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Description : Check out this medical presentation on Erythema Multiforme, which is titled "Smallpox", to get an overview of smallpox.

Tags : Erythema Multiforme, Smallpox Vaccine

Published on : Jul 05, 2021 | Views : 2279 | Downloads : 2

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Slide 1-

Smallpox Variola
Slide 2-

Center for Food Security and Public Health Iowa State University - 2004 Overview Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control
Slide 3-

The Organism
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Center for Food Security and Public Health Iowa State University - 2004 The Organism Double stranded DNA Orthopoxvirus Variola, cowpox, vaccinia, monkeypox, Variola major or minor Stable out side host Retains infectivity Last case, 1977 Eradicated, 1980
Slide 5-

History
Slide 6-

Center for Food Security and Public Health Iowa State University - 2004 History of Smallpox First appeared in Northeastern Africa around 10,000 BC Skin lesions on mummies 1570-1085 BC Ramses V
Slide 7-

Center for Food Security and Public Health Iowa State University - 2004 History of Smallpox 1763, Sir Jeffrey Amherst Smallpox in blankets for Indians 18th century Europe 400,000 deaths Case fatality, 20-60% Scars, blindness Infants, 80-98% CF
Slide 8-

Center for Food Security and Public Health Iowa State University - 2004 Variolation Ground scabs, pus, vesicles used to vaccinate China, powdered scabs blown into nostrils Pills from fleas of cows India, application of scab or pus to scarified skin Children exposed to mild smallpox
Slide 9-

Center for Food Security and Public Health Iowa State University - 2004 Variolation Variolation came to Europe early 18th century 1715, Lady Mary Wortley Montague 1718, Inoculated her 5 yr. old son 1721, inoculated her daughter 1745, London Smallpox Inoculation Hospital founded
Slide 10-

Center for Food Security and Public Health Iowa State University - 2004 Variolation 1721, variolation reaches U.S. 1765, connection between milkmaid, cowpox, and smallpox made 1777, George Washington had all soldiers variolated
Slide 11-

Center for Food Security and Public Health Iowa State University - 2004 Edward Jenner 1796, England, May Inoculated James Phipps with fluid from milkmaid’s pustule Subsequent variolation of boy produced no reaction Development of vaccine using cowpox Protective for smallpox Edward Jenner 1749-1823
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Center for Food Security and Public Health Iowa State University - 2004 Smallpox Vaccine Vaccine comes from vaca, Latin for cow Cows used in early 19th century for vaccine production
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Center for Food Security and Public Health Iowa State University - 2004 Smallpox Vaccination 1800, new vaccine used in U.S. 1805, Napoleon begins vaccination of troops
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Center for Food Security and Public Health Iowa State University - 2004 WHO Smallpox Eradication Campaign Begins
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Center for Food Security and Public Health Iowa State University - 2004 WHO Smallpox Eradication Campaign Continues
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Center for Food Security and Public Health Iowa State University - 2004 The End of Smallpox Oct. 26, 1977, last case of smallpox May 8, 1980, official declaration by WHO - Smallpox Eradicated! Last case of Variola minor, Somalia 1977 Last case of Variola major, Bangladesh 1975
Slide 17-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox Eradication 1967-1980, $300 million $24 billion to put a man on the moon 1967 10 million cases 2 million deaths 1972 Last U.S. vaccination
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Center for Food Security and Public Health Iowa State University - 2004 Eradication Success Vaccine available No animal reservoir Vaccinees easily identifiable Vaccinees could “vaccinate” close contacts Diseased easily identifiable
Slide 19-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox Stores CDC in Atlanta, Georgia, U.S. Vector Laboratories in Koltsovo, Russia Unknown others?
Slide 20-

Transmission
Slide 21-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox Transmission Person-to-person Inhalation of droplets Direct contact With infected body fluids Scabs Contaminated objects Bedding, clothing, bandages Aerosol Rarely
Slide 22-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox Transmission Spread more easily in cool, dry winter months Can be transmitted in any climate No transmission by insects or animals
Slide 23-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox Transmission Transmission from a smallpox case Prodrome phase, less common Fever, no rash yet Most contagious with rash onset First 7-10 days Contagious until last scab falls off
Slide 24-

Disease in Humans
Slide 25-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox Clinical Disease Incubation period 7-17 days Range 12-14 d Initial signs Small red spots in mouth and on tongue Rash on face Spreads to arms, legs, hands, feet (centrifugal) Entire body within 24 hours
Slide 26-

