This disease is a contagious viral infection, which, in turn, can only affect people.

Smallpox is characterized by general intoxication of the body and peculiar rashes on the skin and mucous membranes. People who have had smallpox leave numerous scars on their skin.

The cause of smallpox is two types of viruses - the causative agent of smallpox and the causative agent of alastrim. The death of these viruses occurs when heated to 60 0 C after half an hour, and when heated from 70 to 100 0 C - after 1-5 minutes. You can neutralize the smallpox virus at home using alcohol, acetone, ether and hydrochloric acid.

Experts distinguish two types of disease.

1. Smallpox

This viral disease is particularly sharp character currents. In this case, smallpox manifests itself equally in children and adults. In addition to the symptoms mentioned above, fever is noted. Rashes on the skin and mucous membranes initially resemble small spots, but over time they turn successively into blisters and pustules, in place of which a crust forms, and then scars.

2. Chicken pox

In children and adults, this disease occurs with moderate intoxication, with the appearance of a rash that has many forms. Transfer is carried out by airborne droplets, therefore, mass infection with smallpox most often occurs in kindergartens.

Symptoms

With chickenpox in adults and children, the incubation period is 8-12 days; the initial signs are severe tearing pain in the lower back, chills, fever, thirst, vomiting and dizziness.

The rash usually appears on the 2-4th day. Its main location is the area on both sides of the chest (from the pectoral muscles to the armpits).

In addition, it is worth noting that with smallpox there is a spotted rash (which does not go away within a few hours) and hemorrhagic rash, the duration of which significantly exceeds the first.

It is worth noting that, after literally 4 days, the symptoms of this disease become less pronounced.

Pockmarks appearing on the mucous membrane of the oral cavity/larynx, rectum, trachea, oropharynx, on the female genital organs or on urethra, in the absence of the necessary treatment, chickenpox can turn into erosion.

Usually on the 8-9th day of this disease, the previously formed blisters suppurate. In children, smallpox can lead to convulsions; in adults, it can lead to impaired consciousness, increased agitation and delirium.

The crusts dry out and fall off within 1-2 weeks.

Currently, there is a Varioloid vaccine that can extend the incubation period by 15-17 days. After vaccination, the symptoms of smallpox become less pronounced, the formation of pustules and scars is not observed. The skin remains in its original form, and full recovery occurs within 2 weeks.

Chicken pox in children

The virus that causes smallpox can also cause shingles. Most often, smallpox occurs in children aged 4 to 9 years. It is noted that during this period the course of the disease has a favorable form, which cannot be said about smallpox in children over 10 years of age. Infants more in the first six months of their life are protected from this virus by maternal antibodies found in milk. At this age, smallpox is transmitted to mild form and the child develops a strong immunity to this disease.

The rash that covers the child's body does not affect the palms and soles of the feet.

In some children, smallpox occurs in atypical forms, which are characterized by:

• rudimentary form (rashes are single blisters);
• generalized form (severe form of smallpox, characterized by damage to internal organs, namely the lungs, kidneys and brain);
• gangrenous form (in place of the vesicles, suppuration forms, leading to the formation of deep ulcers in their place);
• hemorrhagic form (bleeding of the contents of the vesicles into the mucous membranes and onto the skin).

The development of an atypical form of smallpox most often occurs in newborns, in children with reduced immunity, in weakened children against the background of a bacterial infection, in patients suffering from various disorders of the circulatory system.

Treatment of smallpox

Treatment of this disease should be carried out in a specially equipped hospital. At the same time special meaning attached to local therapy for damage to the eyes, ears and mouth.

Does not currently exist specific means treatment of smallpox.

In severe cases of the disease, detoxification therapy is necessary, which is carried out by administering protein and water-electrolyte solutions. Treatment of smallpox with complications is carried out using broad-spectrum antibiotics.

Discharge from the hospital is carried out only after the scales formed at the site of the bubbles have completely fallen off.

