Smallpox risk factors. The Resurgence of Smallpox: Understanding the Risks, Symptoms, and Prevention Strategies

04.07.197315.09.2021 by alexxlab

What are the causes and risk factors of smallpox? How can it be transmitted and what are the treatment options? Explore the potential for smallpox’s re-emergence and the importance of vaccination in this comprehensive article.

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Uncovering the Variola Virus: The Cause of Smallpox

Smallpox is caused by the variola virus, which belongs to the orthopoxvirus group. This group also includes viruses like monkeypox, cowpox, and vaccinia. While smallpox was declared eradicated in 1980 following a global vaccination and isolation program, the potential for its re-emergence remains a concern, as the virus could potentially be used as a biological weapon.

Transmission and Infectivity: How Smallpox Spreads

Smallpox is primarily transmitted through close, prolonged contact with an infected individual. The variola virus is airborne and typically transmitted through the respiratory tract. Patients are infectious as soon as they exhibit symptoms and remain so until the rash and sores have completely healed. Researchers are still uncertain whether the virus is primarily spread through large or small airborne droplets.

Vaccination: The Key to Combating Smallpox

The smallpox vaccine, which is derived from the vaccinia virus, has been a crucial tool in the fight against the disease. After the eradication of smallpox in 1980, routine vaccinations have ceased worldwide, leaving a significant portion of the population without immunity to the variola virus. In the event of an outbreak, the CDC has enough doses of the smallpox vaccine to inoculate every person in the United States.

Bioterrorism Concerns: The Threat of Weaponized Smallpox

One of the biggest concerns surrounding the variola virus is the potential for its use as a biological weapon. Even though naturally occurring smallpox has not been reported in decades, healthcare officials must maintain a plan to respond in the event of a widespread exposure to the virus.

The Potential for Re-emergence: Searching for Frozen Variola Virus

While the variola virus does not naturally live in any known animal, scientists have found degraded examples of the virus in ancient human tissue samples. One concern is that a less degraded form of the virus might exist frozen in the permafrost, which is thawing at higher rates every year.

Symptoms and Treatment: Recognizing and Managing Smallpox

The symptoms of smallpox typically include a rash that develops into fluid-filled blisters, which eventually scab over and fall off. Patients remain infectious until the rash and sores have completely resolved, which can take up to four weeks. While there is no specific treatment for smallpox, supportive care and management of complications are crucial.

Preventing the Spread: Healthcare Precautions and Protocols

Healthcare providers must take strict precautions when caring for patients with suspected or confirmed smallpox. This includes the use of personal protective equipment and the implementation of isolation protocols to prevent the further spread of the virus.

What are the main causes of smallpox? Smallpox is caused by the variola virus, which belongs to the orthopoxvirus group.

How is smallpox transmitted? Smallpox is primarily transmitted through close, prolonged contact with an infected individual. The variola virus is airborne and typically transmitted through the respiratory tract.

What is the significance of the smallpox vaccine? The smallpox vaccine, derived from the vaccinia virus, has been a crucial tool in the fight against the disease. However, routine vaccinations have ceased since the eradication of smallpox in 1980, leaving a significant portion of the population without immunity.

Why is the potential re-emergence of smallpox a concern? One of the biggest concerns is the potential for the variola virus to be used as a biological weapon. Additionally, scientists have found degraded examples of the virus in ancient human tissue samples, raising the possibility that a less degraded form could exist frozen in the permafrost.

How can healthcare providers protect themselves and others from the spread of smallpox? Healthcare providers must take strict precautions when caring for patients with suspected or confirmed smallpox, including the use of personal protective equipment and the implementation of isolation protocols.

Smallpox: Causes and Risk Factors

Smallpox is caused by the variola virus and is only known to be transmitted between humans. Live virus is kept for research purposes in only two laboratories in the world: the Centers for Disease Control and Prevention (CDC) in the United States and the VECTOR Institute in Russia.

The disease was declared eradicated in 1980 following a worldwide program of vaccination and isolation. The last known naturally occurring cases came from an outbreak in Somalia in 1977. Smallpox remains eradicated to present day.

Since 1980, routine vaccinations against smallpox have ceased worldwide, leaving a significant portion of the population with no immunity to the virus that causes smallpox.

Verywell

The Variola Virus

Variola comes from a group of viruses collectively known as orthopoxvirus It also includes monkeypox, cowpox, vaccinia, camelpox, and some derivatives.

While smallpox is thought to be completely eradicated in nature, another orthopoxvirus could potentially lead to an outbreak. Viruses that are hosted in nonhuman species but can infect humans are known as zoonotic. All of the orthopoxviruses are capable of infecting humans but are not as dangerous as smallpox and can’t easily be transmitted from human to human.

Bioterrorism

The biggest concern about the variola virus is the potential for its use as a biological weapon. Even though smallpox has not occurred naturally in decades, healthcare officials must maintain a plan to react in the event that the population is exposed to the virus.

The CDC would consider a single confirmed case of smallpox a medical emergency due to the lack of immunity in the current population.

Millions of doses of smallpox vaccine are stored in the United States in the event of an outbreak.

First responders, military, and healthcare providers would be vaccinated as quickly as possible to act as a barrier to spreading the virus beyond the healthcare setting. The CDC has enough doses of smallpox vaccine to inoculate every person in the United States.

Potential Re-Emergence

Even though naturally occurring smallpox variola virus does not live in any known animal, just waiting to infect a human, scientists have found very degraded examples of variola in ancient human tissue samples.

One concern is that a less degraded form of the variola virus might exist frozen into the permafrost, which is thawing at higher rates every year.

Transmission

Influenza, pertussis, and measles are all more contagious than smallpox. Smallpox is transmitted through close contact over long periods. The variola virus is airborne and usually transmitted through the respiratory tract.

Who Is Infectious?

Patients are infectious as soon as they exhibit signs and symptoms of smallpox and remain infectious until the rash and sores have completely resolved. The pustules will scab over and fall off, leaving a scar. Once they are completely dry, which takes about four weeks, then the patient is no longer considered infectious.

Airborne and Contact Transmission

Usually, the patient with the infection and the person receiving the infection lived in the same home. The assumption was that smallpox was usually transmitted via large airborne droplets when the patient coughed or sneezed. However, there have been rare reported cases of casual contact transmission and of transmission seemingly between floors of a hospital, which would suggest smaller airborne particles.

Since natural transmission of smallpox hasn’t occurred since 1977, researchers aren’t too sure whether the disease is conveyed airborne through large or small droplets. Modern recirculated air systems in hospitals didn’t exist when smallpox was being treated in the United States. If the virus is carried via large droplets, the new air systems shouldn’t make a difference. On the other hand, if the virus is carried via fine droplets deeper in the respiratory tract, recirculated air systems might create a problem that would have to be overcome.

The variola virus also lives in the fluid that comes from the open sores common in pox diseases. The fluid can contaminate bedding and clothing, making it infectious. Healthcare providers must use precautions when caring for patients with smallpox.

Vaccination

The term “vaccination” was coined because of the smallpox vaccine, which is from the vaccinia virus and is related to the cowpox virus. “Vacca” means cow in Latin.

Variola virus, which causes smallpox, is a stealthy virus that spends its incubation period sneaking around its human host and reproducing without triggering an immune response. By the time the variola virus is developing into smallpox and making its host sick, the virus has spread throughout the body. The immune system hardly has time to react.

Vaccinia, on the other hand, stays local in a human and doesn’t replicate as much as variola. It also doesn’t cause as much, if any, illness. It does trigger an immune response, which the body can use to fight either virus.

Getting vaccinated within the first three days of a smallpox exposure gives the immune system time to ramp up for the fight with the variola virus.

Even if getting vaccinated after an exposure doesn’t stop the patient from getting sick, it can significantly reduce the severity of the smallpox.

Susceptibility Risk Factors

Hardly anyone born in the United States after 1971 received the vaccine, which leaves that population susceptible to infection if the variola virus re-emerges.

Population density since smallpox was declared eradicated in 1980 has grown exponentially, which makes it hard to predict how fast the variola virus would spread in modern times. The best data, gathered in the 1960s and 1970s, was based on a population that had largely been immunized as a matter of course and did not have immune suppression conditions like HIV in much of the population.

Frequently Asked Questions

What is the cause of smallpox?

Smallpox is caused by the variola virus, which is in a family of viruses known as orthopoxviruses. Smallpox has been eradicated thanks to vaccination programs.

How did smallpox originate?

Genome studies of the variola virus indicate smallpox emerged 3,000 to 4,000 years ago in the continent of Africa. Investigators suggest changes to the climate in Africa triggered its evolution from another orthopoxvirus.

What animal did smallpox come from?

Research suggests the variola virus started as a variant of cowpox—another orthropoxvirus—and evolved after the introduction of camels to Africa.

Who is at risk for smallpox?

At this time, there is a very limited risk of anyone developing smallpox. However, there are a few situations that could revive the disease:

Bioterrorism: The smallpox virus, which is stored in laboratories in the United States and Russia, could potentially be used as a biological weapon.
Melting permafrost: Scientists are concerned that permafrost could house variants of the variola virus. As permafrost melting accelerates, the virus could potentially re-emerge.

If smallpox were to re-emerge, anyone born after 1971 in the United States would be at risk. This is because the smallpox vaccination program ended in the U.S. at that time.