Center for Food Security and Public Health Iowa State University - 2004 FEVER RASH Pre-eruption Papules-Vesicles Pustules Scabs Onset of rash Days – 4 – 3 – 2 – 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 21
Slide 27-

Center for Food Security and Public Health Iowa State University - 2004 Clinical Forms of Smallpox Variola major Most common and severe form Extensive rash, higher fever Ordinary (discrete, confluent, semi-confluent) Modified Flat Hemorrhagic (early and late) Variola minor Less common, less severe disease
Slide 28-

Center for Food Security and Public Health Iowa State University - 2004 Variola Major Discrete Pustules separate and not merging with one another Most common form of smallpox
Slide 29-

Center for Food Security and Public Health Iowa State University - 2004 Variola Major Semi-Confluent Pustules begin to merge Confluent Pustules joining and becoming confluent
Slide 30-

Center for Food Security and Public Health Iowa State University - 2004 Variola Major Flat No raised vesicles Very uncommon Grave prognosis
Slide 31-

Center for Food Security and Public Health Iowa State University - 2004 Variola Major Hemorrhagic Less than 3% of all cases 2 types, early and late Death occurs before pox lesions appear
Slide 32-

Center for Food Security and Public Health Iowa State University - 2004 Variola Minor
Slide 33-

Center for Food Security and Public Health Iowa State University - 2004 Differentiating Diseases
Slide 34-

Center for Food Security and Public Health Iowa State University - 2004 Chickenpox vs. Smallpox Chickenpox Lesions on trunk Very few lesions on arms or hands Smallpox Lesions are dense on arms and legs
Slide 35-

Center for Food Security and Public Health Iowa State University - 2004 Chickenpox vs. Smallpox
Slide 36-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox or chickenpox?
Slide 37-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox or chickenpox?
Slide 38-

Center for Food Security and Public Health Iowa State University - 2004 Treatment If exposed but not showing signs, vaccinate Within 3 days, lessens severity Within 4-7 days, some protection Quarantine If showing clinical signs Isolate patient Supportive therapy Cidofovir?
Slide 39-

Center for Food Security and Public Health Iowa State University - 2004 Prognosis Variola major Ordinary cases, 20-40% case fatality rate Flat and hemorrhagic cases, usually fatal Blindness, limb deformities Variola minor Less than 1% case-fatality rate Recovered cases, lifelong immunity
Slide 40-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox and Animals Animals do not show signs of disease No animal reservoir for smallpox Not zoonotic Some animals naturally susceptible to pox viruses Cats and cowpox
Slide 41-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox and Animals Vaccinia transmission from milkers to cows No cow-to-cow spread Experimental vaccinia infection Dogs No signs Cows and horses Lesions
Slide 42-

Center for Food Security and Public Health Iowa State University - 2004 Smallpox and Animals Cantagalo virus, Brazil Mutant of virus used in smallpox eradication Outbreaks of lesions in dairy cattle and human contacts Established in nature Animal reservoir unknown
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Center for Food Security and Public Health Iowa State University - 2004 Smallpox and Vaccinia Concerns of vaccination Could pets serve as a vector? Dog chews bandage, then licks child’s face Close contact of pet to vaccinee and an immunocompromised person No evidence to date More research needed Wildlife eats garbage with bandage in it Establish enzootic cycle like Brazil?
Slide 44-

Prevention and Control
Slide 45-

Center for Food Security and Public Health Iowa State University - 2004 The Smallpox Vaccine Vaccinia virus Protects against variola virus Origins unknown Live vaccine Used in US until 1972 Immunity high for 3-5 years Potentially protective much longer
Slide 46-

Center for Food Security and Public Health Iowa State University - 2004
Slide 47-

Center for Food Security and Public Health Iowa State University - 2004 Duration of Immunity 2000, over 140 million Americans vaccinated 2003, Hammerlund et al study Virus specific T cells Half-life of 8-15 years Detected up to 75 yrs. after vaccination Serum antibody levels stable for 1-75 yrs Booster vaccination increase Ab response, not T cell memory
Slide 48-

Center for Food Security and Public Health Iowa State University - 2004 US Outbreak Control Strategy Ring vaccination
Slide 49-

Center for Food Security and Public Health Iowa State University - 2004 US Smallpox Vaccination Terrorist threats upon US real Bush recommends vaccinating healthcare and military personnel December 2002 Jan 2003, CDC ships vaccine and needles to the states Nov 2003, 38,908 civilians in 50 states and 526,677 military vaccinated
Slide 50-

