Small pox is Dead

8/9/2019 Small pox is Dead

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SMALLPOX

A DEAD DISEASEDr.T.V.Rao MD


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Small Pox - Variola

Variola - Small pox

• WHO 1977 ended

• 8th May 1980 WHO declares Global

eradication

• Most Fatal – Small po !ariola Ma"or

• #on $atal % &lastrim – !ariola minor

• !accine – !ir's – (o) po 'sed $or *accination

• !accina – !iral *ector+


3/46

Origin of Smallpox

• ,he name !ariola )as $irst 'sed in the -th

cent'ry+ .eri*ed $rom the /atin )ord *ari's

spotted or *ar's pimple+

• &n2lo%Saons in the 10th cent'ry 'sed the

)ord poc or pocca ba2 or po'ch to describe

an eanthemo's disease3 possibly smallpo+

• 4n the 15th cent'ry3 the 6n2lish 'sed thepre$i small to distin2'ish *ariola the

smallpo $rom syphilis3 the 2reat po+


4/46

First Cas of Smallpox

• ,here is no animalreser*oir3 and noh'man carriers+

• First certain e*idencecomes $rom them'mmi$ied remains o$amses+ 1157 +(+

• Written descriptions

did not appear 'ntilthe 10th cent'ry inSo'th)estern &sia+


5/46

!istor" of Variolation an#

Va$$in• no)n that s'r*i*ors became imm'ne to the

disease+

• As a rs%lt& p'"si$ians intntionall"

inf$t# 'alt'" prsons (it' smallpoxorganisms+

• !ariolation is the act o$ ta:in2 samples p's$rom p'st'les or 2ro'nd scabs $rompatients )hose disease had been beni2n3and introd'cin2 it into others thro'2h thenose or s:in+


6/46

Species of the Genus Orthopoxvirus

Species Animals Infected Host Range Geographic Range

Variola Human Narrow Formerly worldwide

Vaccinia Human,a cow, pig, buffalo, rabbit, etc !road "orldwideb

#owpox $odent,a cow, human, cat, etc !road %urope

&on'eypox S(uirrel,a mon'ey, ape, human !road "estern and central )frica

%ctromelia &ouse, mole Narrow %urope

#amelpox #amel Narrow )frica and )sia

*aterapox Gerbil Narrow "estern )frica

Volepox Vole + nited States

$accoonpox $accoon + nited States

S'un'pox S'un' + nited States

asin Gishu Horse &edium %astern )frica

a

-rimary hostbSecondary to vaccination. no 'nown natural host

http;


7/46

SMALLPOX• )n%s Ort'opox*ir%ss

Smallpox& mon+" pox&

$o(pox&*a$$inia

• D,A Vir%s

• nm /ri$+s'ap#

• Smallpox-prson to

prson spra# *ia

rspirator"

s$rtions0#ir$t $onta$t

• Spra# /st in lo(

'%mi#it"0tmprat%r


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C!ARACTERISTICS S!ARED 12

SPECIES OF ORT!OPOXVIR3S 4

%% T' largst an# most $omplx *ir%ssT' largst an# most $omplx *ir%ss% Virons parti$ls $an / sn (it' a lig'tVirons parti$ls $an / sn (it' a lig't

mi$ros$opmi$ros$op

- T'" $ontain a linar gnom of a singl- T'" $ontain a linar gnom of a singl

#o%/l-stran## D,A#o%/l-stran## D,A% T'" rpli$at in t' $"toplasm of t'T'" rpli$at in t' $"toplasm of t'

'ost $ll&'ost $ll&

D,A s"nt'ti$ ma$'inr"D,A s"nt'ti$ ma$'inr"

5in$l%#ing D,A-#pn#nt R,A5in$l%#ing D,A-#pn#nt R,A

pol"mraspol"mras

% Srologi$al $ross-ra$ti*it"Srologi$al $ross-ra$ti*it"

- Pro#%$ a 'maggl%tininin antign 5!A6- Pro#%$ a 'maggl%tininin antign 5!A6


9/46

G'arnieriAs bodies or

6lementary bodies• In$l%sion /o#is4

t"p A an# t"p 1

• Virions 'a* a/ri$+-li+ s'ap

an# ar prsnt

in

forms& /ot' ar

inf$tio%s


10/46

!accinia!accinia !ir's – 6lectron micro2raphs!ir's – 6lectron micro2raphs

&+ #on% en*eloped *irion s'r$ace o$ o'ter membrane )ith t'b'lar elements

(+ ,hin section o$ non%en*eloped *irion biconca*e core

+ 6n*eloped *irion3 $o'nd in etracell'lar medi'm

.+ !iral core3 released a$ter treatment o$ *irions )ith #onidetFenner3F+ et al+ Smallpo and 4ts 6radiction+ Gene*ea3 S)itBerland;WHO+ 1998;1C-0


