3. DEFINITION
Smallpox is an acute contagious disease caused
by variola virus, a member of the Orthopoxvirus
family.
Naturally occurring smallpox was eradicated
worldwide by 1980-the result of an
unprecedented global immunization campaign.
4. Epidemiology
Smallpox was a major killer all over the world.
It was endemic in India.
An international campaign by the World Health
Organization led to smallpox eradication.
Smallpox had been eradicated from India since April
1977.
The last indigenous case of smallpox occurred in Bihar
on May 17, 1975.
5. Etiology
Smallpox spreads through direct contact.
It is most often transmitted through the air by droplets that escape
when an infected person coughs, sneezes, or talks.
In rare instances, airborne virus may spread farther, possibly
through the ventilation system in a building, infecting people in
other rooms or on other floors.
Smallpox can also spread through contact with contaminated
clothing and bedding, although the risk of infection from these
sources is slight.
6. Pathophysiology
Inhalation of the droplets
Viral replication in mucosa
Viremia
Dissemination to the skin and organs
Incubation phase (7- 12 days )
Toxemia phase
Appearance of the symptoms
7. Clinical Manifestations
The first symptoms of smallpox usually appear after 12-14 days of infection.
Following the incubation period, a sudden onset of flu-like signs and symptomns
occurs.
These include:
Fever
Overall discomfort
Headache
Severe fatigue
Sometimes vomiting, diarrhoea or both
8. Clinical Manifestations
Within a day or two, many
A few days later, fat, red spots appear first on face, hands,
and forearms, and later on trunk .
Within a day or two, many of these lesions turn into small
blisters filled with clear fluid. which then turns into pus.
Scabs begin to form 8-9 days later and eventually fall of,
leaving deep, pitted scars.
The rash is usually most noticeable on the palms of hands
and the soles of feet. Lesions may also develop in the
mucous membranes of nose and mouth and quickly turn into
sores that break open, spreading the virus into the saliva,
9. Complications:
Most of the people suffering from smallpox survive.
However, there are a few rare varieties of smallpox that
are almost always fatal. Severe forms of smallpox
commonly affect the pregnant women and people with
impaired immune systems/mechanisms.
People who recover from smallpox usually have severe
scars, especially on the face, arms, and legs.
In some cases smallpox may cause blindness.
10. Tests / diagnosis
Even a single confirmed case of smallpox would be considered an
international health emergency.
The center local, and state health agencies, hospital
epidemiologists, and response team should be notified
immediately if any case of smallpox is suspected.
Other diseases or illnesses producing skin rash such as
chickenpox (varicella) can be included as differential diagnosis of
chickenpox.
A careful and thorough history may be useful in differentiating
chickenpox from smallpox.
11. Medical Management
To control the spread of the variola virus, people who have
smallpox would be admitted to the hospital and should be kept
under isolation in rooms with negative atmospheric pressure and
equipped with high-efficiency particulate a arrestance (HEPA)
filtration.
The staff providing care to patients should wear well-fitted N95
or higher-quality respirators.
If the patient is not placed in a negative-pressure room, then he
/she should wear a mask and gown or covered with a sheet to
prevent the spread of infection.
12. Medical Management
All the people who had contact with the infected
person would receive the smallpox vaccine,
which can prevent or lessen the severity of the
disease if given within 3 days exposure to the
smallpox virus,
The vaccine uses a live virus that is related to
smallpox. and it can occasionally cause serious
complications, such as infections affecting the
heart or brain.
13. Medical Management
The waste, linen, and the laundry should be
placed in the biohazard bags and must be
autoclaved first before washing or
incinerating.
The contaminated floor or other surfaces
must be disinfected with the disinfectants
according to the agency policy.
14. Nursing Management
Skin and mucous s membrane:
Provide the compress saturated with solution of boric acid and
sodium bicarbonate.
Avoid giving sponge bath, prevent scratching of lesions and cut
short the nails.
Diversional therapy can be provided to the patient.
Frequently change the position and massage bony prominences.
15. NURSING Management
Diet:
Provide well-balanced diet and small and
frequent meals.
Monitor intake and output.
Encourage patient and members of the family to
use mask.
Emphasize the importance of hand washing.