Center for Food Security and Public Health Iowa State University - 2004 Who Should Not Get the Vaccine? Eczema or atopic dermatitis Skin conditions Chickenpox, herpes, psoriasis, shingles Weakened immune system Transplant, chemotherapy, HIV, others Pregnant women Less than 18yr. Breastfeeding mothers If exposed, get vaccine no matter what
Slide 51-

Center for Food Security and Public Health Iowa State University - 2004 Adverse Vaccine Reactions Prior to 2003 vaccination campaign For every 1 million people vaccinated 1,000 serious reactions 14-52 life-threatening reactions 1-2 deaths Vaccinia immune globulin (VIG) Effective treatment for serious or life-threatening reactions to the vaccine IV form, Investigational new drug
Slide 52-

Center for Food Security and Public Health Iowa State University - 2004 Serious Vaccine Reactions Inadvertent inoculation A vaccinia rash or sores in one area Generalized vaccinia Widespread vaccinia rash or sores Erythema multiforme Toxic or allergic reaction
Slide 53-

Center for Food Security and Public Health Iowa State University - 2004 Life Threatening Vaccine Reactions Progressive vaccinia (vaccinia necrosum) Ongoing skin infection Common in immunocompromised Virus continues to grow Vaccinia immune globulin necessary Without it = death
Slide 54-

Center for Food Security and Public Health Iowa State University - 2004 Life Threatening Vaccine Reactions Postvaccinal encephalitis 3 per million vaccinees 40% fatal Permanent neurological damage Eczema vaccinatum Skin rashes Widespread infection
Slide 55-

Center for Food Security and Public Health Iowa State University - 2004 Military U.S. Vaccination Campaign December 2002-January 2004 578,286 military vaccinees 71% primary vaccinees 30 suspected cases of contact transfer to other people Mostly minor skin infections No eczema vaccinatum No progressive vaccinia Data as of Feb 13, 2004; MMWR
Slide 56-

Center for Food Security and Public Health Iowa State University - 2004 2003 U.S. Vaccination Campaign January 24-December 31, 2003 39,213 civilian vaccinees 11 cases of inadvertent inoculation 1 case of generalized vaccinia 97 serious events 712 nonserious events Rash, fever, pain, headache, fatigue Myocarditis/pericarditis 16 suspected, 5 probable cases Data as of Feb 13, 2004; MMWR
Slide 57-

Center for Food Security and Public Health Iowa State University - 2004 2003 U.S. Vaccination Campaign 2003, more cardiac related reactions than expected 1947, compared to NYC vaccinations Data indicated no relationship to vaccine Defer vaccine with 3 or more cardiac risk factors Current smoker/tobacco user, high blood pressure, high cholesterol or triglycerides, high blood sugar, heart condition before age 50 in a parent, brother or sister
Slide 58-

Center for Food Security and Public Health Iowa State University - 2004 Monkeypox: The Agent Orthopoxvirus, related to smallpox Transmission Reservoir may be African squirrel Bites, aerosol, direct contact Zoonotic, animal-to-animal, person-to-person Animals: Fever, rash, pustules conjunctivitis Humans: Flu-like, rash, pustules, lymphadenopathy
Slide 59-

Center for Food Security and Public Health Iowa State University - 2004 Monkeypox: Public Health Significance 2003 U.S. Outbreak Zoonotic disease 6 Midwestern states Animal illness Suspect cases: 93 Confirmed cases: 10 Human illness Suspect cases: 72 Confirmed cases: 37 All had contact with infected prairie dogs Potential bioweapon
Slide 60-

Center for Food Security and Public Health Iowa State University - 2004 Monkeypox: The Response Treatment: supportive care Smallpox vaccination Moderately protective (85% of cases) 30 individuals in 2003, no adverse events Infection Control EPA registered detergent disinfectant 0.5% sodium hypochlorite (bleach) Embargo Euthanasia of animals Quarantine for 6 weeks
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Center for Food Security and Public Health Iowa State University - 2004 Additional Resources CDC smallpox information emergency.cdc.gov/agent/smallpox/ WHO slide set www.who.int/csr/disease/smallpox/preparedness/en/ Textbook of Military Medicine www.cs.amedd.army.mil/borden/Portlet.aspx?ID=66cffe45-c1b8-4453-91e0-9275007fd157
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Center for Food Security and Public Health Iowa State University - 2004 Acknowledgments Development of this presentation was funded by a grant from the Centers for Disease Control and Prevention to the Center for Food Security and Public Health at Iowa State University.
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Center for Food Security and Public Health Iowa State University - 2004 Acknowledgments Author: Co-author: Reviewer: Radford Davis, DVM, MPH Danelle Bickett-Weddle, DVM, MPH Jean Gladon, BS