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Smallpox

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  • 1. Smallpox D. GOLDBERG PED ID SVCE WRAMC
  • 2. SMALLPOX
    • Genus Orthopoxvirus
    • Smallpox, monkeypox, cowpox,vaccinia
    • DNA Virus
    • 200 nm brick
    • shaped
    • Smallpox-person to person spread via respiratory secretions/direct contact
    • Spread best in low humidity/temperature
  • 3. SMALLPOX
  • 4. SMALLPOX
    • 2 principle forms-
    • variola major-Europe/Asia
    • variola minor-19th century USA
    • 2 minor forms-malignant & hemorrhagic
    • Spread via respiratory droplets/direct contact at time of rash
    • Historically spreads slower than chicken pox, measles
  • 5. SMALLPOX-Pathogenesis
    • Incubation period (7-17 days):
    • Virus infects respiratory/pharyngeal mucosa--> regional lymph nodes--> viremia-->spleen, bone marrow, lymph nodes-->second viremia--> fever,
    • toxemia--> rash and infectivity
  • 6. SMALLPOX-Pathogenesis
    • Clinical Stage-
    • Onset fever (103 0 ), HA, prostation, bachache, malaise, +/- abd pain, delerium, rash by day 3
    • Rash-macularpapular on oropharynx, face
    • forearms-->trunk, legs
    • -turns vesicular 24-48 hrs
    • - turns tense round pustules
  • 7.  
  • 8. SMALLPOX
  • 9. SMALLPOX
  • 10. SMALLPOX
  • 11. SMALLPOX
    • Secondary infection is rare
    • Death in second week due to toxemia
    • Variola minor-less severe symptoms, rash
    • Vaccinated -milder form
    • HIV-? (Disseminated vaccina in HIV+ soldier in 1986)
  • 12. SMALLPOX- Laboratory Diagnosis
    • Level BL-4 only
    • EM of fluid/scabs
    • Culture/PCR
    • Oropharyn swabs-day 7/8 of infection
    • AB titers (day 6 of rash)
  • 13. SMALLPOX- Clinical Diagnosis
    • Smallpox Varicella
    • Prodrome: 2-4 days 1-2 days
    • Rash: 1-2 days several days
    • Lesions: deep/tense superficial
    • Distribution: centrpetal centrifugal
    • (truncal) (face/extremeties)
    • Stage: same new crops
  • 14. SMALLPOX Chickenpox Shingles
  • 15. SMALLPOX-Therapy
    • Cidofovir ?
    • ?
  • 16. SMALLPOX
    • Postexposure Control-
    • Home care vs hospital care (neg pressure)
    • Mass “contact” vaccination (up to 4 days post exposure may ameliorate/prevent)
    • Vaccinated individuals serve as caretakers
    • Cremation of bodies
  • 17. Smallpox-Vaccination
  • 18. SMALLPOX
    • Vaccination-
    • limited stock (6 million/ ? dilution)
    • untrained administrators
    • Special risk groups immuno- suppressed/ pregnant women/eczema
    • limited Vaccina IG (VIG)
    • side effects
  • 19. SMALLPOX-Vaccine complications * 70% children with fever > 39C day 4-14
  • 20. SMALLPOX-Autoinoculation