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Lecture 6

HLTA01 Lec6 Smallpox.docx

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Health Studies
Sandy Romain

HLTA01 Lec6 Smallpox 12/02/2013 7:20:00 AM Origin of smallpox  Indiscriminate disease  Earliest evidence Egyptian mummies o In the face of mummies o Pharaoh Ramses V – died 1157BC  Describe in ancient Chinese and Indian texts  430BC- plague of Athens (overcrowded) o they are locked in the city o ship brought in disease  166AD – plague of Antonine  Europe- frequent epidemic o High mortality rate o 16 thcentury became a serious disease in England and Europe Smallpox and the Americas  New world in the 16 thcentury- fall of the empires of the Aztecs and the Incas o It wipe out the entire city 50% mortality rate o Many people from Europe have lifetime immunity but not for the Incas and Aztecs o Large religious and societal breakdown  Contributed to the settlement of N America by the French and English Smallpox Morbidity/Mortality th  20 century o 300-500 million death  1950 o Estimated 50 million cases per year Smallpox endemic countries  More in warmer country even though the virus itself are more sensitive in sunlight  Majority of the disease decrease in the 1920s  At 1959 resolution of global smallpox eradication, most went low except Africa  At 1967- mostly in Brazil and Africa Etiology  Pathogen: orthopoxvirus o Variola major : chicken pox, cow pox all have the same o Ordinary 90%, modified, falt and hemorrhagic o There’s different version  Modified  90% of the cases  Flat 5-10% cases mostly children  Flat to the skin  A lot are more internal  Hemorrhagic  Black pox  Bleeding under tissue  Bleed from their eyes and bleeding gum o Vaiola minor  Milder variation  Cross immunity  Anything from the major will have lifetime immunity Mortality Rates  “Natural” smallpox 20-30%  Modified ≤1%  Flat or hemorrhagic nearly always fatal  Variola minor ≤1%  There is NO treatment for smallpox Clinical Symptoms  spread of smallpox are different-> how it can be diagnose  fever can be really high from 101-104  after rash start it’ll start to form pox o spread and scab from 5-10days th 9 days of rash pustule rash  pustules have reached maximum size and are started to flatten th 13 day of rash  Lesions and scabs  Lesions are now scabbing. 20 thday of rash  Scabs resolved  The scabs have separated, leaving depigmented areas. Social implication  Women will not be able to marry if they are disfigured  Slave trade- slave that are expose will be more susceptible  Smallpox are mistake for measles and syphilis and chickenpox because of the rash  Chickenpox are more on the torso while smallpox are everywhere Transmission  Prolonged face-to-face contact (respiratory) o 3-4 hours prolong contact  Direct contact with infected body fluids o E.g use infected clothing in the colonial time  Contaminated fomites such as bedding or clothing  Rarely congenitally – mother to fetus o Those who are pregnant have greater mortality rate  Humans are the only natural reservoir o Need direct person to person contact o Chain system in the old world  20 healthy people – and start w 1  need active smallpox to get it through the Americas Host Risk Factor  Caring for an infected person  “Natural” infection, variolation or vaccination provides immunity o children are mostly infected because parents are immune  Pregnancy  Children Environmental Risk Factors  Virgin populations o Those who are no infect o Washington need his military to be infected before war Case Definition  Confirmed case o Lab confirmed or meets case definitio
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