Smallpox
Author/s: Rosalyn S. Carson-DeWitt
Definition
Smallpox is an infection caused by the virus called variola, a member of the poxvirus family. Throughout all of history, smallpox has been a greatly feared disease, responsible for huge epidemics worldwide, and the cause of great suffering and massive numbers of deaths. In 1980, the World Health Organization (WHO) announced that an extensive program of vaccination against the disease had resulted in the complete eradication of the virus, with the exception of samples of stored virus in two laboratories.
Description
Smallpox was strictly an infection of human beings. Animals and insects could neither be infected by smallpox, nor carry the virus in any form. Most infections were caused by contact with a person who had already developed the characteristic skin lesions (pox) of the disease, although a person who had a less severe infection (not symptomatic or diagnosable in the usual way) could unwittingly spreading the virus.
Causes & symptoms
Smallpox was a relatively contagious disease, which accounts for its ability to cause massive epidemics. The variola virus was acquired from direct contact with individuals sick with the disease, from contaminated air droplets, and even from objects used by another smallpox victim (books, blankets, utensils, etc.). The respiratory tract was the usual entry point for the variola virus into a human being.
After the virus entered the body, there was a 12-14 day incubation period during which the virus multiplied, although no symptoms were recognizable. After the incubation period, symptoms appeared abruptly and included fever and chills, muscle aches, and a flat, reddish purple rash on the chest, abdomen, and back. These symptoms lasted about three days, after which the rash faded and the fever dropped. A day or two later, fever would return, along with a bumpy rash starting on the feet, hands, and face. The rash would progress, ultimately reaching the chest, abdomen, and back. The individual bumps (papules) would fill with clear fluid, and eventually become pus-filled over the course of 10-12 days. These pox would eventually scab over, each leaving a permanently scarred pock or pit when the scab dropped off.
Death from smallpox usually followed complications such as bacterial infection of the open skin lesions, pneumonia, or bone infections. A very severe and quickly fatal form of smallpox was called "sledgehammer smallpox," and resulted in massive, uncontrollable bleeding (hemorrhage) from the skin lesions, as well as from the mouth, nose, and other areas of the body.
Fear of smallpox came from both the epidemic nature of the disease, as well as from the fact that no therapies were ever discovered to either treat the symptoms of smallpox, or shorten the course of the disease.
Since our current medical practitioners have no experience with diagnosing smallpox, I hope that CDC is supporting them with the necessary information, photos, etc. As potential first-line diagnosticians, school nurses should also be alerted to symptoms and isolation procedures. Given what's happened with Anthrax, I suspect this is too much to expect of CDC.
Apart from preparing our family for potential isolation and keeping alert, I feel too, too helpless on this threat.