Small POX
Smallpox Disease Overview   pox part of smallpox is derived from the Latin    word for “spotted” and refers to the raised...
Two clinical forms1.      Variola major         is the severe and most common form of smallpox,        more extensive ra...
Incubation period..   Incubation Period    (Duration: 7 to 17 days)    Not contagious   Initial Symptoms (Prodrome)    (...
   Early Rash    (Duration: about 4 days)    Most contagious   Rash distribution:   Pustular Rash    (Duration: about 5...
   Pustules and Scabs    (Duration: about 5 days)    Contagious   Resolving Scabs    (Duration: about 6 days)    Contagi...
   Smallpox may be contagious during the    prodrome phase,   most infectious during the first 7 to 10 days    following...
Possible Ways of Getting Smallpox   Prolonged face-to-face contact with    someone who has smallpox   Direct contact wit...
Treatment   There is no proven treatment for smallpox
best ways to prevent smallpox isthrough vaccination   If given before exposure to smallpox – complete    protection   wi...
Eradication
one of the greatest triumphs in medicine   The global eradication of smallpox in 1977   the last naturally occurring cas...
Smallpox Eradication Timeline   Written descriptions occurred as early as 400    AD.
   In science credit goes to the man who    convinces the world, not the man to whom the    idea first occurs..          ...
1796: The first smallpoxvaccine was developed byEdward Jenner.
   After WWI: Most of Europe smallpox-free.   After WWII: Transmission interrupted in    Europe and North America
1940s    the development of a freeze-dried vaccine    was more stable in higher temperature and    humidity climates,  ...
1950:   The Pan American Sanitary Organization,    undertook a program to eradicate smallpox in    the Western Hemisphere.
1958:   The first proposal for global eradication was    made to the World Health Assembly by the    USSR in 1958.   The...
1966   The World Health Assembly decided to    intensify the eradication program by    providing a special budget of $2.4...
1967: The Intensified GlobalEradication program began    cases still occurred in 31 countries where the    disease was en...
Global Eradication Initiative  The initial eradication campaign was based on a   two-fold strategy.1.Mass vaccination cam...
Mass Vaccination   In 1966, the Smallpox Eradication and    Measles Control Program was initiated in 18    West African c...
Efforts..   Through the use of vaccination guns,    government resources, and, most importantly,    traditional health au...
Ring vaccination-Key strategy ofglobal eradication program   great impact on smallpox transmission even in areas    where...
   If the primary contacts developed smallpox    despite vaccination, their close contacts    would already be protected ...
Special surveillance teams…   were recruited and trained to search for smallpox cases and    vaccinate their contacts.  ...
Final Eradication   By the end of 1975, smallpox persisted only in the    Horn of Africa   Conditions were very difficul...
world’s last indigenous patient withsmallpox   intensive surveillance and containment and    vaccination program was init...
Laboratory accident-1978   Searches for additional cases continued in    Africa for more than 2 years, during which    ti...
Eradication Declared..   The World Health Organization officially    certified that smallpox had been eradicated on    De...
Small pox virus today   kept in two approved labs in the U.S. and    Russia.
bronze grouping   symbolizes the coming together of peoples    from all nations    to solve a major health scourge that ...
Why Smallpox is aConcern today??
smallpox virus, Today,   credible concern exists that the virus was    made into a weapon by some countries and    that t...
After 9/11   the U.S. govt improved its level of    preparedness against terrorism.   be prepared for an intentional rel...
bioterrorism                        Category A   can be easily disseminated or transmitted from    person to person;   ...
Category A   Bacillus anthracis)   Botulism (Clostridium botulinum toxin)   Plague (Yersinia pestis)   Smallpox (vario...
Category B   Brucella species)   Epsilon toxin of Clostridium perfringens   Food safety threats (e.g., Salmonella speci...
How Public Health Officials willRespond to a Smallpox Outbreak   CDC has a detailed plan to protect Americans    against ...
If a smallpox outbreak happens1.public health officials will use television,   radio, newspapers, the Internet and other  ...
2. Officials will tell people where to go for care   if they think they have smallpox.3. Smallpox patients will be isolate...
4.Anyone who has had contact with a smallpox patient   will be offered smallpox vaccination as soon as   possible. Then, ...
5.The smallpox vaccine may also be offered to   those who have not been exposed, but would   like to be vaccinated.At loca...
