Understanding Smallpox - Essay Example

Understanding Smallpox Introduction One of the more dangerous illnesses currently being discussed within public circles as a potential virus to be used in biological warfare or terrorism is commonly known as smallpox. This name generally refers to a number of related illnesses, but the most deadly form of the disease is known in scientific circles as Variola major. As the name suggests, smallpox is caused by the variola virus, which is a member of the orthopoxvirus genus. This genus also incorporates cowpox, monkeypox, orf and molluscum contagiosum (CDC, 2004). Some strains of this virus are highly lethal to human existence while others are relatively benign. Even when not fatal, the disease can cause significant disfigurement and scarring. It was once the scourge of mankind, wreaking havoc across the European continent for centuries. Fortunately, modern medicine has determined the variola virus to be the only known cause of smallpox, making it possible to contain the illness by eliminating the variola virus. Uncontrolled, a smallpox outbreak can be expected to infect approximately 30 percent of those individuals exposed to it. Approximately 30 percent of these can be expected to die from the infection. The potential of the illness for use as a biological weapon has been proven in the past with its introduction to the ‘new continent’ and its use in decimating the American Indian tribes while more recent research suggests it retains a highly dangerous potential in the modern world setting. According to Henderson (et al, 1999), “researchers estimate that only 10-100 virus particles are necessary to infect someone” while inoculation supplies and efforts are insufficient to meet the challenge. An understanding of the history of the illness illustrates the importance for the nation’s healthcare workers to be familiar with the symptoms, diagnosis and treatment, prevention efforts and gaps in information regarding this illness. History For centuries, the smallpox virus plagued mankind, regularly decimating populations in Europe and Asia as the virus was passed from person to person throughout the world on a continuous basis. Smallpox does not survive in animals nor is it known to be a carrier disease, in the sense that individuals might carry the illness without suffering its ill effects, so it can only survive as long as there are humans to suffer from it and more humans for these to pass it along to. With all the devastation that the illness caused, it wasn’t until 1796 before the first experimental vaccine against the illness was attempted. In this year, Edward Jenner tried inoculating a small boy against smallpox by introducing material from a cowpox sufferer, a milder form of the disease (Christopher et al, 1997). While still a risky procedure, the vaccination proved successful and a vaccination program was started throughout Europe to eradicate the disease. However, smallpox was also perhaps the world’s first incidence of biological warfare as the Native Americans were intentionally infected with it as a means of reducing their population, making conquest of the new world easier. By the 1900s, the cause of the illness had been definitively identified and developed countries began making vaccination mandatory. A worldwide vaccination program was brought into the less developed countries and smallpox was virtually eliminated with the last case of reported smallpox occurring in Somalia in 1977 (CDC, 2004). The United States stopped mandating smallpox vaccinations in 1980 with other developed countries following suit, meaning the younger generations of these countries are no longer protected against the illness (Benenson & Kaslow, 1997), because it was widely believed the illness had been eradicated. However, laboratory stockpiles, one in the United States and one in Russia, kept the possibility of smallpox resurgence a possibility and recent evidence suggests that some of these stockpiles might be in the hands of those who would use it for bioterrorism purposes (Gordon, 1999). Complicating the issue, symptoms of smallpox are not always easy to catch in the early phases making it possible for contagion to spread quickly. Symptoms The smallpox virus is capable of surviving without a human host for up to one week on materials such as clothing, bedding and other surfaces, making it possible to spread the disease without actually causing the next victim to come into contact with the previous one. In addition, outward symptoms may take as long as 7-17 days before appearing. Symptoms begin in the lungs with inhalation of the variola cells. From this point, the virus enters the bloodstream and is distributed throughout the body. It affect the skin, intestines, lungs, kidneys and brain (Franz et al, 1996). Initial symptoms include fever, body aches, headache, chills and backache. More than half of the people diagnosed with smallpox have experienced chills and vomiting while 15 percent of smallpox sufferers become confused as a result of the fever. The characteristic rash appears 48-72 hours after the