11/46

Variola *ir%s

• ric: shaped3cosists

o$ do'ble layered

membrane )hich

s'rro'nds –iconca*e –#'cleoid

con2ain2 .#& core

• 6ither side lens

shaped lateral body

D00 >00 100 nm


12/46


13/46

P'"si$al $'ara$trs

• emain *iable $or months at

room temperat're

• esists 50E Glycerin and 1 E

phenol

• 4nacti*ated by $ormalin andoidiBin2 a2ents


14/46

Antigni$ str%$t%r

• ,arl" antign

• !at lia/l an# sta/l antigns

• C%lt%r# on C'orioallontoi$ mm/ran of 77

8 79 #a"s ol# $'i$+ m/r"o• Variola po$+s ar small s'in"& ('it $on*x

non n$roti$& non 'morr'agi$

• Variola po$+s ar largr irrg%lar flat gra"is'

n$roti$ lsions som ar 'morr'agi$• Tiss% $%lt%r on Mon+" +i#n"& !la $lls


15/46

Vir%s spra# /" rspirator" ro%t


16/46

Variola (Smallpox)

Smallpox is an acute exanthematous disease caused

by infection with the poxvirus variola.

The significant clinical features include:

Three-day prodromal illness characterized by

fever, headache, backache, and vomiting. eneralized centrifugal rash that follows prodrome

!egins centrally then spreads to the

extremities and face "apid succession of papules, vesicles, pustules,

umbilication, and crusting over a #$-day period.

%rior vaccination may alter the clinical presentation

of smallpox. The following description applies to the

classic presentation in unvaccinated individuals.


17/46

Variola (Smallpox) Vie

& macular red rash may precede the appearance of the papules,

which are deep and firm to palpation. %apules soon vesiculate,

forming a circumscribed, elevated lesion that contains clear

fluid.

'entral umbilication of the pustule is characteristic of smallpox.A second important distinguishing characteristic of smallpoxis that all of the lesions at a given time are in the same stageof development. That is, at any one point in time the lesions are allpapules or vesicles or pustules. !acterial infection of the lesions can occur,

producing localized abscesses and cellulitis.


18/46

Variola (Smallpox) V

'hart from the 'enter

for (isease 'ontrol and%revention showing the

characteristic

distribution of smallpox

lesions.


19/46


20/46

Variola (Smallpox)View Table

Smallpox on the hand: )otice how these lesions have

become confluent.


21/46

Variola (Smallpox) Vi

Smallpox in a child: )otice that all lesions are in the

same stage of development.


22/46


23/46

Small pox

• /ast case Saiban ibi &ssam >C may

1977

• @atients are so'rce o$ in$ection• (lose contacts

• Sin2le crop centri$'2al distrib'tion

• Mac'les – @ap'les – !esicles –

@'st'les


24/46

Pat'ognsis of Smallpox

• ,he portal o$ entry $or smallpo is therespiratory tract or inoc'lation on the s:in

• 6cretions $rom the mo'th and nose3 rather

than scabs3 are the most important so'rce o$in$ectio's *ir's

• St'dies ha*e sho)n that primary in$ection in

the nose or mo'th do not prod'ce a primarylesion that 'lcerates and releases *irionsonto the s'r$ace


25/46

(linical Feat'res

• ash sta2es o$ de*elopment

– &ll lesions in one re2ion at same sta2e

– Starts mac'lar3 then pap'lar – .eep3 tense *esicles by .ay > o$ rash

– ,'rns to ro'nd3 tense3 deep p'st'les

– @'st'les dry to scabs by .ay 9

– Scabs separate


26/46

Clini$al Fat%rs

• Scarrin2

–From separated scabs

–Fibrosis3 2ran'lation in sebaceo's2lands

–@in:3 depressed poc: mar:s

–@rominent on $ace3 's'ally 5 lesions

–@ermanent


27/46

Clini$al Fat%rs

• (omplications

– Sepsis


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29/46

Clini$al Fat%rs

• (omplications

– Secondary bacterial in$ections 'ncommon

• Staphylococc's a're's cell'litis

– esponds to appropriate antibiotics

• (orneal 'lcers

– & leadin2 ca'se o$ blindness be$ore >0th (ent'ry

– (on"'ncti*itis rare

• .'rin2 1st )ee: o$ illness


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A #isfig%ring Disas


31/46

Epi#miolog"