   No one will be forced to be vaccinated, even if they    have been exposed to smallpox.   To prevent smallpox from spr...
The Smallpox Vaccine   The vaccine is made from a virus called    vaccinia which is a “pox”-type virus related    to smal...
Length of Protection   Smallpox vaccination provides high level    immunity for 3 to 5 years and decreasing    immunity t...
Receiving the Vaccine   The vaccine is given using       .    a bifurcated (two-pronged)    needle that is dipped into  ...
Anyone directly exposed tosmallpox…   regardless of health status, would be offered    the smallpox vaccine           bec...
Smallpox Vaccine Availability   Until recently, the U.S.    government provided    the vaccine only to a    few hundred s...
Vaccine availability..   the U.S. government has enough vaccine to    vaccinate every person in the United States in    t...
Smallpox Vaccination May HaveProtected Against HIV InfectionWeinstein RS et al. Significantly reduced CCR5-tropic HIV-1rep...
Small pox vs HIV   As the HIV virus enters T cells, it makes use of a    cell-surface receptor called CCR5.   The smallp...
   Weinstein’s study is based on a small number    of subjects,    these results are intriguing enough to warrant    fur...
   scientists are focusing on understanding the    effects that the smallpox virus, Vaccinia, has    on the immune system...
…it stands as a reminder of the power of international health cooperation to do great and lasting goodDr Margaret Chan
Small pox
Small pox
Small pox
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Small pox

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Small pox

  1. 1. Small POX
  2. 2. Smallpox Disease Overview pox part of smallpox is derived from the Latin word for “spotted” and refers to the raised bumps that appear on the face and body of an infected person.
  3. 3. Two clinical forms1. Variola major is the severe and most common form of smallpox, more extensive rash and higher fever. four types of variola major smallpox1. ordinary (the most frequent type, accounting for 90% or more of cases)2.modified (mild and occurring in previously vaccinated persons);3.flat,4. hemorrhagic (both rare and very severe). variola major has an overall fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal.2.Variola minor is a less common presentation of smallpox, and a much less severe disease, with death rates historically of 1% or less
  4. 4. Incubation period.. Incubation Period (Duration: 7 to 17 days) Not contagious Initial Symptoms (Prodrome) (Duration: 2 to 4 days) Sometimes contagious*
  5. 5.  Early Rash (Duration: about 4 days) Most contagious Rash distribution: Pustular Rash (Duration: about 5 days) Contagious
  6. 6.  Pustules and Scabs (Duration: about 5 days) Contagious Resolving Scabs (Duration: about 6 days) Contagious Scabs resolved Not contagious
  7. 7.  Smallpox may be contagious during the prodrome phase, most infectious during the first 7 to 10 days following rash onset.
  8. 8. Possible Ways of Getting Smallpox Prolonged face-to-face contact with someone who has smallpox Direct contact with infected bodily fluids or an object such as bedding or clothing that has the virus on it. Exposure to an aerosol release of smallpox (the virus is put in the air).
  9. 9. Treatment There is no proven treatment for smallpox
  10. 10. best ways to prevent smallpox isthrough vaccination If given before exposure to smallpox – complete protection within 3 days after exposure will prevent or greatly lessen the severity of smallpox in most people. 4 to 7 days after exposure likely offers some protection from disease or may decrease the severity of disease. Vaccination will not protect smallpox patients who already have a rash
  11. 11. Eradication
  12. 12. one of the greatest triumphs in medicine The global eradication of smallpox in 1977 the last naturally occurring case in the world was in Somalia in 1977.
  13. 13. Smallpox Eradication Timeline Written descriptions occurred as early as 400 AD.
  14. 14.  In science credit goes to the man who convinces the world, not the man to whom the idea first occurs.. Francis Galton
  15. 15. 1796: The first smallpoxvaccine was developed byEdward Jenner.
  16. 16.  After WWI: Most of Europe smallpox-free. After WWII: Transmission interrupted in Europe and North America
  17. 17. 1940s the development of a freeze-dried vaccine was more stable in higher temperature and humidity climates, the smallpox vaccine was available for wider use throughout the world
  18. 18. 1950: The Pan American Sanitary Organization, undertook a program to eradicate smallpox in the Western Hemisphere.
