Smallpox

Introduction

Smallpox is very infectious, and it occurs in humans. The disease became an epidemic since it was killing many people. A virus which is replicated in the lymphoid tissue and later released to the body causes smallpox. The virus is known to spread through many ways which include sneezing, direct contact with the victims’ dried scabs and even clothing. The symptoms of smallpox become evident within 9-12 hours after exposure. The disease has been under documentation to be the most destructive that eliminate a majority of human beings. The World health organization indicates that millions of people died from smallpox in the 20th century. The paper will analyze the smallpox history, types, symptoms, diagnosis, treatment, prevention and vaccines.

History

Smallpox has got a unique history in the field of medicine. It was the earliest and deadliest disease among humans and up to date it the only disease that vaccination can eradicate. The disease first appeared around 10,000 B.C.E in the northeastern Africa in the agricultural settlements. Later the Egyptian merchants spread the virus it to India. The smallpox skin lesions were the earliest evidence which was on the faces of mummies from the 18th- 20th Egyptian dynasties. The first smallpox epidemic was in the 1350 B.C.E during the time of the Egyptian-Hittite war. During the Peloponnesian war’s second year in the 430 B.C.E, the disease hit Athens where it killed about 30,000 people leading to a reduction in their population by approximately 20 percent. During that period, the virus hit several Egyptians, Rome and the city of Greek. The trades spread the disease from the Carthage trade routes. Rhazes gave the initial smallpox medical description in 910. He provided documentation that the virus was being transmitted from one individual to another. Rhazes came up with an explanation as to why the smallpox survivors to not acquire the infection in the first time. His report made him the proponent of the theory of acquired immunity (Kotar & Gessler, 2013). 

The disease transmission patterns regularly paralleled the people’s migration and travel routes. Smallpox which was already present in Africa and Asia spread to the European nations in the middle ages. The Spanish colonists spread the disease in the 15th and 16th century to the Americans. It was evident since the smallpox infection caused many Inca and Aztec people leading to the destruction of their empires. The disease continuously ravaged Africa, Asia, and Europe for centuries. Approximately 400,000 deaths occurred in Europe in the 18th century including kings due to smallpox. The survivors of the infection became blind. In the 20th century, the smallpox mortality rate was at 300- 500 million. The number is highly exceeding the total number of deaths in all the world wars. In 1921, more than 100,000 smallpox cases were in the United States. There was a substantial decline in the mortality rate since there was the widespread usage of the preventative vaccines. As per 1939, there were less than fifty death cases per year. The eradication of the disease has been the international public health’s greatest since currently there are vaccines which are enabling the reduction in the mortality rates. 

Types of Smallpox

There are two primary forms of smallpox which highly differ in their death rates. The first one is variola major which is a serious illness that can threaten the life of persons that are not vaccinated (IICAB, & CFSPH, 2004). The second type is variola minor which is mild, and it rarely results in deaths. Variola major has four subtypes namely ordinary smallpox, modified smallpox, flat smallpox and hemorrhagic smallpox. Ordinary smallpox is the commonest one, and it accounts for about 90% of the disease cases. Modified smallpox is mild, and it develops in persons that were earlier vaccinated. Flat smallpox also known as malignant smallpox is a severe variety where the lesions are not projecting above the skin surface. Hemorrhagic or fulminant smallpox which is rare but highly severe and fatal occurs by the hemorrhages developing in the mucous and skin membranes.

Variola minor is less virulent and less common. It was common in South America, South Africa, Australia and Europe. The other types of smallpox include Variola sine eruption which is less common; pulmonary smallpox, pharyngeal form, and influenza-like form. The pulmonary form of smallpox has severe symptoms, bilateral infiltrates and cyanosis. It is common among people who have little or lack smallpox immunity. There are no precise numbers on its mortality rates. The pharyngeal form is present in immunized people, and it presents itself with spotty enanthem on the uvula, pharynx and the soft palate. The influenza-like form does not result in rashes. 

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Symptoms

Smallpox disease brings upon severe symptoms. In many cases, the symptoms appear nine to twelve days and the initial infection. Its early symptoms start with prostration, muscle pain, and high fever. The temperature may rise to 105 degrees farenht. After that, the symptoms become progressively worse where they lead to extreme diarrhea and vomiting. Days later, a rash starts to appear on the palms of the hands, the face and the feet. After approximately one week, those rashes become pus-filled pimples. The fever will appear again, and the pimples will have a bacterial infection. The blisters start becoming crusted, and they slowly fall off leaving visible scars. The symptoms start leaving after some time (Theves & Crubézy, 2014). Death occurs when the virus causes infections to the lungs, heart and the brain. The long-term symptoms and effects of smallpox include deformed feet and hands, blindness and scars.

Diagnosis

The diagnosis of disease is through examining the skin scrapings where the physician scan finds the evidence of the virus (Theves & Crubézy, 2014). The health professionals conduct an examination in the laboratory where they use an electronic microscope. Through the microscope, they find the accretions of the virus particles. The particles are known as the Guarnieri bodies. Virus identification and isolation are necessary for differentiating variola from the other viruses. They can conduct the differentiation through investigating the characteristic lesions that are on the chorioallantoic membranes of the 10-12 day-old chick embryos under room temperature. They characterize the strains by polymerase chain reaction analysis. The physician can also diagnose it by conducting enzyme-linked immunosorbent assays and serologic tests which measure antigen and variola virus-specific immunoglobin.