Treatment of smallpox in children in most cases does not take a long period of time. In mild to moderate forms, the disease goes away on its own, without any complications. Therapy in this case is symptomatic.

Until the 5th day after the last rash appears, the child is subject to isolation, which can be done at home. Treatment of chickenpox in in this case consists of bed rest, a dairy-vegetable diet and plenty of warm drinks. In addition, it is necessary to monitor the cleanliness of the child’s underwear (underwear/bedding) and his hands. Rashes should be treated with a solution of potassium permanganate/diamond green.

If the body temperature exceeds 38.5°C, you should take antipyretic drugs (Paracetamol, Ibuprofen). If there is severe itching, treatment of chickenpox in children should include taking antihistamines (orally and externally).

Treatment of severe and atypical smallpox requires oral or intravenous antiviral drugs.

Chicken pox in adults can lead to a number of complications, since quite often the attachment of pathogenic microbes occurs, disruption of the adaptation mechanisms of the endocrine and immune systems.

The most common:

1. Herpetic lesions of the respiratory system:

• tracheitis (inflammation of the tracheal mucosa);
• pneumonia (inflammation of lung tissue);
• laryngitis (inflammation of the mucous membranes of the larynx).

2. Pathologies of organs responsible for detoxification:

• nephritis (inflammatory kidney disease);
• hepatitis (inflammatory liver disease);
• abscesses in the liver.

3. Nervous system lesions

• meningitis;
• swelling and formation of cysts in the brain.

In addition, chickenpox in adults can lead to arthritis, myocarditis, hemorrhagic syndrome and increased thrombus formation.

That is why treatment of smallpox in adults is primarily aimed at preventing severe complications.

It is recommended to take antiviral drugs in the form of ointments, tablets and solutions, which are administered without involving the gastrointestinal tract. Acyclovir is considered the most effective in this case, but it is not used in the treatment of severe forms of the disease.

In the presence of purulent deposits, treatment of chickenpox includes taking antibacterial drugs.

Emergency prevention of smallpox in adults is carried out using immunoglobulin through administration or vaccination.

Attention!

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

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“The smallpox virus is among the causative agents of deadly diseases that terrorists can use for biological attacks,” US Secretary of Health Tommy Thompson said at a hearing in the US Congress. American government put 7,000 epidemiologists on full alert, who will immediately go anywhere in the United States if a smallpox outbreak is detected. The United States currently has 15.4 million doses of smallpox vaccine. This is clearly not enough, so it is planned to dilute the vaccine 5 times, which will bring its quantity to 77 million individual doses. It is not yet known how effective such diluted vaccines will be.

In Russia, after a many-year break, vaccinations against smallpox will be resumed. While in special program The Russian Ministry of Health includes only people working in outbreaks emergency situations. According to some experts, it is necessary to restore universal vaccination of the population.

The smallpox virus, the use of which as a biological weapon is of greatest concern not only to the US government, has been known since biblical times. The most terrible epidemics raged in the 17th and 18th centuries. in Europe, when about 10 million people were sick every year, and by the end of the 18th century at least 150 million died. The virus has also been a leading cause of blindness in humans. After E. Jenner received the smallpox vaccine in 1796, an active fight against this disease began, ending, oddly enough, with its complete elimination. This is perhaps the only case when humanity managed to win a confrontation of this kind. At the beginning of the 20th century, with the help of a vaccine, smallpox was eradicated from Europe. North America, as well as in the USSR (the last case was registered in 1936; due to imported cases, the disease was registered until the year 60). In 1958, on the initiative of the USSR, the WHO (World Health Organization of the United Nations) Assembly adopted a resolution to eradicate smallpox throughout the world, which was successfully implemented thanks to global smallpox vaccination of people. October 26, 1977 The last case of this disease on Earth was registered (in Somalia). In 1980, WHO officially announced the complete eradication of smallpox from the planet.

