smallpox vaccine. Nowadays, the vaccine is rarely used. No countries give routine smallpox vaccinations to the public, today. The longterm consequence of eradication is that much of the world's population is now unvaccinated and at risk for smallpox infection. Currently, nearly half of the US population has not been vaccinated and has no immunity to Variola. (Smallpox-Web MD). Studies have shown that about 30% of people exposed to the virus can become infected. Death usually occurs between the tenth and sixteenth days of the illness and has an overall rate of 30%. For children younger than one year, the mortality rate is about 40-50% (Smallpox Wikipedia). Smallpox may have been eradicated but it still exists. Stocks of the virus are kept for research purposes at the Centers for Disease Control in Atlanta, Georgia and Russian State Research Center of Virology and Biotechnology in Siberia (Ridgway 2001). According to the CDC, smallpox is a high-priority (category A) agent for bioterrorism due to the low population immunity and because of difficulty in diagnosis as health professionals have no experience of cases.

Work Cited Bray R. S. 1996. Armies of Pestilence The Impact of Disease on History. New York: Barnes & Nobles Books. 258 p. Ridgway, Tom. 2001. Epidemics Deadly Diseases Throughout History Smallpox. New York: The Rosen Publishing Group, Inc. 64 p. Tucker, Jonathan B. 2001. Scourge The Once and Future Threat of Smallpox. New York: Atlantic Monthly Press. 291 p. Smallpox Disease Overview [Internet]. 2007 Feb 6. Atlanta (GA): Centers for Disease Control and Prevention; [ cited 2013 Nov 29]. Available from: http://emergency.cdc.gov/agent/smallpox/overview/disease-facts.asp Smallpox [Internet].Wikipedia, 2013 Nov 7. Wikimedia Foundation, Inc.; [cited 2013 Nov 29]. Available from: http://en.wikipedia.org/wiki/Smallpox Smallpox [Internet]. Web MD, n.d. Web MD, LLC.; [cited 2013 Nov 29]. Available from: http://www.webmd.com/a-to-z-guides/smallpox-causes-treatment Smallpox [Internet]. WHO N.p., n.d ; [cited 2013 Nov 29]. Available from: http://www.who.int/csr/disease/smallpox/en/index.html