Exam Study Guide - Small pox, Measles, Malaria

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26 Feb 2011
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Small pox Variola Vera
Origin
-Old world disease and an indiscriminate disease
-10,000BC first agricultural settlements in NE Africa and spread to India by means
of ancient Egyptian merchants
-1570-1085BC: earliest evidence on mummies
oPharaoh Ramses V died 1156BC pockmarks
-1122BC in China mentioned in ancient text of India
-100AD Plague of Antonine
-Europe: frequent epidemic during middle ages
-16th century became a serious disease in England and Europe
Effects of Smallpox
-New world 16th century fall of the empires of the Aztecs and the Incas
-1617: Contributed to the settlement of N America by the French & English
-biological warfare
oFrench Indian War (1754-1767) deliberate use of smallpox
-slave trade
Etiology
-Virus: genus Orthopoxvirus (also includes: monkeypox, cowpox, camelpox virus
etc.)
-Family: Poxviridae
-At least two strains exist: variola major and variola minor
ovariola minor mortality rate is less than 2% in unvaccinated persons
ovariola major mortality rate is 3% in vaccinated individuals and 30%-50%
in unvaccinated
-Hemorrhagic smallpox or blackpox
omalignant and hemorrhagic forms of variola major develop in approximately
5-10% of infected people
oalmost always fatal; mortality rate of 95%
Transmission
-continuous transmission required
-only short term carriers
-animal reservoirs do not exist
-direct contact inhalation of aerosols or contaminated fomites
-virus multiples in the mucous membranes of the mouth and nose then moves to the
lymph nodes and then to internal organs, there it re-enters the bloodstream
-infectious virus oronasal secretions and in skin scabs
-potential for long distances aerosol spread is controversial
-transmission on fomites possible for short periods of time
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-virus only remains viable for up to 2 days outside human host
-average incubation period of 12-14 days
Clinical Manifestation
-acute onset - fever, malaise, rigors, vomiting, headache, backache, and occasionally
delirium
-2-3 days later skin lesion appear
-8-14 days after symptoms appear the pustules develop scabs and heal (can lead to
severe scarring)
-infectious day prior to the appearance of the rash and until the time the scab have
separated
-secondary infections, distributions - most on the face, hands and feet
Epidemiology
-case fatality rate varied from 20-60%
-1/3 of survivor became blind
-acquired immunity disease of childhood
-epidemic every 5-15 years
Variolation inoculation
-earlier treatment-prayer and quack remedies
-instillation of smallpox virus into non immune individuals
-practiced initially in Africa, India and China
-1670 introduce to Turkish Ottoman Empire
-Europe at the beginning of the 18th century
-simultaneous practices in Boston 1721
Lady Mary Wortley Montague (1689-1762)
-1715: contracted smallpox
-18 months later brother died of illness
-1717: husband was appointed ambassador
-learned about the variolation practiced at the Ottoman court
-1718: inoculated 5 year old son
-London 1721: 4 year old daughter inoculated in the presence of physicians of the
royal court
-Royal Experiment
-repeat of experiment on orphaned children
-variolation gained acceptance in the Royal family
-2-3% of variolated persons died from the disease
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-case fatality rate associated with variolation is 10 times lower than that associated
with naturally occurring smallpox
-1721 Boston epidemic which lead to regular practice of variolation in N America it
was a controversy
-First comparative analysis study case fatality rate for the naturally contracted
disease of 14% compared to 2% among variolated individuals
Edward Jenner (1749-1823)
-variolation led to the practice of vaccination
-controversy over who started vaccination
-planned the experiments
-1796 Jenner found a young dairymaid, Sarah Nelms, who had fresh cowpox lesions
-inoculated an 8 year old boy, James Phipps
-inoculated boy again, this time with matter from a fresh smallpox lesion; no disease
developed
-gradually variolation became prohibited in England
Smallpox in Canada
-1796 Dr.John Clinch forwarded a letter to Dr.Edward Jenner in Gloucestershire
requesting info about using cowpox pustule matter
-1799 vaccinating people in Newfoundland
Eracdication of Smallpox
-program of eradication began in 1967
-global campaign succeeded - smallpox eradicated in 1977
-May 8 1980: World Health Assembly announced that world was free of smallpox
-Janet Parker (1938-1978)
-August 1978: University of Birmingham Medical School
-her mom contracted the disease but survived
-radical changes in how dangerous pathogens are studied
-debate over stocks of vaccine
-transmitted via aerosol through vents under her apartment was a lab, owner of lab
committed suicide
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