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Adeno virus
Host specific virus
Respiratory
> 40 types
Acute febrile pharyngitis
Infants & young children
Pharyngo - conjunctival fever
Swimming pool conjunctivitis
School age children
Acute respiratory disease New military recruits
DNA, non enveloped
Infection of RT, Eye, bladder, intestine & heart
Appearance of space vehicle
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Infantile
Gastoenteritis
1-15% of all viraldiarrheal disease in
children
(Serotypes 40 - 41)
Hemorrhagic cystitis
Occurs primarily in boys-
self limited
(Serotypes11 - 21)
Left ventricular
dysfunction
Both children& adults
Ocular
Follicular conjunctivitis
Self limiting
Epidemic Kerato conjunctivitis
Shared towels, ophthalmic
soln. unsterile instruments
Leads to corneal opacity (shipyard eye)
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Lab diagnosis
Specimens Swabs from throat, eye,urine or feces
Culture Human embryonic kidney,HeLa, HEP-2
Identification CPE- Grape like clusters
Serology Rise in titre of Abs inpaired sera - ELISA
Treatment No drugs
Prevention Live attenuated vaccine
only military population
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Molluscum Contagiosum
Children & young adults
Causes pink or pearly whiteumbilicated wart like lesions on skin
DNA virus belong to pox viruses
Spreads by direct contact (STD)
Can not be cultured
Diagnosis by clinical picture & HPE
HPE: Molluscum bodies
Disappears within 1yr
To avoid spread - Surgical
removal / Cryotherapy/ Laser
Avoid touching, rubbing,
scratching, shaving over the area
Eosinophilic intracytoplasmic inclusions
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8/3111/26/08 8Abandoned small pox hospital
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In the early eighteenth
century, especially in
Britain, there was
renewed interest in
oriental medical practice,
and in particular the useof inoculation against
smallpox (variolation).
This arose in part from
the fact that, in 1718,
while resident at the
Embassy in Istanbul,
Lady Mary Wortley
Montagu was so
determined to prevent the
ravages of smallpox and
so impressed by the
Turkish method that she
ordered the Embassy
surgeon at Istanbul,
Charles Maitland, to
inoculate her 5-year-old
son in March 1718. Sheherself had suffered from
a bout of smallpox in
1715 that disfigured her
beautiful face, and her 20-
year-old brother had died
of the illness 18 months
earlier.
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2 clinical varities
Highly fatal seen in Asia -
Non - fatal seen in Latin America -
Variola major (classical small pox)
Variola minor (Alastrim)
Vaccinia virus Artificial virus
Employed as a vector for developing recombinant vaccine
Brick shape, can be seen undermicroscope 300 nm
Small pox - Variola Virus
By inhalation- reach reticulo endothelialcells viremia seeding of mucosa &
skin
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Pocks of small pox virus on CAMof developing chick embryo
Pocks of variola are small,shiny, white, non necrotic & nonhemorrhagic
Pocks of vaccinia are large,irregular, greyish, necrotic &hemorrhagic
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Features Chicken poxSmall pox
Distribution of
RashCentrifugal Centripetal
Characteristics
of Rash
Evolution of
Rash
Palms & soles involved Seldom affected
Axilla free Axilla affected
Deep seated Superficial
Vesicles multilocular& umbilicated
Unilocular & dewdrop appearance
Only one stage of
rash at one time
Pleomorphic: rash in
successive crops
No area of inflammation
around vesicles
Area of inflammation
around vesicles
Slow macule, papule,
vesicle, pustule
Rapid
Scabs form after 10-14 days After 4 - 7 days
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Successful eradication
Life long immunity after recovery
No long term carriers
No known animal reservoir
Case detection was simple with characteristic rashes
Subclinical infections did not transmit disease
Highly effective vaccine - heat stable & long term protection
International cooperation
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Unanswered Questions
Are we absolutely certain that laboratory infection such as that whichoccurred in Birmingham, England will not occur?
Can another orthopox virus be transferred to small pox virus?
Are there hitherto unknown animal reservoirs of small pox virus?
Will animal pox (Monkey) eventually replace the eradicated small pox
virus as a wide spread pathogen?
Lastly could biological warfare with small pox virus be waged infuture?
Gl b l H lth
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Global Health
HistoriesJuly 2006
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The end of smallpox but for WHO it is only
the end of the beginningvictory oversmallpox has implications that go far beyondthe individuals directly concernedIt
reasserts our ability to change the worldaround us for the better.
1980
Hal fdan Mahl er ,Director- General , W HO1973- 1988.
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1988
For centuries, variola virus stalked the world with
impunity, causing unmeasured suffering, death andblindness. Today it is confined to glass vials keptunder high security in six laboratoriessmallpox is adisease which can be confined to history the first
disease ever eradicated by man.
Donald Ainslie Henderson,
Chief, Smallpox Eradication,
WHO 1966-1977.
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April 1999
"While we fervently hope smallpox would
never be used as a weapon, we have aresponsibility to develop the drug andvaccine tools to deal with any future
contingency a research and developmentprocess that would necessarily requiresmallpox virus.
US President Bill Clinton
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May 1999
During the World Health Assembly, the USA
successfully argues against calls for the destruction
of smallpox stocks held in the USA and Russia,recommending instead that stocks should bekept for therapeutic research
purposes
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June 9, 1999
"If used as a biological weapon, smallpoxrepresents a serious threat to civilianpopulations because of its case-fatality rate of
30% or more... Although smallpox has long beenfeared as the most devastating of all infectiousdiseases its potential for devastation today is far
greater than at any previous time.
Henderson et al.
JAMA 1999;281:2127-2137
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After September 11, 2001
2002: US government orders 200 million doses ofsmallpox vaccine, costing $428 million. The UKgovernment orders 20 million doses, costing 32Million
2003: UK government sets up Health ProtectionAgency to help prevent terrorist attacks and limittheir impact
2003: WHO, US, UK, European Commission and 6other countries stage "Global Mercury smallpoxalert exercise
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September 2003: Global Mercury
In this scenario, two travelers collapse at Vancouver airportwith a suspicious rash. They confess they are members of aterrorist group who have infected themselves with smallpoxand dispersed to 14 countries just as their infectivity ispeaking.
Quarantine officers issue an international alert. Franticcommunications ensue among the affected countries.Problems include cross-border coordination, languagedifficulties and equipment failures.
Afterwards, the exercise was described as a wellcoordinated, realistic and valuable test of internationalcommunications. "Participants believe that similar exercisesshould be scheduled regularly, possibly annually."
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Exercise Global Mercury
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2005
"We are not saying there might not befatalities, but we could prevent any
widespread disaster.
Gordon MacDonald,
Head of Emergency Strategic Planning,
UK Health Protection Agency
The Times August 24, 2005
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2006: WHO GlobalOutbreak Network
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