Safety Information for Smallpox Vaccine

What Is Smallpox? Symptoms, Causes, Diagnosis, Treatment, and Prevention

In the past, smallpox treatment focused on relieving symptoms and preventing the spread of the disease by isolating the patient until all the smallpox scabs fell off. (16,17)

But in recent years, researchers have developed antiviral medications for smallpox.

In 2018, the U.S. Food and Drug Administration (FDA) approved the drug tecovirimat (TPOXX) to treat smallpox. The drug works by inhibiting the activity of a protein called p37, which ultimately prevents viral particles from leaving an infected cell and spreading to other cells. (18)

Research shows that tecovirimat is effective against the variola virus in laboratory settings (in cell cultures) and can treat diseases similar to smallpox in animals. Studies also show tecovirimat is safe, with the most frequent side effects being headache, nausea, and abdominal pain.

But since the drug was developed after the eradication of smallpox, it hasn’t been tested on human subjects, causing some uncertainty about how well it would work in the unlikely event of an outbreak.

Other studies have shown that the antiviral drugs cidofovir (currently used to treat an eye infection called cytomegalovirus retinitis in people with AIDS) and brincidofovir (an experimental drug also used to treat cytomegalovirus retinitis as well as adenovirus) are effective against smallpox in lab settings and can treat smallpox-related diseases in animals.

Neither cidofovir nor brincidofovir have been tested on people with smallpox. Scientists continue to study the drugs’ effectiveness and toxicity.

The CDC has stockpiles of tecovirimat and cidofovir in case of a public-health emergency. (19)

Prevention of Smallpox

Healthcare workers no longer routinely administer smallpox vaccines to the general public. The CDC recommends smallpox vaccination only for laboratory researchers who study the variola virus or its close relatives.

Still, the CDC has stockpiles of smallpox vaccine — enough to give one to every person in the United States if necessary. (20)

The original smallpox vaccine contains live vaccinia virus, which is in the same Orthopoxvirus genus as the variola virus but causes a less severe illness. Exposure to the vaccinia virus prompts the immune system to produce antibodies that are also effective against the variola virus.

This method of gaining smallpox immunity was first developed by the English doctor Edward Jenner. In 1796, after observing that milkmaids who got cowpox never developed smallpox, he took material from a cowpox sore and inoculated it into the hand of his gardener’s 9-year-old son. Then he repeatedly exposed the boy to the variola virus — and the child did not develop smallpox.

Sometime in the 1800s, the virus used to make the smallpox vaccine switched from cowpox to vaccinia. (4)

The smallpox vaccine prevents infection in 95 percent of those who receive it, and is also able to prevent or lessen infection when given within a few days of exposure to variola virus.

The smallpox vaccine can’t help people with advanced infection who are already developing a rash. (21)

Since the eradication of smallpox, scientists have developed a newer version of the vaccine that uses attenuated (weakened) viral strains. This vaccine is suitable for people who can’t take the original vaccine, such as those who are pregnant, have a weakened immune system, or have had a bone-marrow transplant.

The new smallpox vaccine hasn’t been tested against the variola virus in people, so its effectiveness is still unproven. (22)

Side Effects of the Smallpox Vaccine

Unlike most other vaccines, the smallpox vaccine does not involve an injection or “shot.”

Instead, it’s administered with a bifurcated (two-pronged) needle that is first dipped into the vaccine solution. A doctor uses the needle to prick the skin (usually in the upper arm) multiple times in a few seconds.

A successful vaccination causes a red and itchy lesion to develop at the vaccine site within three to four days. This lesion turns into a large blister that fills with pus and begins to drain in the first week. It begins to dry and scab over in the second week and then falls off (leaving a small scar) in the third week. (21)

During this process, the vaccinia virus can be easily transferred to another part of the body or even another person through touch. Touching the vaccination sore and then the eye can lead to a serious infection that can threaten vision. The vaccination sore may also develop into a serious toxic or allergic rash.

Rarely, people develop other significant or even life-threatening reactions to the vaccine, including:

Inflammation of the heart, heart lining, or both
Heart pain and heart attack
Serious rash called eczema vaccinatum (in people with preexisting skin conditions, particularly eczema or atopic dermatitis, who got infected with the vaccinia virus from someone else who was vaccinated)
Progressive vaccinia, or a buildup of inflamed tissue at the vaccination site, in people with a weakened immune system
Brain inflammation

Research suggests these complications kill one or two people out of every million vaccinated for smallpox. But most people who get the smallpox vaccine experience only mild reactions. These may include:

Pain and redness at the vaccination site
Swollen lymph nodes in the armpits
Low-grade fever
Trouble sleeping
General malaise that interferes with daily activities (1,23)

Smallpox (variola) – health.vic

Notification requirement for smallpox (variola)

Smallpox is an ‘urgent’ notifiable condition and must be notified by medical practitioners and pathology services immediately by telephone upon initial diagnosis (presumptive or confirmed). Pathology services must follow up with written notification within 5 days.

This is a Victorian statutory requirement.

Smallpox is included on the Commonwealth Quarantine List, and all cases will need to be notified immediately to the Victorian Chief Human Quarantine Officer.

Smallpox is subject to Australian quarantine.

Infectious agent of smallpox (variola)

Variola virus is a DNA virus of the genus Orthopoxvirus.

The virus used in the live smallpox vaccine is known as vaccinia virus, which is also a member of the genus Orthopoxvirus.

Identification of smallpox (variola)

Clinical features

Smallpox is a severe, prostrating illness characterised by fever, and a macular, papular, vesicular and pustular rash. It has a historically observed mortality rate of 30 per cent. There are three major forms. The most common form, described below, occurs in 90 per cent of cases. The remaining two are known as haemorrhagic and malignant (flat) variants. These both have significantly higher mortality (more than 95 per cent) and seem to be related to alterations in immune status.

Common smallpox begins with symptoms of fever (100 per cent), headache (90 per cent), backache (90 per cent), chills (60 per cent), vomiting (50 per cent), malaise, prostration and cough. Less commonly, pharyngitis and severe abdominal pain are observed. In pale-skinned patients, an erythematous rash sometimes accompanies the prodromal phase. This occurs rarely as a petechial rash. This may be misdiagnosed as meningococcal disease, erythema multiforme or measles.

By the 2nd or 3rd day, fever begins to descend from its peak (40.5–38.5 °C), and the eruptive phase begins, with the development of rash lesions. These lesions first appear on the buccal and pharyngeal mucosa, and then emerge on the face, forearms and hands. The rash spreads down, and within a day the trunk and lower limbs are involved.

Smallpox produces a single crop of lesions, which are distributed in a centrifugal pattern: most profuse on the face, more abundant on the forearms and lower legs than the upper arms and thighs, and often involving palms and soles. This is in contrast to chickenpox, which typically has more lesions located on the trunk and fewer on the limbs, with very few, if any, on palms and soles.

Prominent surfaces and areas most exposed to irritation are more heavily affected by the rash. Protected surfaces such as flexures and depressions (e. g. axilla) are usually spared.

The eruptive lesions appear as flat, discoloured macules that progress to firm papules on the 2nd day of the rash. These are typically described as ‘shotty’. They become clearly identifiable as vesicles on the 4th or 5th day of the rash, and progress to pustules on day 7.

Day 10 commonly sees the pustules at maximal size, and the lesions then begin to flatten. Approximately 14 days after rash onset, the pustules begin to dry up and crust. Most pustules begin to scab and separate at day 19. Lesions on the palms and soles separate last and typically leave pitted scars.

A patient is no longer infectious once all the scabs have separated from the skin, which is usually 3–4 weeks after the onset of the rash. Recovery results in complete clearing of the virus from the body and prolonged immunity.

The major differential diagnoses are chickenpox and disseminated herpes simplex infections. Other poxviruses may also present with similar lesions to smallpox.

Smallpox may be complicated by secondary bacterial skin infection, corneal scarring, keratitis, arthritis, osteomyelitis, bronchitis, pneumonitis, pulmonary oedema and encephalitis.

Diagnosis

The diagnosis of smallpox will be made on the basis of a consistent clinical presentation, combined with the results of electron microscopy and polymerase chain reaction (PCR) testing, which will be performed at the National High Security Quarantine Laboratory at the Victorian Infectious Diseases Reference Laboratory, Peter Doherty Institute, in Melbourne.

Incubation period of variola virus

The incubation period is regarded to be 7–17 days, with a median of 12 days.

Public health significance and occurrence of smallpox (variola)

In 1980, the World Health Organization (WHO) declared smallpox the first communicable disease ever to be globally eradicated. This was a direct consequence of the Global Smallpox Eradication Program and was achieved by a population-based smallpox vaccination strategy.

The virus has been retained legally under strict security in two WHO collaborating centres in the United States and the Russian Federation.

The virus is believed to have been part of the bioweapons research of certain countries, and there have been recent concerns that nonstate actors may obtain access to the virus for deliberate release.

A single confirmed case of smallpox would prompt a global public health alert from WHO and would raise the spectre of an intentional release.

Historically, smallpox has a significant mortality, and it would be reasonable to expect a greater impact on today’s unimmunised and older populations. It is clear that an outbreak would be of extreme public concern, requiring action at the highest level of government and involving the mobilisation of significant resources.