However, eliminating the disease does not mean eliminating the virus. According to WHO recommendations, states that stored the smallpox virus were required to destroy their stocks. All research on the use of the virus as a biological weapon was outlawed. Currently, there are only 2 countries left that officially recognize that they have a conserved virus - these are Russia (the strain is stored at the Vector State Scientific Center for Virology and Biotechnology in Novosibirsk) and the United States (the Center for Infectious Diseases in Atlanta). It is also known that another copy is stored in South Africa. But this is only official data. Where is the guarantee that the virus was not preserved in one of the many commercial laboratories that did not destroy it at one time? And the probability of resuscitating some instances of smallpox from the corpses of people buried in cold conditions is very high, because the virus is quite persistent in the external environment.

We will try to summarize what is known about this virus so far, so that we can be warned and armed.

Description of the object

The family Poxviridae (from the English Pox - ulcer, smallpox) includes, in addition to the actual causative agent of smallpox, also a whole series relatives calling similar diseases in other vertebrates, as well as in insects. The Ortopoxovirus genus includes variola virus, monkeypox virus, and vaccinia virus.

All representatives of this genus are the largest of the existing animal viruses, their sizes reach 450 nm (which is practically the limit for all viruses). These are the most complexly organized viruses. Under an electron microscope they look like a brick with rounded edges. Inside the brick, in the center is a dumbbell-shaped "nucleus" or "nucleoid". It contains DNA bound to a protein. On the sides of the dumbbell there are 2 oval-shaped lateral bodies. This entire structure is surrounded by a supercapsid - an additional outer shell, consisting mostly of the membrane of the affected cells. In this way, the virus “robs” conquered territories, appropriating other people’s property and using it for completely non-peaceful purposes. Its structure also contains more than 30 different proteins, including enzymes for its own reproduction, as well as a set of phospholipids and carbohydrates. In general, this is no longer just a nucleoprotein (like most simply organized viruses, which are the simplest combination of nucleic acid and protein, for example, the tobacco mosaic virus, which was discovered by the very first), but a complex system, somewhat reminiscent bacterial cell in miniature.

Now about such an important issue as reproduction. Here, for our friend, everything is not the same as for people (sorry, viruses). All self-respecting DNA-containing viruses multiply in the nucleus of the affected cells, while our hero preferred the cytoplasm. In fact, the virus first penetrates the selected cell using special receptors located on its surface. Then, like any self-respecting gentleman, he undresses (according to science, the nucleic acid is freed from the supercapsid, and then from the internal proteins) and begins to reproduce its constituent parts, which are then independently packaged into ready-made virions. The nimble babies are released by budding from the cell that raised them, capturing a piece of its membrane as they exit. They can also completely destroy (lyse) the mother’s nest, thus gaining the necessary freedom of action. Under optimal conditions, the entire development cycle takes about 6 hours. When multiplying in cells, the variola virus forms fairly large clusters in the cytoplasm, which are clearly visible under a light microscope. They were first discovered in 1892. G. Guarnieri, examining sections of the cornea of ​​an infected rabbit under a microscope. Now such clusters are called Guarnieri bodies.

Several antigens were found in the virus - nucleoprotein (all viruses of the smallpox family have the same), soluble antigens and hemagglutinin. Due to the presence of a common antigen among different members of the family, genetic recombinations are possible, and, consequently, the formation of new antigenic variants (antigenic drift), the harm of which (for humans, of course, for the virus, on the contrary, is very good property) will be mentioned later.

Smallpox viruses are quite resistant in the external environment (again bad for humans), can withstand drying for many months, and are resistant to most disinfectants(under the influence of 1% phenol they are inactivated only after a day, under the influence of 5% chloramine - after 2 hours), the virus can be stored in a glycerin solution in the refrigerator for several years. They die instantly at 1000C, at 60 - in 15 minutes.

For cultivation, chicken embryos are used, in which the variola virus forms white plaques, and the vaccinia virus produces black plaques. Various cell cultures are also used, on which viruses of this family have a cytopathic effect.

