(Survival manual/6. Medical/c) Disease/Smallpox)

Smallpox is a contagious, disfiguring and deadly disease caused by the Variola virus. Smallpox is believed to have been around for thousands of years. Few other illnesses have had such a devastating effect on human health and history.
There’s no treatment or cure for smallpox. The only prevention is vaccination.

Naturally occurring smallpox was eradicated worldwide by 1980 — the result of an unprecedented immunization campaign. However, interest in the disease remains high because stocks of smallpox virus, kept for research purposes, are stored in two high-security labs — one in the United States and one in Siberia. In addition, its suspected that other governments or entities may hold stockpiles. This has led to concerns that smallpox may be used as a biological warfare agent.

Until its ‘eradication’ in 1980, smallpox killed 100s of millions of people. An estimated 300 million died in the 20th Century alone.  Smallpox has killed more people than all the other disease in history, combined. While there are several virulence’s of smallpox, the Black Pox is always 100% fatal

The danger
This  is a time [right now] when even one case of smallpox could be catastrophic. At one time, not long ago, most of us were vaccinated against the disease, but this resistance only lasts about 10 years. Everyone vaccinated before 1980 has lost their resistance, everyone born after 1983-85 (when civilian vaccinations were terminated) has not had a vaccination for the disease. The world’s population, is now like the pre 1500 AD, North American Indians, who having no history of the disease were decimated by it.
Smallpox is explosively contagious. As few as  1  virus is said to be able to infect  the next victim. There follows a 10 day incubation period during which time the victim feels no effects of their infection. Then the disease hits: First a headache with a backache and uncontrollable vomiting. Small spots start to appear all over the body. The spots turn into puss filled blisters. The blisters join and cover the entire
body, the skin continues to erupt and split. Victims cannot speak because of blisters in their throat, their eyes are squeezed shut from pus sacks, lastly the internal organs disintegrate and are discharged with the diarrhea and vomiting. The victims die in the most excruciating painful manner possible.

Within a community of humans, the virus must find new victims in not over 14 days intervals or it begins to die out. The virus can live 14-20 outside  a host. Plants and animals do not harbor the disease, just humans.
The government has set the stage for a global catastrophe when they made it impossible for citizens to secure inoculation protection.

The first symptoms of smallpox usually appear 12 to 14 days after you’re infected. During the incubation period of seven to 17 days, you look and feel healthy and can’t infect others.
Following the incubation period, a sudden onset of flu-like signs and symptoms occurs.
These include:

  • Fever
  • Overall discomfort (malaise)
  • Headache
  • Severe fatigue (prostration)
  • Severe back pain
  • Sometimes vomiting, diarrhea or both

A few days later, the characteristic smallpox rash appears as flat, red spots (lesions). Within a day or two, many of these lesions turn into small blisters filled with clear fluid (vesicles) and later, with pus (pustules). The rash appears first on your face, hands and forearms, and later on your trunk. It’s usually most noticeable on the palms of your hands and the soles of your feet. Lesions also develop in the mucous membranes of your nose and mouth. The distribution of lesions is a hallmark of smallpox and a primary way of diagnosing the disease.

When the pustules erupt, the skin doesn’t break, but actually separates from its underlying layers. The pain can be excruciating. Scabs begin to form eight to nine days later and eventually fall off, leaving deep, pitted scars. All lesions in a given area progress at the same rate through these stages. People who don’t recover usually die during the second week of illness.
 [The Smallpox rash progression shown above has a sanitary and optimistic outcome; not showing burst pustules or skin seperation followed by death. Typically, Day 15 above would be worse than Day 10, there woul be no Day 25.]

 Smallpox vs. chickenpox
In the past, smallpox was sometimes confused with chickenpox, a childhood infection that’s seldom deadly. Yet chickenpox differs from smallpox in several important ways:

  • Severity and location of lesions. Chickenpox lesions are much more superficial than are those of smallpox and occur primarily on the trunk, rather than on the face, arms and hands.
  • Types of lesions. You’ll often see a combination of scabs, vesicles and pustules in someone with chickenpox. In smallpox, all of the lesions in a given area are at the same stage.
  • Timing of transmission. A person infected with chickenpox can unknowingly transmit the virus to others before symptoms develop. But smallpox becomes infectious only when signs and symptoms appear and remains contagious until scabs fall from the pustules. Smallpox is most contagious after the fever starts and during the first week of the rash. You’re less likely to become infected if you’re exposed to someone in the later stages of the disease.