initial symptoms and the individual becomes highly contagious as the virus moves into the mucous membranes (Franz et al, 1996). As the body sheds cells, the virus particles are released as they are coughed or sneezed into the atmosphere. The smallpox sufferer can be infectious for as long as three weeks until the last of the scabs fall off while their clothing, bedding and the scabs themselves can remain infectious for as long as two more weeks. Little is known about what exactly causes death in smallpox victims or why some sufferers survive while others do not (Martin, 2002). The most obvious symptom of smallpox is the rash that develops on the skin. This rash starts with flat red lesions called macules which then develop into vesicles, or raised blisters. These can easily be mistaken for chicken pox in the early stages and are most commonly found first in the mouth and facial areas. The rash then spreads to the hands and forearms and then to the rest of the body. The distinguishing difference between smallpox and chicken pox is that the lesions in chicken pox typically progress from the arms and legs to the trunk and seldom appear in the areas of the elbow, palms of the hands, soles of the feet or armpits as smallpox does (Franz et al, 1997). These blisters further develop into pustules, pus-filled pimples. These pustules typically form between 12 and 17 days after the person has been infected with smallpox and are the symptom after which the disease is named. The pustules often cause severe scarring that affect survivors for the remainder of their lifetime. Anyone familiar with the more common ailment of chicken pox is aware of the way in which the scars linger as a lighter-toned depression in the skin, sometimes severe enough to cause disfigurement as the image of an infant suffering from the disease demonstrates. . (Fenner et al 1988) Diagnosis and Treatment Diagnosis of smallpox must be completed on a clinical basis by taking a throat swab or a sample from a freshly opened pustule (Franz et al, 1997). Other diagnosis techniques may include taking sample fluid from a spinal tap in order to diagnose hemorrhagic smallpox as cytoplasmic inclusion bodies may be visible within the cells (Franz et al, 1997). Samples are sent using special containment measures to one of only two labs in United States currently capable of properly testing for the virus in appropriately secured labs through the process of viral cultures, enzyme-linked immunoabsorbant assays or polymerase chain reaction (Franz et al, 1997). Should even a single case of smallpox be diagnosed, a worldwide public health emergency will be declared. As has already been discussed, the world is not sufficiently vaccinated against this highly contagious and virulent disease nor is there sufficient vaccine available to inoculate the public against it should it reappear as a human threat. Treatment of smallpox begins with isolation of the patient suspected of suffering from a smallpox infection. Those individuals who have been exposed to the patient, such as hospital workers, doctors or nurses, will also be quarantined until full diagnosis is made or for up to 17 days to watch for further signs of illness. Those who must treat the patient are vaccinated against smallpox. Treatment is designed primarily to ease the symptoms through activities such as replacing body fluids lost through fever and the breakdown of skin tissue and supplying antibiotics to reduce secondary skin infections (Henderson et al, 1999). While there are currently experiments underway attempting to develop new antiviral medications that would directly combat the smallpox disease, these are not yet perfected nor will they be available for some time. Prevention efforts Prevention of smallpox took place on a worldwide scale during the 1900s during which time every nation participated in a smallpox vaccination program. By inoculating the world’s populations against the disease, smallpox was unable to survive through its normal channels of continuous human infection and the disease was declared eradicated near the end of the century. Vaccination is still considered the most effective means of disease prevention with vaccines remaining effective even when administered as long as four to five days after exposure to the virus (Franz, 1997). While vaccine administered following exposure may not be completely effective in preventing illness, it can significantly reduce the effects and potentially save lives. Vaccines are administered with a special two-pronged needle that has been dipped into a vaccine solution. The needles prick the skin of the upper arm 15 times without being completely inserted. The pricked area becomes predictably sore and red. After approximately three or four days, an itchy bump will appear followed by the development of a pus-filled blister. This blister will begin to drain after a few days and, by the second week after inoculation, the blister dries and forms a scab. When the scab falls off, it leaves behind a characteristic scar. Until the scab falls off, the area of inoculation should be kept