Reservoir of variola virus

Smallpox is a disease only of humans, and there are no nonhuman hosts.

Mode of transmission of variola virus

Variola virus is most frequently transmitted from an infectious person via direct deposition of large, infective airborne droplets of saliva onto the nasal, oral or pharyngeal mucosal membranes, during close, face-to-face contact with a susceptible individual.

The generation of infectious fine-particle aerosols provides a possible, although less common, means of smallpox transmission. This may result in the infection of people involved in non–face-to-face contact with the case, with the virus carried in aerosols spread by drafts and air-conditioning systems. Such spread is most likely in instances where the case has a significant cough.

Cases may contaminate objects in their environment, including their clothing and linen, with the large droplets or aerosols during sneezing or coughing, and these fomites may serve as a further route of transmission.

Physical contact with a smallpox pustule or crusted scab may also transmit the virus. The virus has been found to survive in scabs for many years; however, encased in this form, it is not considered to represent a significant infectious risk.

Body fluids are also infectious, and care is needed in the disposal of clinical waste.

Variola virus is thought to be unlikely to survive on its own for more than 48 hours when exposed to normal environmental conditions (ambient temperature, usual humidity and sunlight).

During the smallpox era, the disease had secondary-household or close-contact attack rates of up to 80 per cent.

Period of communicability of smallpox (variola)

Patients are not infectious during the asymptomatic incubation period. They become increasingly infectious after onset of fever, and this usually results from the release of virus from oropharyngeal lesions.

For the purpose of contact tracing, cases are regarded as infectious 24 hours before the recognition of fever. Any contacts identified from this time on need suitable management.

Susceptibility and resistance to smallpox (variola)

Resolved infection confers lifetime immunity.

Pregnant women and people who are immunocompromised are more susceptible to variant forms of smallpox.

It is unclear how long the smallpox vaccine provides effective immunity, but it is unlikely to be more than 10 years. As a result, essentially all people in Victoria and Australia will now be regarded as susceptible to smallpox.

Control measures for smallpox (variola)

Preventive measures

The Australian Government Department of Health has stockpiled a certain amount of smallpox vaccine, which will be accessed under appropriate situations.

In the event of an outbreak, there will be a stepwise process to vaccinate people who will be required to assist in containment of the outbreak, such as doctors, nurses and ambulance personnel.

All others will be offered vaccination only if they have had contact with a case or form part of a ‘ring vaccination’ control strategy.

Control of case

Any patient that raises a concern of smallpox must be notified to the Communicable Diseases Section of the department as soon as possible. A mobile smallpox care team will be dispatched to provide a swift and expert provisional diagnosis, and to implement suitable patient care and public health management.

All such patients (and their possessions) should be placed in the best available form of isolation as soon as possible. They should have limited contact with any people other than those directly involved in their care, who must wear personal protective equipment (PPE). Any air-conditioning should be turned off immediately.

All people in contact with the case or sharing the same air space (for example, hospital or practice staff, other patients) should be requested to remain in a safe area until the smallpox care team arrives and makes an assessment. They may need to be given access to smallpox immunisation in the short term. Their details, including contact numbers, must be collected. This should be commenced as soon as practicable. The smallpox care team will advise about infection control matters, including disinfection, and provide information to those present.

Cases will be categorised as possible, suspected, probable or confirmed, depending on the epidemiology, clinical presentation, and results of electron microscopy and PCR testing of vesicular fluid.

All confirmed and probable cases will be managed in the treatment ward of the smallpox care centre, where they will receive optimal healthcare by staff who have been successfully immunised, while maintaining appropriate isolation precautions for the community.

Those who meet the possible or suspected criteria will be placed in the observation ward of the smallpox care centre.

Control of contacts

The strategy of ring vaccination will be used in the control of any smallpox outbreak. This means that all contacts of a case (see ‘Category A – primary contacts’ and ‘Category B – primary contacts’) will be immunised. As an extra precaution, people with ongoing household contact with category A contacts, during the formal monitoring period, will also be offered access to the vaccine.

Category A – primary contacts

These are people who are likely to be exposed to the virus through large droplets or contaminated fomites. They include:

household contacts – all usual residents, and any visitors who spent more than 1 hour at the address during the infectious period
face-to-face contacts (within 2 metres) during the infectious period – this will include work and social settings, as well as unvaccinated healthcare and emergency services personnel
fomite contacts – all people with direct contact with clothing or articles that have been used by infectious cases of smallpox.

Actions required:

Urgent vaccination, preferably before day 3 but up to day 7.

Active surveillance for 17 days after the last exposure, involving
- daily reporting of the contact by phone to the department; if there is failure to contact, the department will actively follow up cases by phone or in person
- details of oral temperature and presence of constitutional symptoms.

• Restriction of movement from 7 days after first exposure until 17 days after last exposure. During this time, the contact must

o avoid contact with unvaccinated people

o stay away from school and work

o remain within local area, as defined by the department.

If symptomatic, category A cases need to stay at home and immediately contact the department.
- A category A contact who develops fever will be regarded as a possible case and transferred immediately to the observation ward of the smallpox care centre.
- A category A contact who develops fever and rash will be regarded as a probable case and transferred immediately to the treatment ward of the smallpox care centre.
Outside the restricted period, category A contacts will need to stay within the local area until their vaccination site is completely healed and their formal monitoring period is over.

Category B – primary contacts

These contacts are less likely to have been exposed to the virus than category A contacts. They include all people who have shared a room or other enclosed spaces with the case while infective and not meeting the criteria of category A contacts.

They may include those who have visited the same premises, travelled on the same public transport (trains, planes or buses), or shared the same floors of buildings or the same air-conditioning space as an infectious case.

Actions required:

Vaccinate unless contraindicated.

Commence passive surveillance.
- Details will be taken by the department, and information provided about the nature of smallpox and actions to be taken if symptoms (fever, rash or constitutional symptoms) develop.
- If symptoms develop, they must immediately contact the department and remain at home, avoiding contact with all unvaccinated people.
- Surveillance will continue until 17 days after the last exposure to the virus.

• Restrict movement.

o Category B contacts will not be allowed to travel abroad until their vaccination site is completely healed and their formal surveillance period is over.

o No other restrictions of activity are required unless the case is unwell.

If symptomatic, they will be admitted to the smallpox care centre.
- Category B contacts who develop fever will be classified as possible cases and transferred to the observation ward of the smallpox care centre.
- Category B contacts who develop fever and vesicular rash will be classified as probable cases and transferred to the treatment ward of the smallpox care centre.

Secondary contacts

These are people who will have ongoing household contact with category A contacts during the formal monitoring period. As such, they are at risk of exposure to the virus if the primary contact becomes symptomatic. Secondary contacts would be expected to include usual household residents of category A contacts, together with any visitors to the household who expect to spend extended periods there during the formal monitoring period.

Actions required:

Vaccinate unless contraindicated.
- If vaccination is contraindicated, the secondary contact will need to avoid contact with the primary contact until the vaccination site is completely healed.
- • Passive surveillance and no restriction of movement. o No monitoring or restriction requirements are necessary unless the primary contact becomes symptomatic. If they become confirmed with smallpox, the secondary contact will be reclassified as a category A contact and will need to be managed accordingly.

Unimmunised primary contacts

These are primary contacts (both category A and B) who fail to respond to the vaccine after 3 days, who are vaccinated later than 3 days after first exposure to the virus, or who refuse to be vaccinated.

Actions:

- • Limited options are available for the pharmacological management of people vaccinated late. The smallpox response team’s infectious diseases specialist may suggest the use of vaccinia immunoglobulin or cidofovir in very limited circumstances.
- • Category A primary contacts who are categorised as unimmunised will be required to remain in isolation accommodation until the incubation period has elapsed.
- Category B primary contacts will be managed as if they were a category A contact (active surveillance, restricted movement from day 7 after first exposure to day 17 after last exposure; see above).

Control of environment

All people in contact with a case of smallpox must wear the appropriate PPE. To limit any further spread, this will then be removed, and the person will be required to shower on leaving the infected area. PPE includes gloves, theatre cottons with head cover, disposable apron, eye protection, footwear such as overshoes, and a P2 respiratory mask.

Until the smallpox care team arrives, the possibly infected area should be cordoned off, and access limited to those already present and those required for urgent medical care. The case of concern should be isolated as best as possible, and all others should remain within a safe distance of the cordoned-off area. Information and care should be afforded to all people involved, with particular attention on advising that the earliest possible access to the vaccine will provide the best possible outcome if the case proves to be smallpox.

The smallpox care team will advise on suitable decontamination processes and disposal of possibly infectious materials. This will be in accordance with the Guidelines for smallpox outbreak, preparedness, response and management.

Because the virus is transmitted through infectious respiratory droplets and body fluids, or contaminated clothing, dressings, linen, towels or clinical waste, every effort must be made by relevant staff to limit spread through these routes. Air-conditioning must be isolated or turned off, and the time documented. Any object that enters the infected area must remain there until disinfected or disposed of appropriately. This includes all linen, dressings, disposable eating utensils and medical notes.

Outbreak measures for smallpox (variola)

Smallpox management will be framed in one of the five Australia response codes for smallpox:

response code 0: smallpox remains eradicated – no credible threat of a release
response code 1: imminent threat or a case overseas
response code 2: one case or a cluster of related cases in Australia
response code 3: unrelated cases or unrelated clusters in Australia
response code 4: outbreak controlled – no further cases occurring.

