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HLTB21H3 (177)
Chapter 7

Chapters 7, 8, 9

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University of Toronto Scarborough
Health Studies
Caroline Barakat

Small pox variola vera Origin-old world disease and an indiscriminate disease, 10000BC first agricultural settlements in NE Africa and spread to India by means of ancient Egyptian merchants, earliest evidence on mummies (1570-1085BC) pharaoh ramses v died 1156BC pockmarks, 1122BC in China mentioned in ancient text of India, 100AD plague of Antonine, Europe: frequent epidemic during middle ages, th 16 century became a serious disease in England and Europe th Effects-new world 16 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(also includes: monkeypox, cowpox, camelpox virus etc.), family Poxviridae, at least two strains exist: variola major and variola minor, 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 (blackpox) 1.malignant and hemorrhagic forms of variola major develop in approximately 5-10% of infected people 2.almost always fatal; mortality rate of 95% Transmission-continuously transmission required, only short term carriers, animals 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 and 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, 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 th Epidemiology-18 century-60 million Europeans, case fatality rate varied from 20-60%, 13 of survivor became blind, acquired immunity disease of childhood, epidemic every 5-15 years Variolation inoculation-earlier treatment-prayer and quack remedies, instillations of smallpox virus into non immune individuals, practiced initially in Africa, India and China, 1670 introduce to Turkish Ottoman Empire, Europe at the th beginning of the 18 century , simultaneous practices in Boston 1721 -Lady Mary Wortley Montague (1689-1762) -contracted sp in 1715, 18 months later brother died of illness, 1717 husband was appointed ambassador, learned about the 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, 2-3% of variolated persons died from the disease, case fatality rate associated with variolation is 10 times lower than that associated with naturally occurring sp, 1721 Boston epidemic which lead to regular practice of variolation in N America it was a controversy 14% compared to 2% amond variolated individuals -Edward Jenner (1749-1823) www.notesolution.com
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