Treatment

The treatment is basically for easing the smallpox symptoms. It involves replacing the fluid with the sick person has lost from skin breakdown and fever. The antibiotics need to be present in the treatment so as to cure the secondary infections. Administering smallpox vaccination immediately within three days of exposure prevents or lessens the smallpox severity symptoms in many people. Administering vaccines four to seven days from the days of exposure offers protection or modifies the severity of the infection. The other treatments for this disease are supportive like possible ventilator assistance, fluid therapy, infection control and wound care (Preston & Henderson, 2009). The hemorrhagic and flat smallpox type treatment is through shock treatments such as fluid resuscitation. The confluent and semi-confluent type treatment is similar with that of individuals with extensive skin burns.

People who have exposure to smallpox require vaccination and quarantine if they did not previously receive treatment. In the cases of isolation, the person with the infection is under strict confinement. Quarantine is where is done for people who have been in contact with a person with the disease for up to 17 days before the ill person’s onset of infection. The person remains in quarantine for about 17 days to ensure that they do nit acquire the virus. The person under quarantine moves to strict isolation if they develop the signs and symptoms. There are current experiments which are testing the new antiviral medications, but they require time before producing results. The post-exposure interventions and vaccinations are the primary forms of treatment. There is no particular smallpox treatment, but there has been an improvement in the antiviral therapies. Physicians administer the cidofovir antiviral drug as a therapeutic agent which they administer intravenously. The supportive management of smallpox is essential since there is no known treatment. There should be monitoring and maintenance of the electrolyte and fluid balance to avoid dehydration. The health professional should offer pain and fever medications, and good nutritional support needs to be present. There should be proper skin care and monitoring and treatment of any complications that may emerge (Hansen, 2012). The topical idoxuridine can be important in treating the corneal lesions.

Prevention

The prevention of smallpox encompasses different practices. First, the prevention can be through the administration of vaccines. The vaccine can prevent the infection if the administration takes place before contact with the virus occurs. Receiving the vaccination within three days direct exposure to the virus will help in protecting an individual from acquiring the disease. However, if the infection occurs, it will be less severe that in an unvaccinated person. Receiving the vaccine 4-7 days after exposure is essential in protecting one from acquiring the infection and it reduces the severity in case the disease is present.

The other preventative strategies include excluding the infected people from work, school, preschool and childcare. The isolation should take place from the initial period of the illness up to the time when the scabs have entirely disappeared. The physician should offer guidance when the individuals can interact with others (Hansen, 2012). Other countries such as Australia do not recommend the administration of the vaccines as a preventative measure to the general public, but instead, it should be given to the laboratory staffs that have constant exposure with the vaccinia poxviruses.

Vaccines

Some vaccines are available, and they protect an individual for around three years. Vaccination can be critical in reducing or preventing the clinical signs thus leading to the reduction in the mortality rate. The vaccines are highly effective if administered with the early days of exposure. The vaccinia immune globulin is helpful in the post-exposure prophylaxis. The smallpox vaccines are useful in helping the body to develop an active immunity to the smallpox infection (Hsu, 2013). The vaccines contain the vaccinia virus which is ‘live’ thus the vaccination area needs monitoring to prevent further spread of the virus.

The vaccines that were successful and in use during the intense eradication program are the first generation vaccines. The health experts came up with other vaccines during the elimination phase which was under the modern cell culture techniques production. The second generation vaccines use similar smallpox vaccine strains like the first generation. The vaccines have clonal virus variants plaque purification, unlike the traditional vaccine stocks. The third generation vaccine is representing the more attenuated vaccine strains. The strains are specifically developed to be safe. During the eradication phase, they were passing through animal or cell culture test. The researchers produce the second and third generation vaccines using the modern standards of appropriate manufacturing practices and advanced cell culture techniques.

The World Health Organization has a core responsibility of maintaining the smallpox vaccine reserve. The vaccine that is currently in use in many countries is made up of the vaccinia virus that has a relation to smallpox disease. The vaccine does not contain the exact variola smallpox virus (Hsu, 2013). The vaccine makes the body produce antibodies which have a role in protecting against smallpox attack and other similar viruses. The usual body response after vaccination is the development of a red spot in the area of immunization 2-5 days after the injection. The place changes to being pustule, and it gets to its maximum size after around ten days. A pustule develops a scab which leaves a scar after two to three weeks. The center for disease control is the primary supplier of smallpox vaccines. There is the current development of a reformulated vaccine.

Conclusion

Smallpox is a contagious and infectious disease which is caused by a virus. There are two major types of smallpox namely varola major and varola minor. There is no exact date for the first appearance of smallpox, but others argue that its first appearance is about 10,000 B.C.E in the northeastern Africa.it has severe symptoms which include high fever, headache, vomiting, and fatigue. Diarrhea and punk rash. If there is no early treatment, the infection can lead to death, blindness, eye infections and brain swelling. The diagnosis is through laboratory microscopic examination to identify the presence of the virus. There is no accurate and approved smallpox treatment, but the administration of antibiotics helps in treating the secondary infections. The preventative measures include isolating the affected individuals and administering vaccines. There are first, second and third generation vaccines which contribute to boosting the body’s immunity to fight the smallpox virus.