The variola virus causes smallpox. Once you’re infected, the virus replicates inside your cells — first in the lymph nodes and then in your spleen and bone marrow. Eventually, the virus settles in the blood vessels in your skin and the mucous membranes of your nose and throat. When the lesions in your mouth slough off, large amounts of virus are released into your saliva. This is when you’re most likely to transmit the disease to others.

How smallpox spreads
Smallpox usually requires fairly prolonged face-to-face contact to spread. It’s most often transmitted in air droplets when an infected person coughs, sneezes or talks. In rare instances, airborne virus may spread further, 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.

Types of smallpox
Two main forms of smallpox exist:

  • Variola minor. This is a milder form of the disease and causes a less serious illness. It’s fatal in less than 1 percent of people who contract it.
  • Variola major. By contrast, this form of the disease kills one-third of the people it infects.

Variola major smallpox is further divided into five subtypes:

  • Ordinary smallpox. This is the most frequently occurring type, accounting for more than 70 percent of all smallpox cases.
  • Modified smallpox. This milder form of the disease occurs in people who have been vaccinated against smallpox in the past.
  • Variola sine eruptione. People with this form of the disease develop fever but no rash.
  • Hemorrhagic smallpox. This rare form is characterized by a red, pinpoint rash and bleeding in the skin and mucous membranes. In some cases, hemorrhagic smallpox may destroy the entire skin surface and all mucous membranes. Hemorrhagic smallpox is almost always fatal within three to four days.
  • Flat smallpox. This rare form, which occurs mainly in children, also is often fatal. The early signs and symptoms are similar to other forms of the disease, but the lesions are flat and never become filled with pus. Eventually, the skin takes on a rubbery appearance. Bleeding in the
    skin and intestinal tract also may occur.

Although most people who get smallpox survive, variola major is fatal in about 30 percent of people who contract it. Almost no one survives the hemorrhagic and flat forms of the disease. People who recover from smallpox usually have severe scars, especially on the face, arms and legs. In some cases, smallpox may cause blindness.

Tests and diagnosis
Even a single confirmed case of smallpox would be considered an international health emergency. Based on symptoms and appearance of the rash, the Centers for Disease Control and Prevention (CDC) or
a CDC Laboratory Response Network-designated variola testing laboratory can do definitive testing using a tissue sample taken from one of the lesions on the skin of the infected person.

Treatments and drugs
No cure for smallpox exists. The smallpox vaccine can prevent or lessen the severity of the disease for some people if given within four days of infection. But vaccination doesn’t help once signs and symptoms develop. For now, the best that doctors can offer people with symptomatic smallpox is supportive therapy and antibiotics to treat secondary bacterial infections.

[Photo right: An actress with make up, simulating Smallpox.]

Apart from immediate vaccination, isolation of the infected person is the only way to manage the disease. Unfortunately, isolation can only contain the spread of the virus, not eradicate it.

Because of the bio-terrorism threat, new treatments are under investigation. One of these, cidofovir, has shown promise in laboratory studies.

Smallpox vaccine: In 1967, the World Health Organization (WHO) launched a global immunization campaign to eradicate smallpox. The WHO’s efforts were remarkably effective, and the last naturally occurring case of smallpox was reported in 1977. In 1980, smallpox vaccinations were discontinued worldwide.
The vaccine today: The United States currently has enough smallpox vaccine to vaccinate all Americans. The CDC has provided public health officials with a contingency plan to quickly inoculate every American should the need arise.
Such a decision would not be undertaken lightly because the smallpox vaccine also has the small but real potential to cause serious harm. Unlike many other vaccines, the smallpox vaccine contains a live vaccina virus — a pox-type virus related to smallpox, but milder than smallpox. The vaccine can’t cause smallpox, but because it’s live, care must be taken of the vaccination site to keep the virus from spreading. Touching the vaccination site before it’s healed, or touching bandages or clothing contaminated with the virus, can cause it to spread to other parts of your body or to other

Experts in virology say the vaccine causes a fatal complication in about 1 of every 1 million people who receive it. That means that if the entire American population were to be vaccinated, 300 people
would be expected to die of complications from the vaccine. Many others who are vaccinated might develop painful sores and severe scars, and others would likely have residual brain damage from encephalitis — a potentially fatal brain inflammation.