covered and remain untouched as it can become contagious. Vaccines are believed to protect the individual from smallpox for up to ten years before another vaccine is necessary. With the threat of smallpox as a bioterrorism weapon, the United States is currently in the process of developing more vaccine to supplement the nation’s available supplies, the exact number of which are unknown but are clearly unequal to the number of citizens that would need to be vaccinated. As a result, vaccines are carefully monitored and distributed, ensuring those who would be most at risk and most necessary in a state of emergency are inoculated. In addition, citizen-wide vaccination programs are ill-advised at this time because of the significant risk the vaccine itself poses to individuals suffering from immunological disorders (Henderson et al, 1999). For those suffering from some forms of cancer or HIV/AIDS, the vaccine alone can be fatal due to a weakened immune system while others, such as those suffering from eczema or atopic dermatitis could suffer life-threatening reactions as well (Henderson et al, 1999). Researchers and first responders are vaccinated against the illness on a regular basis while some portions of the population, primarily those who had received vaccines prior to 1980, may retain some resistance to the illness. Future research needed Despite the length of time smallpox has threatened human life, there remain some significant questions yet to be answered about the disease which necessitate further research needed. One of the most pressing questions is determining just what factor leads to death in some cases while permitting others to live. Determining the exact cause of death may help to reduce the effects of smallpox in the event of worldwide re-introduction into the population. While treatment options are available to reduce the effects of the symptoms, more must be done to understand the process of the disease and a means of effectively addressing it directly through antiviral medications. In addition, further research needs to be done to determine the effectiveness of vaccines at different dilutions as a means of possibly treating those individuals with reduced immunity or skin conditions that place them at greater risk of death at full strength vaccine. Finally, the duration of vaccine effectiveness should be more accurately assessed. Conclusion Smallpox is a potentially deadly disease that can be quickly re-introduced into the general population with little warning and great effectiveness. The illness affects several areas of the body including intestines, lungs, liver, skin and brain, but it remains unknown what factor causes death in some cases. Diagnosis is a lengthy process requiring isolation of anyone who has come into contact with the potential smallpox sufferer and elaborate laboratory procedures to ensure public safety. The illness cannot be treated directly but treatments can be administered to alleviate the symptoms, particularly the fever and secondary infections caused by the skin lesions. Survivors of the illness often remain marked with permanent, sometimes disfiguring scars. Although smallpox was declared eradicated, experimental strains still exist in laboratories in the United States and Russia. There is reason to believe, however, that some of these strains have found their way into unknown laboratories, opening up the possibility that this virus could be used at some future point in biological warfare or bioterrorism. Although the virus is considered to be ‘in control’, health care professionals need to be well-familiar with the symptoms and procedures of smallpox to ensure early and complete containment of any possible cases to avoid widespread, uncontrollable infection and potentially heavy loss of life. References Benenson, A.S. & Kaslow, R.A. (Eds.). (1997). Smallpox: End of the Story? Viral Infections of Humans: Epidemiology and Control. New York: Plenum Publishing: 861-864. Christopher, G.W.; Cieslak, T.J.; Pavlin, J.A.; et al. (August 6, 1997). Biological Warfare: A Historical Perspective. Journal of the American Medical Association. Vol. 278, N. 5: 412-417. Fenner, F.; Henderson, D.A.; Arita, I; et al. (1988). Smallpox and its Eradication. Geneva, Switzerland: World Health Organization: 10-14, 35-36. Franz, D.R.; Jahrling, P.B.; Friedlander, A.M.; et al. (August 6, 1997). Clinical Recognition and Management of Patients Exposed to Biological Warfare Agents. Journal of the American Medical Association. Vol. 278: N. 5: 399-411. Gordon, S.M. (November-December 1999). The Threat of Bioterrorism: A Reason to Learn More About Anthrax and Smallpox. Cleveland Clinical Journal of Medicine. Vol. 66, N. 10: 592-595; 599-600. Henderson, D.A.; Inglesby, T.V.; Bartlett, J.G.; et al. (June 9, 1999). Smallpox as a Biological Weapon: Medical and Public Health Management. Working Group on Civilian Biodefense. Journal of the American Medical Association. Vol. 281, N. 22: 2127-2137. Martin, David Barrett. (July 2002). “Cause of Death in Smallpox: An Examination of the Pathology Record.” Military Medicine. Read More