Emergency plans would be activated in sequence with these codes, as outlined in the Australian Government’s Guidelines for smallpox outbreak, preparedness, response and management. This would include alerts to the community and health providers, roll-out of the smallpox vaccination strategy, mobilisation and augmentation of the smallpox care teams, and commissioning of the smallpox care centre.

Special settings

General hospital wards and their emergency departments (EDs) may be at increased risk of attending to smallpox cases. To limit this, all community concerns regarding smallpox need to be notified to the department immediately. The department will dispatch a smallpox care team to make an urgent assessment. In this way, cases will be diverted to smallpox care centres without disrupting the working of any hospitals.

However, if a case does present to an ED, activation of the ED infection control procedures should be instituted, such that appropriate action is taken to limit any spread into the broader hospital.

International measures

If there are smallpox cases overseas, the Australian Government may divert all aircraft from that country to a limited number of airports, where screening, immunisation, and the appropriate isolation and quarantine measures will be applied as required.

NIH: National Institute of Allergy and Infectious Diseases

Vaccinia (smallpox) vaccine, derived from calf lymph, and currently licensed in the United States, is a lyophilized, live-virus preparation of infectious vaccinia virus. It does not contain smallpox (variola) virus.

Credit:
CDC

Smallpox, caused by the variola virus, was a highly contagious infectious disease that caused infected individuals to develop a fever and a progressive, disfiguring skin rash. Three of out 10 individuals infected with smallpox died. Many survivors have permanent scars, often on their faces, or were left blind. Through vaccination, the disease was eradicated in 1980. However, research for effective vaccines, drugs and diagnostics for smallpox continues in the event it is used as a bioterror weapon.

The last naturally occurring case of smallpox was reported in 1977. In 1980, the World Health Organization declared that smallpox had been eradicated. Currently, there is no evidence of naturally occurring smallpox transmission anywhere in the world. Although a worldwide immunization program eradicated smallpox disease decades ago, small quantities of smallpox virus officially still exist in two research laboratories in Atlanta, Georgia, and in Russia.

Why Is the Study of Smallpox a Priority for NIAID?

Smallpox is a category A pathogen which are those organisms/biological agents that pose the highest risk to national security and public health because they can be easily disseminated or transmitted from person to person, result in high mortality rates and have the potential for major public health impact, might cause public panic and social disruption, and require special action for public health preparedness.

How Is NIAID Addressing This Critical Topic?

NIAID supports basic, preclinical, and clinical research needed to advance product development for biodefense and emerging infectious diseases. Product development goals in this arena have shifted from a “one bug-one drug” approach to a more flexible strategy that is applicable to a broad spectrum of infectious diseases. Specifically, this broad-spectrum approach is being used to develop products effective against a variety of pathogens and toxins; find technologies that can be widely applied to improve multiple classes of products; and establish platforms that can reduce the time and cost of creating new products. This is evident in both the treatment and vaccine research NIAID has supported for smallpox, outlined below.

Vaccine Supply & Strength

The Dryvax vaccine was used in smallpox eradication, and the United States has enough of its successor, Acam2000, available to vaccinate the population in the case of a terrorist attack. Prior to availability of Acam2000, a NIAID-supported clinical trial that found that Dryvax could successfully be diluted up to five times and retain its effectiveness. These findings helped expand the number of individuals Dryvax could protect until sufficient doses of Acam2000 were made for the entire U.S. population.

Read more about smallpox vaccine supply and strength

Treatment

Although smallpox vaccines have been developed and procured for the SNS, they cannot completely prevent disease or attenuate the illness if given too late following exposure. Smallpox antivirals are needed for treatment or post-exposure prophylaxis. Early results from laboratory studies suggest that the drug cidofovir may be an effective treatment against the smallpox virus. (In 1996, the Food and Drug Administration [FDA] approved the use of cidofovir to treat cytomegalovirus infections.) NIAID-supported scientists are doing studies with animals to better understand the drug’s ability to treat smallpox.

Read more about smallpox treatment

Reevaluating the Risk of Smallpox Reemergence

Introduction:

Smallpox, caused by variola virus, was eradicated in 1980, but remains a category A bioterrorism agent. A decade ago, smallpox ranked second after anthrax in a multifactorial risk priority scoring analysis of category A bioterrorism agents. However, advances in genetic engineering and synthetic biology, including published methods for synthesizing an Orthopoxvirus, require the assumptions of this scoring for smallpox and other category A agents to be reviewed.

Materials and methods:

The risk priority framework was reviewed and revised to account for the capability for creation of synthetic or engineered smallpox and other category A agents.

Results:

The absolute score for all agents increased because of gene editing and synthetic biology capability, which was not present when the framework was developed more than a decade ago, although new treatments revised scores downward for smallpox, Ebola, and botulism. In the original framework, smallpox scored 0 for global availability, given the high security around known seed stocks of variola in two laboratories in the United States and Russia. Now, smallpox can be created using synthetic biology, raising the score for this criterion to 2. Other agents too, such as Ebola, score higher for availability, based on synthetic biology capability. When advances in synthetic biology and genetic engineering are considered, smallpox and anthrax are now equally ranked the highest category A bioterrorism agents for planning and preparedness.

Conclusions:

Revision of a risk priority framework for category A bioterrorism agents shows that smallpox should be elevated in priority for preparedness planning, and that gene editing and synthetic biology raises the overall risk for all agents. The ranking of categories A, B, and C agents should also be revisited, as there is an endless possibility of engineered threats that may be more severe than any agent on the category A list.

Smallpox – an overview | ScienceDirect Topics

Variola (Smallpox)

In 1980, the WHO General Assembly declared that smallpox had been eradicated; destruction of the remaining virus stocks, scheduled for 1999 and then 2002, has been delayed in an effort to permit research for improved preparedness in the event smallpox recurs as the result of the malevolent use of variola virus. The virus has a strict human host range and no animal reservoir. Variola major strains produced a disease with a severe prodrome, fever, and prostration. The virus was most often transmitted between humans via large-droplet respiratory particles inhaled by susceptible persons who had prolonged close face-to-face contact with an infectious person; it was spread less commonly via aerosol or direct contact with the rash lesion or sloughed crust material from the scab.^79,118 A toxemia or other form of systemic shock led to case-fatality rates of up to 30%. Secondary attack rates among unvaccinated contacts within households ranged from 30% to 80%. Variola minor strains (alastrim, amass, or kaffir viruses) produced less severe infection and case-fatality rates of less than 1%, although secondary attack rates among unvaccinated contacts within households also ranged from 30% to 80%. The last naturally occurring smallpox case was in Somalia in October 1977, although a fatal laboratory-associated infection with variola major virus occurred at the University of Birmingham, England in August 1978.⁷⁹

Naturally acquired variola virus infection caused a systemic febrile rash illness. For ordinary smallpox, the most common clinical presentation, after an asymptomatic incubation period of 10 to 14 days (range, 7 to 17 days), was fever, with the temperature quickly rising to about 103° F, sometimes with dermal petechiae. Associated constitutional symptoms included backache, headache, vomiting, and prostration. Within 1 or 2 days after incubation, a systemic rash appeared that was characteristically centrifugally distributed (i.e., lesions were present in greater numbers on the oral mucosa, face, and extremities than on the trunk). Lesions were commonly manifested on the palms and soles (Figs. 135-2 and 135-3). Initially, the rash lesions appeared macular, then papular, enlarging and progressing to a vesicle by days 4 to 5 and a pustule by day 7; lesions were encrusted and scabby by day 14 and sloughed off (Fig. 135-4). Skin lesions were deep seated and in the same stage of development in any one area of the body. Milder and more severe forms of the rash were also documented. Less severe manifestations (modified smallpox or variola sine eruptione) occurred in some vaccinated individuals, whereas hemorrhagic or flat-pox types of smallpox are thought to have developed as a result of impaired immune response of patients.

Variola major smallpox was differentiated into the following four main clinical types:

1.: Ordinary smallpox (90% of cases) produced viremia, fever, prostration, and rash; mortality rates were generally proportionate to the extent of rash. With the WHO classification, mortality rates ranged from less than 10% for “ordinary discrete” smallpox to 50% to 75% for the rarer “ordinary confluent” presentation.
2.: (Vaccine)-modified smallpox (5% of cases) produced a mild prodrome with few skin lesions in previously vaccinated people and a mortality rate well under 10%.
3.: Flat smallpox (5% of cases) produced slowly developing focal lesions with generalized infection and an approximate 50% fatality rate.
4.: Hemorrhagic smallpox (<1% of cases) induced bleeding into the skin and the mucous membranes and was invariably fatal within a week of onset.

