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Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat

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SMALLPOX – Variola vera*******************************************************************************
Disease origins-------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-Old world disease and an indiscriminate disease -10,000 BC - first agricultural settlements in NE Africa and spread to India by means of ancient Egyptian
merchants -Earliest evidence on Egyptian mummies (1570–1085 BC) -Pharaoh Ramses V (died 1156 BC) – pockmarks
-Described1122 BC in China and is mentioned in ancient texts of India -100AD – Plague of Antonine
-Europe - frequent epidemic during the Middle Ages
-16th century became a serious disease in England and Europe
Effects of smallpox-------------------------------------------------------------------------------------------------------------------------------------------------------------------
-Plague of Antonine -New world in the 16th century - fall of the empires of the Aztecs and the Incas -Contributed to the settlement of N America by the French &
English (1617) -Biological warfare: French-Indian War (1754–1767) - deliberate use of smallpox -Slave trade
Etiology-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-Virus : Genus - Orthopoxvirus, family Poxviridae -Common name - variola virus
-At least two strains exist: variola major and variola minor -Orthopoxvirus genus also includes the monkeypox, cowpox, camelpox, chickenpox, and ectromelia
(mousepox) viruses -Variola minor - mortality rate is less than 2% in unvaccinated persons -Mortality rate for variola major - 3% in vaccinated individuals and
30% - 50% in unvaccinated -Hemorrhagic smallpox or black pox -Malignant and hemorrhagic forms of variola major develop in approximately 5 to 10% of
infected people -Almost always fatal; mortality rate of 95%
Transmission--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-Continuously transmission required -Only short-term carriers -Animal reservoirs do not exist -Direct contact - inhalation of aerosols or contaminated fomites
-Virus multiplies 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–distance aerosol spread is controversial -Transmission on fomites possible for short
periods of time -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 to 3 days later skin lesions appear -8 to 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 scabs have
separated -Secondary infections
Epidemiology--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-18th-century - 60 million Europeans - Case-fatality rate varied from 20% to 60% -1/3 of the survivors 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 - introduced to Turkish “Ottoman” Empire -Europe - at the beginning of the 18th century -Simultaneous practices in Boston 1721
Lady Mary Wortley Montague (1689–1762) --------------------------------------------------------------------------------------------------------------------------------------------------
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-In 1715, contracted smallpox -18 months later - brother died of illness -1717, husband was appointed ambassador -Learned about variolation practiced at the
Ottoman court -Inoculated 5-year-old son in 1718 -4-year-old daughter inoculated in the presence of physicians of the royal court (London, 1721) -Royal
Experiment -Repeat of experiment on orphaned children -Variolation gained acceptance in the Royal family -2% to 3% of variolated persons died from the
disease -Case-fatality rate associated with variolation -10 times lower than that associated with naturally occurring smallpox -1721, Boston epidemic – led to regular
practice of variolation in N America -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 -Jenner – planned experiment -In 1796, Jenner found a young
dairymaid, Sarah Nelms, who had fresh cowpox lesions -Inoculated an 8-year-old boy, James Phipps -Jenner inoculated the boy again, this time with matter
from a fresh smallpox lesion -No disease developed -Gradually, variolation became prohibited in England
Smallpox – Canada--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
- In 1796, Dr. John Clinch forwarded a letter to Dr. Edward Jenner in Gloucestershire requesting information about using cowpox pustule matter
-1799 - vaccinating people in Newfoundland
Development in the 20th Century---------------------------------------------------------------------------------------------------------------------------------------------------------------
-Late 19th century, it was realized that subsequent revaccination was necessary -In 1950s, smallpox was eradicated in many areas in Europe and N America
-In 1958 – report of smallpox in 63 countries -Program of eradication began in 1967
Eradication of
smallpox----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-Global campaign succeeded - smallpox eradicated in 1977 -On May 8, 1980, the World Health Assembly announced that the world was free of smallpox
-August 1978 - Janet Parker (1938 – 1978) -University of Birmingham Medical School -Her mother contracted the disease but survived -Radical changes in how
dangerous pathogens are studied -Debate over stocks of vaccine
MEASLES*************************************************************************************************
Historical perspective------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-Earliest description attributed to Rhazes (900 AD) – clinically separated smallpox and measles - believed that both proceeded from same cause -Prevailing theory -
red rash represented the mother's menstrual blood -Measles was way for child to rid himself of the so-called 'poison‘ -Measles also known as rubeola, hard
measles, red measles, morbilli, hasbah -Origins of termmeasles -misellus ormisella i.e. miserable
Modern History of Measles-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
-1670 - Thomas Sydenham's observed clinical features; description of his son's attack -Clearly separate measles from smallpox, and recognized complications, such
as cancrum oris and encephalitis -Scientists rejected the mother's blood theory -1757 - Francis Home demonstrated the infective nature - he succeeded in
transmitting measles using blood from an infected child
Peter Ludwig Panum (1820 – 1885) ------------------------------------------------------------------------------------------------------------------------------------------------------------
-Sent by Danish government to investigate an epidemic in Faeroe Isles in1846 -Panum conducted the first epidemiological study -Geographic location ideal for an
epidemiological study -Approximately 7,800 inhabitants – 102 died of measles -Arrival of a boat noted in the local calendar -Visits from the Danish mainland
were rare -Epidemic originated in a single seaman from Copenhagen -On arrival, he had not recovered completely -Panum followed the course of the epidemic
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Description
SMALLPOX Variola vera******************************************************************************* Disease origins------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -Old world disease and an indiscriminate disease -10,000 BC - first agricultural settlements in NE Africa and spread to India by means of ancient Egyptian merchants -Earliest evidence on Egyptian mummies (15701085 BC) -Pharaoh Ramses V (died 1156 BC) pockmarks -Described1122 BC in China and is mentioned in ancient texts of India -100AD Plague of Antonine -Europe - frequent epidemic during the Middle Ages -16th century became a serious disease in England and Europe Effects of smallpox------------------------------------------------------------------------------------------------------------------------------------------------------------------- -Plague of Antonine -New world in the 16th century - fall of the empires of the Aztecs and the Incas -Contributed to the settlement of N America by the French & English (1617) -Biological warfare: French-Indian War (17541767) - deliberate use of smallpox -Slave trade Etiology----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -Virus : Genus - Orthopoxvirus, family Poxviridae -Common name - variola virus -At least two strains exist: variola major and variola minor -Orthopoxvirus genus also includes the monkeypox, cowpox, camelpox, chickenpox, and ectromelia (mousepox) viruses -Variola minor - mortality rate is less than 2% in unvaccinated persons -Mortality rate for variola major - 3% in vaccinated individuals and 30% - 50% in unvaccinated -Hemorrhagic smallpox or black pox -Malignant and hemorrhagic forms of variola major develop in approximately 5 to 10% of infected people -Almost always fatal; mortality rate of 95% Transmission-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -Continuously transmission required -Only short-term carriers -Animal reservoirs do not exist -Direct contact - inhalation of aerosols or contaminated fomites -Virus multiplies 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 longdistance aerosol spread is controversial -Transmission on fomites possible for short periods of time -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 to 3 days later skin lesions appear -8 to 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 scabs have separated -Secondary infections Epidemiology-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -18th-century - 60 million Europeans - Case-fatality rate varied from 20% to 60% -13 of the survivors 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 - introduced to Turkish Ottoman Empire -Europe - at the beginning of the 18th century -Simultaneous practices in Boston 1721 Lady Mary Wortley Montague (16891762) -------------------------------------------------------------------------------------------------------------------------------------------------- www.notesolution.com
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