  19. 19. 1958: The first proposal for global eradication was made to the World Health Assembly by the USSR in 1958. They proposed a worldwide vaccination program to be completed in a 3-to-5 year period. Some progress was made during the next 7 years, but the results overall were disappointing.
  20. 20. 1966 The World Health Assembly decided to intensify the eradication program by providing a special budget of $2.4 million per year specifically for this effort.
  21. 21. 1967: The Intensified GlobalEradication program began cases still occurred in 31 countries where the disease was endemic. A major reservoir was Africa. A second major reservoir was in Asia, extending from Bangladesh through India, Nepal, Pakistan, and Afghanistan. The third was the Indonesian archipelago, The fourth was Brazil, which compromised half the people of South America
  22. 22. Global Eradication Initiative The initial eradication campaign was based on a two-fold strategy.1.Mass vaccination campaigns in each country, using vaccine of ensured potency and stability, that would reach at least 80% of the population.2.The development of surveillance systems to find cases and outbreaks so that more focused containment measures could be implemented.
  23. 23. Mass Vaccination In 1966, the Smallpox Eradication and Measles Control Program was initiated in 18 West African countries to move toward eradication in this disease-endemic area. Sierra Leone had the highest infection rates in the world
  24. 24. Efforts.. Through the use of vaccination guns, government resources, and, most importantly, traditional health authorities, large numbers of people were vaccinated. The program administered over 100 million vaccinations in a 5-year period. Surveys showed that 90% of the population had been vaccinated. Smallpox rates fell as a result of these efforts.
  25. 25. Ring vaccination-Key strategy ofglobal eradication program great impact on smallpox transmission even in areas where overall vaccination coverage was low by using a strategy called surveillance and containment, or ring vaccination. The principle behind this strategy was to identify cases of smallpox, vaccinate their household and other close contacts, vaccinate the close contacts of the primary household and close contacts to the case
  26. 26.  If the primary contacts developed smallpox despite vaccination, their close contacts would already be protected and the chain of transmission would have been broken.
  27. 27. Special surveillance teams… were recruited and trained to search for smallpox cases and vaccinate their contacts. They visited each health unit in an area of endemic smallpox to ensure that each week the health officer submitted a report indicating the number of cases seen. When cases were reported, the teams worked with local health staff to find additional cases and to contain the outbreaks by vaccinating the contacts. Although setbacks occurred, this surveillance and containment strategy proved to be the strategy that finally brought about the eradication of smallpox throughout the world.
  28. 28. Final Eradication By the end of 1975, smallpox persisted only in the Horn of Africa Conditions were very difficult in Ethiopia and Somalia, where there were few roads. Civil war, famine, and refugees made the task even more difficult. With the interruption of smallpox transmission in Asia, more resources were made available in Africa, including more staff and transport
  29. 29. world’s last indigenous patient withsmallpox intensive surveillance and containment and vaccination program was initiated in the spring and summer of 1977. As a result, the world’s last indigenous patient with smallpox on earth was a hospital cook in Merka, Somalia, on October 26, 1977 with variola minor.
  30. 30. Laboratory accident-1978 Searches for additional cases continued in Africa for more than 2 years, during which time thousands of rash illnesses were investigated. None proved to be smallpox Although 2 cases of smallpox occurred in England in 1978 as a result of a laboratory accident, smallpox was gone as a naturally transmitted disease
  31. 31. Eradication Declared.. The World Health Organization officially certified that smallpox had been eradicated on December 9, 1979, 2 years after the last case in Somalia. In 1980 the World Health Assembly recommended that all countries cease routine vaccination
  32. 32. Small pox virus today kept in two approved labs in the U.S. and Russia.
  33. 33. bronze grouping symbolizes the coming together of peoples from all nations to solve a major health scourge that plagued the human family since the beginning of recorded history. Together, the peoples of the world achieved this unprecedented success of eradicating smallpox
  34. 34. Why Smallpox is aConcern today??
  35. 35. smallpox virus, Today, credible concern exists that the virus was made into a weapon by some countries and that terrorists may have obtained it. CDC calls it a “Category A” agent. Category A agents are believed to present the greatest potential threat for harming public health
  36. 36. After 9/11 the U.S. govt improved its level of preparedness against terrorism. be prepared for an intentional release of the smallpox virus updating and releasing a smallpox response plan.