A discrete type of the ordinary form, with a typical febrile prodrome and rash, resulted from alastrim variola minor infection.⁷⁹ The WHO established a classification system for smallpox case types based on disease presentation and rash burden. The hemorrhagic and flat types have already been briefly described. The ordinary type was subgrouped into three categories on the basis of the extent of rash on the face and the body. In the ordinary confluent category, no area of skin was visible between vesiculopustular rash lesions on the trunk or the face. Patches of normal skin were visible between rash lesions on the trunk in ordinary semiconfluent disease and on the face in ordinary discrete disease. (Vaccine)-modified disease arose with sparse numbers of lesions. Infection conferred lifelong immunity.^79,119

Before its eradication, smallpox as a clinical entity was relatively easy to recognize, but other exanthematous illnesses were mistaken for this disease.^118,119,120 For example, the rash of severe chickenpox, caused by varicella-zoster virus, was often misdiagnosed as that of smallpox. However, chickenpox produces a centripetally distributed rash and rarely appears on the palms and soles. In addition, in the case of chickenpox, prodromal fever and systemic manifestations are mild, if manifest at all; the lesions are superficial in nature; and lesions in different developmental stages may be present in the same area of the body. Other diseases confused with vesicular-stage smallpox included monkeypox, generalized vaccinia, disseminated herpes zoster, disseminated herpes simplex virus infection, drug reactions (eruptions), erythema multiforme, enteroviral infections, scabies, insect bites, impetigo, and molluscum contagiosum. Diseases confused with hemorrhagic smallpox included acute leukemia, meningococcemia, and idiopathic thrombocytopenic purpura. The CDC, in collaboration with numerous professional organizations, has developed an algorithm for evaluation of patients with smallpox. The algorithm assists in differential diagnoses of the vesiculopustular stage of rash. The algorithm and additional laboratory testing information are available at www.bt.cdc.gov/agent/smallpox/diagnosis/. The differential diagnosis of febrile vesicular pustular rash illnesses is presented in Table 135-1.

GBUZ City Polyclinic No. 111 for adults – St. Petersburg, ul. Olkhovaya, 6

What is measles

Measles (see Knowledge Base for more information) is a classic childhood infectious disease caused by a virus. In the old days, measles was extremely common, but now the incidence has decreased to rare cases thanks to mass vaccinations. Measles manifests itself as cough, runny nose, conjunctivitis, sore throat, fever, and a red spotted skin rash.

Measles can be severe, especially in young children, and even fatal. Global measles deaths have been declining each year as more children receive the vaccine, but the disease still kills more than 100,000 people every year, most of them under 5 years of age.

Measles is spread throughout the world. In the pre-vaccination era, by the age of 15, more than 90% of the world’s population had had measles. The mortality rate exceeded 2-2.5%
In 2000, according to rough estimates, Koryu fell ill from 31 to 40 million.people, the death rate was 773,000 – 777,000 people – that is, 2.1% of cases. High morbidity and contagiousness make measles the fifth leading cause of infant mortality.

Measles symptoms

Skin rash (see also: Measles. Description of the elements of the rash.), In the form of large flat spots that often coalesce; it has stages – it starts from the face and then gradually spreads down to the trunk and limbs.

The disease has a certain stage and takes 2-3 weeks:

Infection and incubation period: In the first 10 to 14 days from contact with an infected person, there are no symptoms.
The period of nonspecific symptoms. The first symptom of measles is usually mild to moderate fever, which is often accompanied by persistent cough, runny nose, conjunctivitis, and sore throat.This stage is relatively easy and lasts two to three days.
Period of rash. The rash consists of small red spots, some of which are slightly raised above the level of the skin (papules). Accumulations of spots and papules in measles give the skin a diffusely hyperemic appearance. The rash first appears on the face, especially behind the ears and along the hairline.

Over the next few days, the rash spreads down to the arms, trunk, then to the thighs, legs and feet.Simultaneously with the appearance of the rash, the fever sharply increases, reaching 40-41 degrees. The rash lasts up to six days and gradually disappears, starting on the face, then on the arms, trunk, and lastly on the thighs and feet.

A measles patient is contagious for about eight days: the virus begins to be released into the environment four days before the onset of the rash and ends four days after the first elements of the rash appear.

When to see a doctor

Call your doctor if you think you or your child has been in contact with a person with measles or have already had measles.Talk to your doctor about the usefulness of your child’s immunization schedule before entering primary school, college, or international travel.

Causes of measles

Measles is caused by a virus that multiplies in the nose and throat of an infected child or adult.

When a person with measles coughs or sneezes, the infected droplets are sprayed into the surrounding air so that other people can inhale them.Infected droplets can also settle on surfaces and remain active for several hours. If a healthy person first touches these surfaces with their hands and then rubs their nose or eyes, they can also become infected.

Risk factors

Lack of vaccination. If your child does not have measles vaccine, his risk of getting sick from contact with a sick person is much higher than that of vaccinated children.
International travel. If you are traveling to developing countries where measles is more common, you are at a higher risk of infection.
Having a vitamin A deficiency. If your diet is low in vitamin A, you are at a higher risk of infection, as well as a higher risk of severe illness.

Complications of measles

Ear infection (otitis media). One of the most common complications of measles is a bacterial middle ear infection.
Bronchitis, laryngitis or false croup. Measles can lead to inflammation of the vocal cords (larynx) or bronchi, and measles is also secreted
Pneumonia. Pneumonia is a common complication of measles. People with weakened immune systems are especially at risk. Sometimes measles pneumonia leads to the death of the patient.
Encephalitis. This complication develops with a frequency of approximately 1: 1000 cases. It is an inflammation of the brain substance that can cause vomiting, seizures, coma, or even death. Measles encephalitis can begin at the same time as measles itself, or it can be delayed by several months.
Problems during pregnancy. If you are pregnant, you need to take special care to avoid measles because measles can lead to abortion (fetal death), premature birth, severe fetal malformations or low birth weight.
Decreased platelet count (thrombocytopenia). Measles can lead to a decrease in platelets – blood cells that are essential for blood clotting.

Complication rate of measles in developed countries:
Overall complication rate – 22.7%
Diarrhea – 9.4% 90 152
Otitis media – 6.6% 90 152
Pneumonia – 6.5% 90 152
Encephalitis – 0.1%
Death – 0.3%
The incidence of complications from measles is higher in developing countries and countries with a high refusal rate .

Preparing for a doctor’s visit

In preparation for your doctor’s appointment, you can make some helpful preparations:

Write down any symptoms you or your child are experiencing, including those that do not seem to you to be related to the condition
Record key personal information, including any recent travel
List all medicines, vitamins and supplements that you or your child are taking
Make a list of questions you would like to ask your doctor.

Your doctor is likely to ask you a number of questions, such as:

Have you or your child been vaccinated against measles? When and how many times were vaccines given?
Have you recently traveled outside the country?
Who else lives in your house? Are they all vaccinated against measles?

What can you do while waiting for a doctor’s appointment?

Make sure you or your child are getting enough fluids.It is optimal to drink not just water, but electrolyte solutions, such as Regidron, Hydrovit, Humana Electrolyte, etc.

If the fever causes severe discomfort or reaches high numbers (above 39 degrees), paracetamol (15 mg / kg) or ibuprofen (10 mg / kg) should be taken.

Do not give aspirin to children to reduce fever as it can cause a life-threatening complication called Reye’s syndrome.

Measles diagnostics

In most cases, your doctor will only need an examination and anamnesis to accurately diagnose measles.If necessary, the diagnosis can be confirmed by a blood test.

Measles treatment

There is no specific treatment for measles, antiviral and antibacterial drugs are ineffective for this disease. The disease goes away on its own, treatment consists only in reducing symptoms and timely identification of complications. However, some measures can still be taken in individuals at high risk of severe and complicated infections:

Post-exposure immunization. Unvaccinated patients, including infants, can be vaccinated against measles within 72 hours of contact with a sick person. In most cases, this can significantly alleviate the severity of the disease and improve the prognosis.
Intravenous immunoglobulin. Pregnant women, infants, and people with weakened immune systems (eg, HIV-infected people) who have been in contact with an infected patient but cannot receive a live vaccine – usually receive injections of immunoglobulin.This drug must be administered within six days of exposure to the virus. The donor antibodies in the drug can prevent measles or make the symptoms of the disease less severe.

Medicines

Antipyretic. Use paracetamol or ibuprofen only. Do not use aspirin on children under 18!
Antibiotics. If a secondary bacterial complication such as pneumonia or otitis media develops during measles, your doctor may prescribe an antibacterial drug.
Vitamin A. People with low vitamin A levels are more likely to have a more severe course of measles. Vitamin A supplementation can reduce the severity of measles. It is usually given in a large dose (200,000 IU) over two days.

Lifestyle changes and home remedies

If you or your child has been diagnosed with measles, you should be in contact with your doctor so that he can monitor the progress of the disease and monitor the development of complications.In addition, the following tips can help you ease your symptoms:

Rest. Observe bed or semi-bed rest
Drink plenty of water, fruit juices, and herbal teas to replenish fluid lost from fever and sweating
Humidify the air in your home. Use a humidifier or wet cloth for this.
Rest your eyes. Keep the room light dim or wear sunglasses.Read as little as possible and look at monitors (computer, telephone, etc.). To fill your leisure time, you can, for example, listen to audiobooks.

Prevention of measles

If anyone in your family has measles, take the following precautions:

Insulation. Since measles is highly contagious 4 days before the onset of the rash, and 4 days after its onset, the sick person should be in maximum isolation during this period of time.No visits, visits or meetings.
It is especially important to isolate unvaccinated people from an infected person
Vaccination and administration of immunoglobulin. Ask your family doctor questions about the need for specific emergency protection for each family member.

Prevention of new infections

If you have had measles before, then your body has lifelong immunity, and you cannot get sick a second time.

