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University of Toronto Scarborough
Health Studies
Caroline Barakat

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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