Well, this is all theory, now let’s move on to the prose of life, namely the question of how you can become infected with smallpox, what damage it causes in the human body, how to make the correct diagnosis, what the consequences will be, how to recover, and, even more interesting, how to prevent infection.

Epidemiology and development of the disease

The source of infection is a sick person who is contagious throughout the entire period of illness. The vast majority of people who have not been vaccinated against smallpox or who have not had the disease are susceptible to this infection. Basically, the virus is spread by airborne droplets and airborne dust, like most diseases of the upper respiratory tract. This transmission mechanism is one of the most “effective” in reaching a still healthy population. Also, the smallpox virus can be transmitted through clothing, furniture, household items, i.e. through contact and everyday life. In the first case, the virus enters the human body through the cells of the mucous membrane of the lungs, in the second - through microtraumas or cracks in the skin.

The development of the virus in the human body begins with the pharyngeal lymph nodes. There the virus accumulates strength for the first decisive assault. After some, very short time, a rapid rush occurs - the multiplied virus enters the spleen and a number of other lymph nodes through the bloodstream, where it continues to increase its numbers. After the second stage of accumulation of forces, virions again enter the blood, now in very large quantities, and are spread throughout the body, affecting various organs. At this stage, the virus mainly prefers to multiply in skin cells. Here, in fact, is what the process of disease development looks like from the inside.

Now about the external picture. I must say that she is very unsightly. Based on its high infectiousness, severity and significant mortality, smallpox is classified as a particularly dangerous quarantine infection, along with such terrible diseases as plague, anthrax, Marburg fever and Ebola, etc. The incubation period is quite long (up to 18 days, we remember that the virus must prepare for the assault), the disease begins suddenly with headache, muscle pain, high temperature(this period coincides with the second massive release of smallpox into the blood). After 2-4 days, a rash appears, which goes through several stages in its development - macula (a red spot on the skin), papules (a nodule is formed), then the vesicle stage begins (a vesicle with transparent contents), and, finally, pustules (a vesicle with purulent contents). content). At the last stage, the affected area becomes covered with a black crust (hence the name of the disease - smallpox). After the crusts fall off, scars remain on the skin, especially noticeable on the face. The entire period of skin rashes lasts 3 weeks. It is characteristic that when the virus multiplies on the skin, the body temperature of patients decreases compared to the febrile period. There are 3 possible options for the development of the disease. In the case of "black smallpox" - the most severe form, the mortality rate reaches 100%. The classic course of the disease causes death in 40% of cases. Variola (minor) causes a milder form of the disease - alastrim - with a mortality rate of 1-2%. This form of the disease is usually observed in people vaccinated against smallpox.

For those who successfully survive the disease, active acquired immunity remains for life. It is mainly provided by virus-neutralizing antibodies. With artificial immunization, strong immunity is also formed, however, it is not lifelong (according to various sources, vaccination lasts for 4-8 years), so repeated vaccinations are required to create it.

The impact of smallpox on human history is perhaps comparable only to another infectious disease - the plague. Both cases demonstrate the destructive power of the disease, which devastated not only cities, but entire countries, even continents. Smallpox has been known since ancient times. Cases of epidemics were recorded throughout the globe. Only in the twentieth century, under the control of the World Health Organization, the disease was eradicated.

Nature of smallpox

The causative agent of smallpox is the Orthopoxvirus variola virus, which belongs to the Poxviridae family. The infectious agent is invisible to the eye, but under its shell it stores everything necessary to penetrate the human body - genes and special proteins that help unpack the contents of the viral particle. This pathogen is not only extremely contagious. It has an amazing ability to persist in the external environment. The virus is present in large quantities in the air surrounding a sick person. In this case, people who are in the same room with the sick person are exposed to infection.