Who should not receive the vaccination
Because of the risk of severe and sometimes fatal reactions, the CDC and WHO recommend that the general public not be vaccinated. But because military personnel and some health care workers
continue to be vaccinated, it’s important to know who should not receive the vaccine.

You should not receive the smallpox vaccine if you:

  • Have certain skin conditions. This includes eczema, a history of eczema or other chronic skin conditions, or sharing a household with someone with eczema, a history of eczema or skin conditions such as impetigo.
  • Are pregnant. The vaccine is not known to cause birth defects, but in rare cases it may cause infection of the fetus, leading to stillbirth or death soon after delivery.
  • Have impaired immunity. You shouldn’t have a vaccination if you have a disease or are undergoing treatment that suppresses your immune system. This includes people with cancer, people with organ transplants, and those undergoing radiation therapy or treatment with drugs that suppress the immune system.
  • Have AIDS or are HIV-positive. The human immunodeficiency virus (HIV) wasn’t identified before the end of routine smallpox vaccination, so it’s not known what effect the vaccine might have on people with the disease. Currently, the CDC recommends that HIV-positive people not be vaccinated.
  • Are allergic to any of the ingredients in the vaccine. This includes the antibiotics polymyxin B sulfate, streptomycin sulfate, chlortetracycline hydrochloride and neomycin sulfate.
  • Have underlying heart disease. You also shouldn’t be vaccinated if you have three or more known risk factors for heart disease, including high blood pressure, diabetes, high cholesterol and smoking, or a parent or sibling of someone with heart disease.

Smallpox in the New World:
by O. Ned Eddins
…Some of the African slaves brought by Columbus to be used on the sugar plantation of the West Indies carried the smallpox virus. In 1495, fifty-seven to eighty percent of the native population of Santa Domingo, and in 1515, two-thirds of the Indians of Puerto Rico were wiped out by smallpox. Ten years after Cortez arrived in Mexico, the native population dropped from twenty-five million to six million five hundred thousand a reduction of seventy-four percent.

Prior to the arrival of Europeans, various sources estimate native population in North and South America at ninety to one hundred million (about 1/3 the current US population). It is impossible to arrive at the number of Indians in the Americas killed by European diseases with smallpox the deadliest by far. Even the most conservative estimates place the deaths from smallpox above 65%.
Stearn and Stearn estimated there were approximately one million Indians living north of the Rio Grande in the early sixteenth-century. By the end of the sixteen hundreds, smallpox had spread up and down the eastern seaboard and as far west as the Great Lakes. Bray estimated by 1907 there were less than four hundred thousand Indians. This decline was not due to smallpox alone. Other diseases played a role, as did intertribal warfare and conflicts with the United States.

Smallpox reached the Atlantic Coast of what was to become the United States either from Canada or the West Indies. The first major outbreak recorded of an infectious disease was 1616-19. The Massachusetts and other Algonquin tribes in the area were reduced from an estimated thirty thousand to three hundred (Bray). When the Pilgrims landed in 1620, there were few Indians left to greet them. Many observers believe this infectious disease was smallpox.

In the Americas, mortality rates were higher due to the virgin soil phenomenon, in which indigenous populations were at a higher risk of being affected by epidemics because there had been no previous contact with the disease, preventing them from gaining some form of immunity [A situation that is now occurring in our post 1972 population. Mr Larry]. Estimates of mortality rates resulting from smallpox epidemics range between 38.5% for the Aztecs, 50% for the Piegan, Huron, Catawba, Cherokee, and Iroquois, 66% for the Omaha and Blackfeet, 90% for the Mandan, and 100% for the Taino.  Smallpox epidemics affected the demography of the stricken populations for 100 to 150 years after the initial first infection..

If you were vaccinated before 1972
Many people may have never been vaccinated against smallpox. Others received the vaccine more than 25 years ago. It’s not known how long immunity lasts, although it’s likely the vaccine is most effective for about three to five years, with immunity decreasing after that.
Partial immunity may last much longer. People who are revaccinated appear to have increased immunity, although one recent study indicates that recent or multiple vaccinations aren’t essential for maintaining antibodies that protect against the disease.

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