For all other people, the introduction of the vaccine is of the utmost importance as a preventive measure. Vaccination forms and maintains the so-called herd immunity against measles.

As soon as the herd immunity against measles weakens, the incidence of the disease begins to increase.

The measles vaccine is a part of the measles + mumps divaccine, or the Priorix trivial vaccine (measles + mumps + rubella).In developed countries, they use the Priorix-tetra tetra vaccine (measles + mumps + rubella + chickenpox). According to the Russian national vaccination calendar, measles vaccination is carried out at 1 year (one dose is administered) and at 6 years (a second dose is administered). Additional vaccinations are given to women planning pregnancy, teachers, health workers, and some other people who, by the nature of their profession, have a high risk of contracting measles.

90,000 The most important epidemics in the history of mankind – Picture of the day – Kommersant

“Plague of Antonines” (III century AD)BC) in the Mediterranean world

Most likely, it was a smallpox epidemic. It was the result of contacts between the Mediterranean civilization (Rome) and the Indian civilization. In parallel with it, the same epidemic broke out in China. It also became the result of contacts between civilizations – between China and India. For the population of the West and the Far East, it was a “new disease”. There was no immunity to her. Therefore, the consequences were dire.

The “Plague of Antonines” led to the depopulation of the Roman Empire.The price of physical labor has risen sharply. Slavery has become ineffective. There were not enough resources to contain the onslaught of the barbarians. The empire was crumbling. The horror of the epidemic and widespread panic led to a weakening of faith in the old gods. Against this background, there was a natural spread of Christianity, which became the “religion of salvation” in this large region. Christians were not afraid of death, they did merciful deeds, took care of the dying, and built hospitals. This was an important factor for the subsequent official recognition of Christianity as the official religion in the Mediterranean world.The same situation occurred at the same time in China, where Buddhism, another “religion of salvation”, spread.

The consequences of that epidemic were enormous. In the West, the Roman Empire collapsed. The Han Empire collapsed in the Far East. There appeared “religions of salvation” – Christianity and Buddhism. At the turn of the 3rd and 4th centuries A.D. NS. in the Mediterranean (Western) world and the Far East (Chinese) world, a new type of social organization began to be built – the church (community of believers).In the West, society within a short period became Christian, in the Far East – Buddhist. In general, the response to this global epidemic in two main regions of the world has been the strengthening of religiosity. There have been profound changes in the field of morality.

“Justinian’s plague” of the 6th century AD NS. in the Middle East

It is generally accepted that this was the first bubonic plague pandemic. We know that it was the highest manifestation of the crisis of the Byzantine Empire. It was preceded by long years of war between Byzantium and Persia, famine.Both empires suffered from the plague. The dream of the Byzantine emperor to revive Rome failed. Huge territories in the Eastern Mediterranean, Asia Minor and North Africa were depopulated. A political and demographic vacuum was formed, which was filled by Islam. The historical consequence of the plague was the emergence of the Arab state and Islam as a world religion.

“Black Death” of the 14th century

Second pandemic of the bubonic plague. China and Western Christendom suffered from it. The reasons for the occurrence are not exactly known until now.I adhere to the hypothesis that it was the result of the revival of contacts between the civilizations of the West and the Far East. These contacts were interrupted after the 3rd century AD. NS. The population of Europe, like the population of China, was not familiar with this disease. It was a “new disease.” After the Mongol conquest and the creation of the transcontinental Mongol empire, the Silk Road was revived, trade over long distances intensified. Natural foci of plague (zoonoses) are scattered over the Eurasian steppes – from Mongolia to Ukraine.The infection has spread to both China and Europe. The consequences were dire. Numerous foci of plague have formed in Europe. Rodents became carriers of the disease. With the growing number of cities, unsanitary conditions, constant wars in Europe, plague epidemics did not stop for another three centuries.

Smallpox and other infections in America in the 16th century

The discovery of the New World was accompanied by the introduction of smallpox and other diseases from Europe to America, where the population of Mexico and Peru had no immunity to them. For America, these were new diseases.As a result, 95% of the indigenous population of Mexico and Peru became extinct. The civilizations of the Aztecs and Incas perished. Two centuries later, a similar story was repeated in Australia and Oceania, where contacts between Europeans and aborigines led to their mass extinction.

The spread of smallpox in America led to the rapid conquest of this continent by Europeans. The wealth of America poured into Europe. The import of capital contributed to the development of capitalism. Smallpox in America also became an important factor in the rise of global trade and European colonialism.

Smallpox in Europe, Russia and North America in the 18th century

After the end of plague epidemics in Europe, smallpox became the main disease. Big cities became its centers. The law of large numbers played a role here. Carriage of smallpox is possible only in large populations, with a high birth rate and infant mortality. Widespread outbreaks, in fact endemics of smallpox, have often influenced both everyday life and big politics. Monarchs were dying. Soldiers died in tens of thousands.In North America, smallpox caused the mass extinction of the Indians. This allowed Europeans to begin settling in the Northeast, Canada (18th century), and then the Wild West (19th century). Smallpox on the American continent has become an important factor in the emergence of a state like the United States.

The answer given by Europe and Russia to smallpox is well known. The enlightened secular government began to fight this disease. But the quarantines were ineffective, as the government wanted to encourage the development of trade – both local and global.Therefore, the monarchies of the Age of Enlightenment began to encourage special, “biopolitical” approaches. The first effective tool of biopolitics was the vaccination of the population. First – variolation, then vaccination. There was no scientific explanation for it until the very end of the 19th century (Pasteur), but the tool showed itself well everywhere – from North America to Russia.

19th century cholera in India, Europe, Russia and North America

The first serious outbreaks of cholera appeared in India. In the humid tropical climate of this country, cholera was considered a common seasonal infection.With the arrival of the British in India, everything changed. British colonial policies disrupted the local communal way of life. The fiscal laws imposed by the British forced millions of Indians to stay in the same places for long periods of time. The inhabitants were not allowed to lead a nomadic lifestyle, which was the traditional way of avoiding dangerous cholera places. It was no longer possible for ordinary Indians to avoid infection with cholera. This soon led to dire consequences. A series of socio-economic crises have transformed cholera from a common disease into an ongoing epidemic.Since 1817, cholera epidemics have not stopped. In the 19th century alone, there were five cholera pandemics, all of which began in India.

Experience with plague and smallpox control helped authorities in Europe, Russia and North America find effective cholera control measures. There were no vaccinations. Quarantine was often used, but this measure caused the discontent of all sectors of society. Particularly unhappy were the commercial and industrial strata, for whom quarantine was worse than cholera. Therefore, in England, and then in other countries, a new approach prevailed – social hygiene.There were sanitary doctors, sanitary inspection, etc. The practice of personal hygiene developed. Soap, boiling water, plumbing, sewerage, and so on. The emergence of “medicine for the population”, social medicine, the core of which is sanitary medicine. On this wave, the first measures to protect public health are being taken. Establishment of the foundations of national health systems begins.

“Spanish flu” (influenza pandemic of 1918–1921)

By the beginning of the 20th century, national health systems had emerged in all developed countries.The authority of medical workers has been strengthened. Many different vaccines have been developed. A rapid eradication of dangerous infections began – plague, cholera, smallpox, “childhood infections” and so on. There has been an improvement in material well-being. The sanitary order has been strengthened. Personal hygiene has become the norm.

In 1914, a global world crisis began – the First World War. Outbreaks of epidemics – typhus, scarlet fever, measles, even plague – occurred everywhere in the territories where hostilities were fought. But the measures to combat them were known, so one way or another the doctors managed to cope with it.

Airborne infectious diseases, however, continued to be a problem. The flu was the quintessence of the problem. In truth, it was not a “new disease.” We’ve had the flu before. Let’s remember the “English sweat” of the 16th century. But a new factor has emerged – global transport links. The end of the First World War led to the movement of huge masses of people. Millions of former soldiers went home. The Spanish flu has appeared on all continents. The greatest damage was incurred by the populations of the colonial countries, especially India and Africa, where there were virtually no health services.But even where they were, the losses were great. Europe and North America, the most developed parts of the world, reacted especially painfully to the “Spanish flu”, there were a lot of victims of the epidemic there.

Dmitry Mikhel

90,000 Risk factors for the development of diabetes mellitus

World Diabetes Day is celebrated on 14 November. More than 425 mln. people in the world are living with diabetes. Most of these cases are type 2 diabetes, which can be largely prevented with regular physical activity, a healthy and balanced diet, and a healthy lifestyle.According to statistics, more than a hundred cases of newly diagnosed diabetes are registered annually in Karsunsky district.

We bring to your attention the so-called “rating of causes” that lead to the onset of diabetes.

1. Heredity

There are observations that type 1 diabetes is inherited with a probability of 3-7% in the mother’s line and with a probability of 10% in the father’s line. If both parents are sick, the risk of the disease increases several times and is up to 70%.Type 2 diabetes is inherited with a probability of 80% on both the maternal and paternal lines, and if both parents are ill with non-insulin-dependent diabetes mellitus, the probability of its manifestation in children approaches 100%, but, as a rule, in adulthood. Well, in this case, doctors differ only in the number of percentages, otherwise they are in agreement: heredity is the main factor in the onset of diabetes.

