Characterized by a telltale rash that often leaves disfiguring "pocks" on the skin of those infected, Smallpox is a potentially deadly virus. The good news? The virus has been nearly eradicated, the last outbreak occurring in Somalia in October of 1977.(1) The bad news? If manufactured and used as a biological weapon, Smallpox is one of a limited number of organisms representing a serious threat to civilian populations.(2) Indeed, Smallpox was once used as a biological weapon during the French and Indian Wars (1754-1767) by British forces in North America.(3)
The virus is so contagious that the discovery of a single suspected case would be treated as an international health emergency and immediately garner the attention of local and state health officials.(4)
A DNA virus, Smallpox is a member of "genus orthopoxvirus" - the largest and most complex of all viruses. The virus is readily transmitted from person to person through the inhalation of virus-infected saliva droplets in the air. Contamination can occur within mere feet from an infected person. The first week of the illness is the most infectious, and it can spread to the spleen, bone marrow and lymph nodes within days. High fever, general malaise, headache, backache, severe abdominal pain, delirium and even blindness also sometimes occur as the virus progresses. A rash eventually appears on the surface of the skin and can quickly spread from the face to stomach to legs. Days later, the rash becomes "scabbed" and the characteristic "pitted scarring" develops.
While at least 90% of Smallpox cases are easily diagnosed, 2 other forms of the virus are difficult to recognize: hemorrhagic and malignant. Hemorrhagic cases are almost always fatal and occur among men, women and children of all ages. Death can occur within a week after the onset of the hallmark rash.(5) In the malignant form, symptoms are similar, but the rash never progresses to the pustular stage. The signs and symptoms of both hemorrhagic and malignant Smallpox are such that the virus was not always suspected until more cases were seen and it was realized that an outbreak was in progress. Hemorrhagic cases were almost always mistaken for acute leukemia; malignant cases were often misdiagnosed as hemorrhagic chickenpox.
While it can be suspected based on symptoms, it is essential to obtain lab confirmation of a Smallpox diagnosis. Fluid samples can be taken from the scabs and rapidly confirmed by microscopic examination. Smallpox can be stopped in its tracks by a vaccine, if started within three to five days of exposure. The entire vaccination process is a series of shots that take about 18 months to complete, and it is about 93% effective against the illness. An antibiotic, Ciprofloxacin, is also very effective at controlling symptoms and preventing death.
The pestilential virus has caused fear in civilization for nearly 2000 years, since it was first detected in the Far East. The virus has claimed the lives of men, women and children, rich and poor; including the Pharaoh Ramses V in 1157 B.C, five reigning European monarchs during the 18th century, and 3,500,000 Aztecs. Smallpox is believed to have been transferred to America by Hernando Cortez in 1520.(6)
The World Health Organization succeeded in eradicating Smallpox in 1977. All countries ceased vaccinations for the virus in 1980;(7) however, two official stocks of the virus still exist. One, in a U.S. government laboratory in Atlanta, GA, remains under constant electronic surveillance; the other, more than 5,000 miles away at a scientific institute in Moscow. That supply is also guarded around the clock.(8) Nevertheless, the ability to produce and deliberately release virulent and highly contagious recombinant strains of Smallpox by rogue terrorist groups is of great concern, particularly in light of the recent Anthrax discoveries.
While there is no reason to assume that the United States may fall prey to a Smallpox attack, and no cases of infection have been discovered, growing fear that bioterrorists may turn to this virus as their next weapon has placed Americans on high alert and prompted medical personnel to take crash courses in disease recognition. We are also preparing on a federal level: the government already has nearly 15.4 million doses of the Smallpox vaccine on hand, and hopes to buy an additional 300 million.(9)
For the latest updates and information on Smallpox, Anthrax and other biological agents, please visit the Centers for Disease Control at http://www.cdc.gov/.
References:
1 & 6: Dr. Alan
Cann, Dept. Microbiology & Immunology/Medical Sciences Building, University
of Leicester, UK.
2: "The New Worry: Smallpox"
by Jessica Reaves; Time Magazine, Oct. 18, 2001.
3: Inglesby TV, Henderson
DA, Bartlett JG, et al. "Anthrax as a biological weapon: medical and public
health management." JAMA.
4 & 5: "Smallpox as
a Biological Weapon," Donald A. Henderson, MD, MPH; Thomas V. Inglesby,
MD; John G. Bartlett, MD; Michael S. Ascher, MD; Edward Eitzen, MD, MPH;
Peter B. Jahrling, PhD; Jerome Hauer, MPH; Marcelle Layton, MD; Joseph
McDade, PhD; Michael T. Osterholm, PhD, MPH; Tara O'Toole, MD, MPH; Gerald
Parker, PhD, DVM; Trish Perl, MD, MSc; Philip K. Russell, MD; Kevin Tonat,
PhD; for the Working Group on Civilian Biodefense.
7: The World Health Organization,
"The Global Eradication of Smallpox: Final Report of the Global Commission
for the Certification of Smallpox Eradication." Geneva, Switzerland: 1980.
8: Jason R. Heimbaug, AFU
Archives.
9: "Single Smallpox case
would trigger federal response," CNN Health; October 19, 2001.
Copyright © 2001 by HCGuidone.