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Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat

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Smallpox, Measles, & Malaria
Smallpox-Variola vera
Disease origins
-Old world/indiscriminate disease
-10,000 BC- first agricultural settlements in NE Africa 
India by Egyptian merchants
- evidence on Egyptian mummies (1570-1085 BC)
-pharoah ramses vpockmarks
-1122 BC china and mentioned in ancient texts of india
-100 AD-plague of antonine
-europe- frequent epidemic during middle ages
-16th century- became serious disease in England and
Europe
Effects
-plague of antonine
-new world in 16th century-fall of empires of Aztecs and incas
-contributed to settlement of NA by French &English (1617)
-biological warfare
-french Indian war (1754-1767) deliberate use of smallpox
-slave trade
Etiology
-genus: orthopoxvirus, family poxviridae
-at least 2 strains exist: variola major and minor
-genus also monkeypox, cowpox, camelpox, chickenpox, and
ectromelia (mousepox) viruses
-Variola minor- mortality rate less than 2% in unvaccinated
ppl. variola major- 3% and 30-50%
-hemorrhagic smallpox or black pox: malignant and
hemorrhagic forms of variola major develop in approx. 5-
10% of infected ppl- almost always fatal; mortality rate 95%
Transmission
-continuously transmission required
-only short term carriers
-animal reservoirs don’t exist
-direct contact-inhalation of aerosols or contaminated
fomites
-virus multiplies in mucous membranes of the mouth, nose
lymph nodes internal organs reenters bloodstream
-infectious virus-oronasal secretions and in scabs
-transmission on fomites possible for short per. Of time
-virus only viable for up to 2 days outside human host
-avg. incubation per. 12-14d
Clinical manifestation
-acute onset- fever, malaise, rigors, vomiting, headache,
backache, and occasionally delirium.2-3 d later skin lesions.
8-14d pustules develop scabs and heal. Can lead to severe
scarring
-infectious day prior to rash and until scabs have separated
Epidemiology
-18th century-60 mill Europeans
-case fatality rate varied from 20-60%
-1/3 of survivors became blind
-acquired immunity of child form
-epidemic every 5-15 yrs
Variolation-inoculation
-earlier treatment-prayer and quack remedies
-instillation of smallpox virus into non immune individs
-practiced initially in Africa, india, and china
-1670-introduced to Turkishottoman empire
-europe at beginning of 18th century
-simultaneous practices in boston 1721
Lady Mary Wortley Montague (1689-1762)
-1715 smallpox, 18 mths later brother died of pox. 1717
husband appointed ambassador
-learned about variolation practiced at ottoman court
-inoculated 5 yr old son 1718
-4yr old daughter inoculate in presence of physicians of
royal court(London 1721)
-royal experiment
-repeat of experim. On orphaned children
-variolation gained acceptance in royal fam.
-2-3% of variolated ppl died from disease
-case fatality rate assoc. w variolation 10 times lower than
assoc. w naturally occurring smallpox
-1721 boston epidemic led to reg. practice of variolation in
NA. controversy. 1st comparitive study- fatlity rate for
naturall contracted disease of 14% compared to 2% among
vario. Individs.
Edward Jenner(1729-1823)
-vario. Led to practice of vaccination
-planned experiment
-1796 dairymaid sarah nelms fresh cowpox lesions
-inoculated 8 yr old james Phipps. Again w fresh smallpox
lesion. No disease developed
-gradually vario. Became prohibited in England
Smallpox Canada
-1796 dr. john clinch forwarded letter to dr. jenner
requesting info. About using cowpox pustule matter
-1799 vaccinating ppl in nfl
Development in 20th century
-late 19th realized subsequent revaccination necessary
-1950s smallpox eradicated in Europe and NA
-1958 smallpox in 63 countries. Eradication began in 1967
Eradication of smallpox
-global campaign succeeds- eradicated in 1977
-may 8 1980 world health assembly announced world free of
smallpox
-1978-janet parker died. Mom contracted disease but
survived
-radical changed in how dangerous pathogens are studied
-debate over stocks of vaccine
Measles-inflammation of brain (herpes virus)
Historical Perspective
-first descrp. And identify differences between small pox and
measles but same etiology/same cause-rhazes (900AD)
-prevailing theory-red rash rep. mothers period
-measles way for child to rid himself of “poison
-rubeola, hard/red measles, morbilli, hasbah
-origin of term, misellus or misella ie. Miserable
-unknown origin
-name specific to where its from, place
Modern History of Measles
-1670-syndenham (father of inspiration) observed clinical
feat. Description of sons attack
-clearly sep. measles from small pox and recognized
complications, eg. Cancrum oris and encephalitis
-sci. rejected mother’s per. Theory, rash gets rid of poison
which is infection from mother
-1757- f. home. Demonstrated infective nature, transmitted
measles using blood from infected child
Panum (1820-1885)
-danish gov. to study epidemic in Faeroe Isles
-17 isolated islands ideal
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Description
Smallpox, Measles, & Malaria Smallpox-Variola vera -1715 smallpox, 18 mths later brother died of pox. 1717 Disease origins husband appointed ambassador -Old worldindiscriminate disease -learned about variolation practiced at ottoman court -10,000 BC- first agricultural settlements in NE Africa -inoculated 5 yr old son 1718 India by Egyptian merchants -4yr old daughter inoculate in presence of physicians of - evidence on Egyptian mummies (1570-1085 BC) royal court(London 1721) -pharoah ramses v pockmarks -royal experiment -1122 BC china and mentioned in ancient texts of india -repeat of experim. On orphaned children -100 AD-plague of antonine -variolation gained acceptance in royal fam. -europe- frequent epidemic during middle ages -2-3% of variolated ppl died from disease -16 century- became serious disease in England and -case fatality rate assoc. w variolation 10 times lower than assoc. w naturally occurring smallpox Europe Effects -1721 boston epidemic led to reg. practice of variolation in -plague of antonine NA. controversy. 1 comparitive study- fatlity rate for th naturall contracted disease of 14% compared to 2% among -new world in 16 century-fall of empires of Aztecs and incas -contributed to settlement of NA by French &English (1617) vario. Individs. -biological warfare Edward Jenner(1729-1823) -vario. Led to practice of vaccination -french Indian war (1754-1767) deliberate use of smallpox -slave trade -planned experiment Etiology -1796 dairymaid sarah nelms fresh cowpox lesions -inoculated 8 yr old james Phipps. Again w fresh smallpox -genus: orthopoxvirus, family poxviridae -at least 2 strains exist: variola major and minor lesion. No disease developed -genus also monkeypox, cowpox, camelpox, chickenpox, and -gradually vario. Became prohibited in England Smallpox Canada ectromelia (mousepox) viruses -Variola minor- mortality rate less than 2% in unvaccinated -1796 dr. john clinch forwarded letter to dr. jenner ppl. variola major- 3% and 30-50% requesting info. About using cowpox pustule matter -hemorrhagic smallpox or black pox: malignant and -1799 vaccinating ppl in nfl th hemorrhagic forms of variola major develop in approx. 5- Development in 20 century 10% of infected ppl- almost always fatal; mortality rate 95% -late 19 realized subsequent revaccination necessary Transmission -1950s smallpox eradicated
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