2. Obesity

From the point of view of the development of diabetes, it is especially dangerous if the body mass index is more than 30 kg / m ² and obesity is abdominal, that is, the body shape takes the shape of an apple.The size of the waist circumference is important. The risk of diabetes increases with a waist circumference of more than 102 cm for men and more than 88 cm for women. It turns out that the wasp waist is not only a tribute to fashion, but also a sure way to protect yourself from diabetes. This factor, fortunately, can be neutralized if a person, realizing the full extent of the danger, will fight overweight (and win this fight).

3. Diseases of the pancreas

Pancreatitis, pancreatic cancer, diseases of other endocrine glands – everything that provokes pancreatic dysfunction contributes to the development of diabetes.By the way, physical trauma can often contribute to damage to the pancreas.

4. Viral infections

Rubella, chickenpox, epidemic hepatitis and several other diseases, including influenza, increase the risk of diabetes. These infections play the role of a trigger, as if provoking the disease. It is clear that for most people, the flu will not be the onset of diabetes. But if this is an obese person with aggravated heredity, then a simple virus poses a threat to him.A person in whose family there were no diabetics can suffer the flu and other infectious diseases many times, and at the same time, they are much less likely to develop diabetes than a person with a hereditary predisposition to diabetes. So the combination of risk factors increases the risk of the disease several times.

5. Wrong way of life

Diabetes registered in the genes may not manifest itself if it is not triggered by one of the following factors: nervous stress, a sedentary lifestyle, unhealthy diet, inability to breathe fresh air and spend time in nature, smoking.All these “urban” troubles only increase the risk. Add to this the increase in life expectancy (the highest incidence of diabetes is recorded in people over 65), and we get huge statistics on the number of diabetic patients.

QUESTIONNAIRE
FOR DETECTING PRE-DIABETES OR DIABETES MELLITUS

Questionnaire “Do you have prediabetes or type 2 diabetes?”

Instruction

Answer all 8 questions of the questionnaire.
For each question, select 1 correct answer and tick it.
Add up all the scores that match your answers to the questions.
Use your total score to determine your risk of developing diabetes or prediabetes.

1. Age

Under 45 0 points
45 – 54 years 2 points
55 – 64 years old 3 points
Over 65 years old 4 points

2.Body mass index

The

Body Mass Index measures whether you are overweight or obese. You can calculate your body mass index yourself:

Weight _____ kg: (height _____ cm) 2 = weight divided by height squared

Less than 25 kg / m2 0 points
25 – 30 kg / m2 1 point
More than 30 kg / m2 3 points

3. Waist circumference

Men Women
<94cm <80cm 0 points
94 – 102cm 80 – 88cm 3 points
> 102cm> 88 cm 4 points

4.How often do you eat vegetables, fruits or berries?

Every day 0 points
Not every day 1 point

5. Do you exercise regularly?

Do you exercise 30 minutes every day or 3 hours a week?

Yes 0 points
No 2 points

6. Have you ever taken blood pressure medications regularly?

No 0 points
Yes 2 points

7.Have you ever been found to have a blood glucose (sugar) level higher than normal (during medical examination, professional examination, during an illness or pregnancy)?

No 0 points
Yes 5 points

8. Did your relatives have type 1 or type 2 diabetes?

No 0 points
Yes: grandfather / grandmother, aunt / uncle / cousins / sisters 3 points
Yes: parent, brother / sister or own child 5 points

RESULTS:

Sum of points __________.

The total number of points will show the risk of developing diabetes mellitus within 10 years:

90,032 90,033 Less than 7: Low risk 1 in 100, or 1%

7 – 11: Slightly increased 1 in 25, or 4%

90,033 12 – 14: Moderate 1 in 6, or 17%

15 – 20: High 1 of 3, or 33%

Over 20: Very High 1 in 2, or 50%

If you have scored less than 12 points: you are in good health and should continue to lead a healthy lifestyle.

If you scored 12-14 points: you may have prediabetes. You should talk to your doctor about how you should change your lifestyle.

If you scored 15 – 20 points: you may have prediabetes or type 2 diabetes mellitus. You may want to check your blood glucose (sugar) levels. You must change your lifestyle. It is possible that you will also need medications to lower your blood glucose (sugar) levels.

If you scored more than 20 points: in all likelihood you have type 2 diabetes.You should check your blood glucose (sugar) level and try to normalize it. You must change your lifestyle and you will need medications to control your blood glucose (sugar) levels.

Patients with scores of 12 or more should visit an endocrinologist at the district hospital.

Doctor-endocrinologist, State Institution “Karsunskaya RB” L.A. Lazareva

90,000 Tito and smallpox: how Yugoslavia survived the epidemic and why Marshal was silent

Alexander Miladinovic
BBC Serbian service

May 4, 2020

Photo author, Getty Images

Photo caption,

At Iosip Broza Tito had a special relationship with the press

On May 25, 1972, Yugoslavia was preparing to celebrate the 80th birthday of President Josip Broz Tito.

At the beginning of the year, Belgrade Television launched the first color TV channel in the country, RTS2.

However, confirmed cases of smallpox, which was believed to have been eliminated in Yugoslavia, threatened to spoil Tito’s plans and the life of the Yugoslavs.

“Tito did not have to fight for votes – he did not appear on television during the epidemic,” recalls epidemiologist Zoran Radovanovic, one of those who fought the largest epidemic in the country’s history.

“He left it to others and, of course, did not condescend to carry the vaccines himself to the hospital in Novi Pazar or somewhere else,” says the doctor.

The smallpox epidemic in Yugoslavia began in February 1972 and continued until May 19, when the last recovered patient was discharged from the hospital in Belgrade. A total of 175 people were infected, 40 patients died.

Six days later, at the stadium of the Yugoslav National Army – today’s stadium of the football club Partizan – the traditional celebration of Youth Day and Tito’s jubilee took place.

What did they say about the media epidemic?

Yaksha Shchekich entered the Faculty of Law in 1971, in the spring of 1972 he was preparing to continue his studies.

His father Jovan was at that time one of the most respected journalists on Belgrade television.

“Then the second channel of Belgrade Television was launched, and my father hosted the information show” 24 Hours “, recalls Šcekic, who later also became a journalist.

The smallpox epidemic was then the central topic of the program.

specials that lasted half an hour or an hour. The guests were doctors and ministers. It was known exactly who would come on the air, because the government forbade them to refuse to be interviewed, ”says Yaksha Shchekich.

Photo author, Getty Images

Photo caption,

This is what a smallpox patient looked like

According to Radio and Television of Serbia (RTS), the successor to Belgrade Television, the first reports of a smallpox outbreak appeared seven days after the first case was confirmed.

RTS says that until April 15, citizens were daily informed about the spread of the disease, after that date the regular reports stopped, but information about the epidemic continued to appear in the news from time to time.

As follows from the archives of Belgrade TV, journalist Jovan Šcekic was the only one in his program “24 Hours” who named the name of a deceased patient from Novi Pazar. Today, his son says that people at the time had a completely different attitude to what the authorities reported about the epidemic.

“Do not think that the authorities and the opposition were represented in the media in 1972. These were the words of the state, or the Communist Party,” he says.

“The information was dosed and more focused on the vaccination process – where and when the vaccines are delivered, where the vaccination points are located,” says epidemiologist Zoran Radovanovic.

“This was information that reassured citizens,” he says.

On April 9, 1972, Belgrade Television announced that one million and 700,000 citizens in Belgrade had been vaccinated against smallpox.

Photo author, Getty Images

Photo caption,

Doctors in Kosovo perform a mass vaccination

Was Tito vaccinated?

“There was no official word on whether he was vaccinated, but I believe he did it because he was a very careful person.His doctors made the decision, so I’m pretty sure he was vaccinated because it was in his best interest. In his case, the risk was low, but there was a likelihood that one of those whom he took would be in the incubation period, “says epidemiologist Zoran Radovanovic.

Unmissable Youth Day

With the second half of May approaching and the successful vaccination throughout Yugoslavia, it became clear that the epidemiological situation was improving.

“Tito did not appear in the media at all to talk about the epidemic; instead, it was done by ministers, secretaries, representatives of party organizations.He did not appear either at the beginning of the epidemic, or to announce its end, “says journalist Jaksha Scekic.

Photo author, Getty Images

Photo caption,

In 1972, Queen Elizabeth visited Yugoslavia and met with Josip Broz Tito

Less than a week after the last cured patient was discharged, a mass rally took place at the Yugoslav National Army stadium, which traditionally marked Tito’s birthday

The rally ended the “Youth Relay” – its participants carried a torch across Yugoslavia.

The Yugoslav leader received the torch from a worker from the town of Bihac, Branko Mandic. The very same relay race began near Novi Sad, just on April 15, when regular reports about the epidemic stopped appearing in the news, and the news that aired said mainly that the situation was returning to normal.

Historian Dmitry Grigorov’s work on the “Youth Relay” does not mention any evidence that the preparation of the 1972 relay was in jeopardy due to an epidemic.

The epidemic factor was not taken into account even in the event scenario. Tito’s birthday was in the spotlight, and Grigorov writes that the closing ceremony of the relay was supposed to symbolize “the creativity, thoughts and feelings of all young people in our country.”

And the biggest news of that year was the appearance of color television – the “Youth Relay” was shown in color for the first time.