• 4n$ectio's Materials

–Sali*a

–!esic'lar $l'id –Scabs

–Irine

–(on"'ncti*al $l'id

–@ossibly blood


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6pidemiolo2y

• 4n$ectio's Materials

– Sali*a

– !esic'lar $l'id – Scabs

– Irine

– (on"'ncti*al $l'id – @ossibly blood


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Diagnosis• (linical dia2nosis

– S'$$icient in o'tbrea: settin2

– 90E ha*e classical syndrome

• @rodrome $ollo)ed by rash

– arely3 *ariants can be di$$ic'lt to reco2niBe• Hemorrha2ic – mimics menin2ococcemia

• Mali2nant – more rapidly $atal

• Sine er'ptione – prodrome )itho't rash

• @artially imm'ne – milder3 o$ten atypical


34/46

.ia2nosis• ,raditional con$irmatory methods

– 6lectron microscopy o$ *esicle $l'id

• apidly con$irms i$ orthopo*ir's

– ('lt're on chic: membrane or cell c'lt're

• Slo)3 speci$ic $or *ariola

• #e)er rapid tests

– &*ailable only at re$erence labs e+2+ (.(

– @(3 F/@


35/46

/aboratory .ia2nosis o$ Smallpo

• ('lt're on 622 chorioallantoic membrane (&; classicalmethodJ po*ir's 2ro) on (&

• .irect eamination o$ *esicle or p'st'lar material;a22re2ations o$ *ir's may be seen in certain cytoplasm 'pon

stainin2• ,iss'e c'lt're; 2ro)th in c'lt'red cells• 6M; ne2ati*e stainin2 is 'sed to *is'aliBe characteristic lar2e

bric: shape o$ po*ir's – elati*ely rapid

– (an distin2'ish orthopo *ir'ses $rom other *iral a2ents – (annot di$$erentiate bet)een *ariola and *accinia *ir'ses – May not be as sensiti*e as @(%ased methods


36/46

La/orator" Diagnosis of Smallpox

• @( ased method; 4n #orth &merica a positi*e test isconsidered dia2nostic $or *accinia *ir's 'nless medical orepidemiolo2ic e*idence s'22ests other)ise

• With sli2ht modi$ications to the $l'orescently labeled probe3this assay can also be 'sed to detect *ariola *ir's – Family speci$ic primers are 'sed $irst3 then s'b2ro'p%speci$ic primers are

'sed i$ the $ormer is not s'ccess$'l in prod'cin2 @( prod'ct

• .#& @robes; &ssays 'sin2 immobiliBed oli2on'cleotides in amicroarray ha*e been de*eloped to identi$y and discriminateamon2 orthopo*ir'ses

• 4n sit' hybridiBation o$ $ormalin%$ied tiss'es• Serolo2y; (lassical methods s'ch as complement $iationand 2el precipitation commonly )ere 'sed in the pastJeperimental enByme%lin:ed imm'noassays are c'rrentlybein2 e*al'ated


37/46

Diagnosis

• .i$$erential .ia2nosis

– (hic:enpo *aricella

• !esicles shallo)3 in crops3 *aried sta2es

• (entripetal3 spares palms


38/46

Pr*ntion

• !accination % History

– 4ntrod'ced by Kenner

• 4noc'lated boy )ith p'st'lar $l'id $rom co)po

• 1st imm'niBation 'sin2 *ir's o$ similar disease

• 4nitially passed arm%to%arm

– &lso passed syphilis3 hepatitis

• 6*ent'ally passed cal$%to%cal$ on scari$ied le2

• 4mm'nity not li$elon2


39/46

@re*ention

• !accine – modern times

– !accinia *ir's

• elated to co)po and *ariola

• So'rce – cal$ lymph

• #o) cell c'lt're methods a*ailable

• Strains

– /ister 'sed by WHO $or eradication campai2n

– #e) Lor: oard o$ Health only I+S+ strain

– #e)er more atten'ated Kapanese strain


40/46

Kenner *accinatin2


41/46

Va$$ination for Small Pox

V i i f S ll


42/46

Va$$inating for Smallpox

Pr*ntion


43/46

Va$$inating for Smallpox


44/46


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46/46

• Program Crat# /" Dr.T.V.Rao MD

for /nfit of man" in t' (orl# for

!istori$al pr$ption on a Da#Disas

• 6mail

• doctort*rao2mail+com

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Small pox is Dead