  37. 37. bioterrorism  Category A can be easily disseminated or transmitted from person to person; result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness
  38. 38. Category A Bacillus anthracis) Botulism (Clostridium botulinum toxin) Plague (Yersinia pestis) Smallpox (variola major) Tularemia (Francisella tularensis) Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Machupo])
  39. 39. Category B Brucella species) Epsilon toxin of Clostridium perfringens Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella) Glanders (Burkholderia mallei) Melioidosis (Burkholderia pseudomallei) Psittacosis (Chlamydia psittaci) Q fever (Coxiella burnetii) Ricin toxin from Ricinus communis (castor beans) Staphylococcal enterotoxin B Typhus fever (Rickettsia prowazekii) Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, western equine encephalitis]) Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)
  40. 40. How Public Health Officials willRespond to a Smallpox Outbreak CDC has a detailed plan to protect Americans against the use of smallpox as a biological weapon.
  41. 41. If a smallpox outbreak happens1.public health officials will use television, radio, newspapers, the Internet and other channels to inform members of the public about what to do to protect themselves and their families.
  42. 42. 2. Officials will tell people where to go for care if they think they have smallpox.3. Smallpox patients will be isolated and will receive the best medical care possible. Isolation prevents the virus from spreading to others.
  43. 43. 4.Anyone who has had contact with a smallpox patient will be offered smallpox vaccination as soon as possible. Then, the people who have had contact with those individuals will also be vaccinated. Following vaccination, these people will need to watch for any signs of smallpox. People who have been exposed to smallpox may be asked to take their temperatures regularly and report the results to their health department.
  44. 44. 5.The smallpox vaccine may also be offered to those who have not been exposed, but would like to be vaccinated.At local clinics, the risks and benefits of the vaccine will be explained and professionals will be available to answer questions.
  45. 45.  No one will be forced to be vaccinated, even if they have been exposed to smallpox. To prevent smallpox from spreading, anyone who has been in contact with a person with smallpox but who decides not to get the vaccine may need to be isolated for at least 18 days. During this time, they will be checked for symptoms of smallpox. People placed in isolation will not be able to go to work. Steps will be taken to care for their everyday needs (e.g., food and other needs)
  46. 46. The Smallpox Vaccine The vaccine is made from a virus called vaccinia which is a “pox”-type virus related to smallpox. The smallpox vaccine contains the “live” vaccinia virus
  47. 47. Length of Protection Smallpox vaccination provides high level immunity for 3 to 5 years and decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts even longer. Historically, the vaccine has been effective in preventing smallpox infection in 95% of those vaccinated. In
  48. 48. Receiving the Vaccine The vaccine is given using  . a bifurcated (two-pronged) needle that is dipped into the vaccine solution. When removed, the needle retains a droplet of the vaccine. The needle is used to prick the skin a number of times in a few seconds.
  49. 49. Anyone directly exposed tosmallpox… regardless of health status, would be offered the smallpox vaccine because the risks associated with smallpox disease are far greater than those posed by the vaccine
  50. 50. Smallpox Vaccine Availability Until recently, the U.S. government provided the vaccine only to a few hundred scientists and medical professionals working with smallpox and similar viruses in a research setting.
  51. 51. Vaccine availability.. the U.S. government has enough vaccine to vaccinate every person in the United States in the event of a smallpox emergency
  52. 52. Smallpox Vaccination May HaveProtected Against HIV InfectionWeinstein RS et al. Significantly reduced CCR5-tropic HIV-1replication in vitro in cells from subjects previously immunized withVaccinia virus. BMC Immunology 2010, 11: 23.
  53. 53. Small pox vs HIV As the HIV virus enters T cells, it makes use of a cell-surface receptor called CCR5. The smallpox virus also uses this receptor. when the smallpox virus grabs hold of this CCR5 receptor to penetrate the T cell, it alters it in some way. The HIV virus may then subsequently find it harder to gain entry and therefore replicate in the cells
  54. 54.  Weinstein’s study is based on a small number of subjects, these results are intriguing enough to warrant further investigation
  55. 55.  scientists are focusing on understanding the effects that the smallpox virus, Vaccinia, has on the immune system and how those effects may influence HIV infection rates and progression to full-blown AIDS
  56. 56. …it stands as a reminder of the power of international health cooperation to do great and lasting goodDr Margaret Chan
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