90 000 The second outbreak of sheep and goat pox was registered on the territory of the Republic of Kazakhstan / Rosselkhoznadzor

According to OIE official data, on July 19, 2019, a second outbreak of sheep and goat pox was recorded in the Atyrau region of the Republic of Kazakhstan. At present, in order to prevent the introduction and spread of this disease on the territory of the Russian Federation, control over the import of controlled products from Kazakhstan has been strengthened.

Smallpox of sheep and goats is a viral, acutely contagious disease characterized by fever, symptoms of intoxication, shortness of breath, swelling of the eyelids, the release of serous-mucous exudate from the eyes and nose, the development of papular-pustular rash on the skin and mucous membranes.

The causative agent of sheep pox is a DNA virus of the genus Capripoxvirus .

The source of infection is sick animals and susceptible animals who have had smallpox, which excrete the pathogen into the external environment with secretions and excretions.

The pathogen is transmitted by direct and indirect contacts of sick and healthy susceptible animals, aerogenic and less often alimentary.

Factors of transmission of the causative agent of infection are feed, care items contaminated with the secretions of sick animals. Blood-sucking insects and ticks, animals of other species, as well as humans are carriers of the disease.

In order to prevent the emergence and spread of smallpox on the territory of the Tomsk region, in accordance with paragraph 7 of the veterinary rules for the implementation of preventive, diagnostic, restrictive and other measures, the establishment and cancellation of quarantine and other restrictions aimed at preventing the spread and elimination of foci of sheep pox and goats approved by order of the Ministry of Agriculture of the Russian Federation of January 23, 2018 No. 24, , owners of susceptible animals are required to comply with the following requirements:

– to prevent environmental pollution by animal waste;

– provide susceptible animals for examination at the request of specialists of the state veterinary service;

– notify within 24 hours of all cases of sudden death or illness of susceptible animals, as well as changes in their behavior indicating a possible illness;

– take measures to isolate suspected susceptible animals;

– to ensure the isolation of corpses of dead susceptible animals in the room in which they were kept;

– to comply with the requirements of specialists for carrying out antiepizootic measures in a personal subsidiary farm, a peasant farm, an individual entrepreneur’s farm, which contains susceptible animals.

For violation of veterinary rules, administrative liability is provided in the form of a fine under article 10.6 of the Code of Administrative Offenses of the Russian Federation.

If you have any questions, you can contact the Office of the Federal Service for Veterinary and Phytosanitary Supervision (Rosselkhoznadzor) in the Tomsk region at the address: Tomsk, Frunze Avenue, 109A or by phone. 45-21-86, 26-34-99.

Source: Department of the Federal Service for Veterinary and Phytosanitary Surveillance in the Tomsk Region

WHO 90,000: Smallpox Eradication 40 Years Ahead Says COVID-19 Victory Is Attainable – Society

GENEVA, 8 May./ TASS /. The eradication of smallpox as a threat to humanity 40 years ago serves as a reminder that victory against the coronavirus is possible if countries join forces to fight it. This was announced on Friday at a briefing in Geneva by the Director General of the World Health Organization (WHO) Tedros Adanom Ghebreyesus.

He recalled that on May 8, 1980, WHO “officially declared that the world and all its peoples have won victory over smallpox.” “It was the first and to date the only human disease that has been eradicated on a global scale,” said the head of the WHO.

“Humanity’s victory over smallpox is a reminder of what can be achieved when nations join forces to combat a common threat,” the CEO said. In the fight against COVID-19, he said, “many of the tools are used” that were used in the fight against smallpox and then Ebola.

Describing smallpox eradication as “the greatest triumph in public health history,” Tedros Adan Ghebreyesus recalled that the availability of a vaccine helped achieve this goal.WHO is currently working with partners “to accelerate the development of a vaccine against COVID-19, which will be a critical tool in controlling the transmission of the virus.” However, for all the importance of the vaccine, “just one is not enough,” said the head of the WHO. “The decisive factor in the victory over smallpox was global solidarity,” he stated, recalling that “at the height of the Cold War, the Soviet Union and the United States of America joined forces in the fight against a common enemy.”

“The same solidarity based on national unity is needed now more than ever to defeat COVID-19,” the head of WHO continued.He said that the implementation of the updated WHO plan to combat coronavirus by the end of 2020 will require $ 1.7 billion. Part of the funds has already been received, so at the moment it is necessary to find $ 1.3 billion. who need it.

History of smallpox control

Smallpox is caused by the variola virus. It is transmitted by airborne droplets, as well as through objects with which the infected person has come into contact.The incubation period is 7-17 days. The disease begins with a sharp rise in temperature, headache, often nausea and vomiting. After 2-3 days, the temperature drops, a nodular-blistering rash appears on the skin and mucous membranes, leaving behind scars (pockmarks). In 30% of cases, a lethal outcome is observed, in rare forms (confluent, hemorrhagic, purple) mortality reaches 70% or more.

It was possible to cope with the disease thanks to the WHO global vaccination program, which has been implemented since the second half of the 1960s.The last human case of smallpox was recorded on October 26, 1977 in Somalia. The victory over the disease was officially announced in 1980. Only two laboratories have the right to store the virus and conduct research: the Russian Center for Virology and Biotechnology “Vector” (Koltsovo, Novosibirsk region) and the American Center for Disease Control and Prevention (Atlanta, Georgia).

90,000 Chickenpox vaccination

The whole truth about vaccination: our goal is not to prove anything, not to impose, but to state only the facts:

Life expectancy increased by tens of years thanks to vaccination
Thanks to vaccinations, we do not see epidemics of smallpox, poliomyelitis, diphtheria, measles
but there is measles in our time, due to the increase in the “layer” of unvaccinated people
infectious diseases are not as bad for people as they used to be

Having ceased to be afraid of diseases, people have become afraid of vaccinations!

ANTI-VACULATION MOVEMENT has appeared, which is fueled by video horror stories on the Internet.

RESULT:

Refusing to vaccinate is a lifelong health threat to your children
postponing vaccination to a later date – a threat to the health, and sometimes the life of the child in infancy
Decreased herd immunity and the emergence of cases of vaccine-preventable infections (like, for example, measles now)

Opinion of some parents: vaccination – “sows” the immune system.

FACT: The immune response to vaccination is generally the same as to any infectious agent, with the only difference that the antigen is weakened or killed! It’s like a “likeness” of a microbe.The vaccine antigen is not capable of causing harm to the body!

Misconception: “breast milk kills everything.”

FACT: There is no doubt that breast milk contains a large number of bioactive factors that contribute to healthy development. Yes! Babies get sick less often. But they SICK, especially premature babies!

The position of anti-vaccinators: the harm of vaccinations is to interfere with the evolutionary process. That is, let the immune system figure it out on its own. The main sign of evolution is “the fittest survives.”

We are against the selection approach!

“DEAR EVERY CHILD” – this is what the Convention on the Rights of the Child says, and this is our position.
Ask yourself the question, “Are you willing to sacrifice your children for the smooth operation of evolution?”

“Let the immune system work by itself” – say anti-vaccine.

FACT: For the development of the immune system, it is enough to be ill with minor acute respiratory viral infections and it is not necessary to get sick, risking your life, for example, to carry measles, diphtheria, flu …

Parents’ fears: “There are many harmful impurities in vaccines.”

FACT: In addition to the vaccine agent, there are indeed a number of other substances in the vaccine. They provide the stability of the vaccine, some work as an immune response enhancer. These compounds are not added to the vaccine to harm the baby! The goal is to ensure the safety of vaccination!

“But isn’t mercury toxic?”

FACT: Absolutely! But negligible amounts of mercury, which are contained in vaccines, cannot cause harm to health! It all depends on the dose! “In a spoon – medicine, in a cup – poison” – the words of Paracelsus.

Smallpox risk factors. The Resurgence of Smallpox: Understanding the Risks, Symptoms, and Prevention Strategies

Uncovering the Variola Virus: The Cause of Smallpox

Transmission and Infectivity: How Smallpox Spreads

Vaccination: The Key to Combating Smallpox

Bioterrorism Concerns: The Threat of Weaponized Smallpox

The Potential for Re-emergence: Searching for Frozen Variola Virus

Symptoms and Treatment: Recognizing and Managing Smallpox

Preventing the Spread: Healthcare Precautions and Protocols

Smallpox: Causes and Risk Factors

The Variola Virus

Bioterrorism

Potential Re-Emergence

Transmission

Susceptibility Risk Factors

Frequently Asked Questions

What is the cause of smallpox?

How did smallpox originate?

What animal did smallpox come from?

Who is at risk for smallpox?

Safety Information for Smallpox Vaccine

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What did they say about the media epidemic?

Unmissable Youth Day

History of smallpox control

The whole truth about vaccination: our goal is not to prove anything, not to impose, but to state only the facts:

Having ceased to be afraid of diseases, people have become afraid of vaccinations!

RESULT:

Opinion of some parents: vaccination – “sows” the immune system.

Misconception: “breast milk kills everything.”

The position of anti-vaccinators: the harm of vaccinations is to interfere with the evolutionary process. That is, let the immune system figure it out on its own. The main sign of evolution is “the fittest survives.”

We are against the selection approach!

“Let the immune system work by itself” – say anti-vaccine.

Parents’ fears: “There are many harmful impurities in vaccines.”

“But isn’t mercury toxic?”

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