Poxvirus contains genetic material

In addition, the virus is resistant to desiccation. Saliva released when coughing and sneezing settles on dust particles. Thus, the virus acquires the ability to spread inside buildings through corridors, heating and air conditioning systems. The infectious agent persists for a long time on objects surrounding the patient - underwear, bed linen, and clothing.

Poxvirus in dried form can survive even at extremely low and high temperatures. Boiling kills the pathogen within ten minutes. In chlorine-containing substances used to disinfect rooms and surfaces, the virus dies only after three hours. Thus, even after the death of the patient, surrounding things and objects pose a real danger of infection.

The poxvirus family includes a number of pathogens that cause smallpox in various animal species, including monkeys, cows, horses and camels.

Modern scientists believe that the causative agent of smallpox originated several tens of thousands of years ago from a virus that caused the disease among camels in the Near and Middle East. From here the disease spread to African countries, including ancient Egypt. In China, Korea and Japan, devastating epidemics have been recorded since ancient times.

Natural smallpox is similar to monkey, cow and horse pox

From Egypt, the disease spread on sea ships to medieval Europe, where it left an indelible mark. The infection did not spare anyone ordinary people, nor royalty. In the Russian Empire, smallpox also became destructive. The infection was brought to the countries of America by conquistadors. A large number of Indians died from this disease.

The cause of such a powerful infection was reliably established only at the beginning of the twentieth century. Moreover, the mortality rate from smallpox in some cases reached the astronomical figure of forty percent. However, the causative agent of the disease that circulated among people is now considered to be completely eliminated. The exception is two closed laboratories in the USA and Russia, where the virus is kept in special conditions. However, a similar disease exists among animals. In African countries, cases of human infection with monkeypox are still being recorded.

Varieties of smallpox

There are several types of smallpox:

• natural, aka black pox. This form is caused by a poxvirus, but is characterized severe course, profuse smallpox rash and a high percentage of deaths (up to 40%);
• alastrim smallpox, or white smallpox. This variant is apparently caused by a slightly modified poxvirus. This disease was isolated as a separate form because it has a milder course, rare rash and low mortality (no more than 1–3%);
• monkey pox. Its causative agent from the poxvirus family circulates among these animals, but in some cases can cause disease in humans. Even cases of transmission of infection from person to person have been proven;
• cowpox. This disease is common among farm animals. Cases of infection in the Middle Ages were often observed among grooms, cavalry soldiers and milkmaids. The pathogen is also a poxvirus, but does not cause deaths or epidemics among humans.

All these diseases are combined into one group according to related characteristics: the pathogen belongs to the poxvirus family and similar manifestations of pathology in the form of fever and characteristic skin rash. Before the discovery of the structure of viruses, chickenpox was also included in this group.

Chickenpox is an independent disease

However, it is currently considered as an independent disease. Its causative agent is a herpes virus, has completely different properties and causes a skin rash that is significantly different from that of smallpox.

Black pox - video

Mechanism of infection development

The human body is extremely susceptible to the smallpox virus. Before the complete elimination of the disease, there were virtually no people who were not familiar with its manifestations. The poxvirus penetrates the body through the least protected areas - the thin, vascular-rich mucous membranes of the nose, pharynx, larynx, trachea and bronchi. It is here that the virus creates the first springboard for capturing living space. He gets inside the cell, after which he gains complete control over its structures, using them as a factory for the construction of his copies.

The cell is used by the virus to create copies of itself

From the cells of the mucous membranes the virus penetrates into lymph nodes. Here it undergoes another phase of reproduction. A large number of copies of the pathogen overcome the last barrier and penetrate the body’s vascular network. From small vessels, the virus enters the cells of the upper layer of the skin - the epidermis. It affects them in such a way that they swell, increasing in volume. This is how the characteristic skin rash of smallpox occurs. In place of the exposed elements, a deep defect remains, healing with the formation of a scar.

The epidermis consists of several layers

The presence of the virus in the blood does not go unnoticed by the body. Smallpox is characterized by a long and persistent fever. The trigger mechanism is toxins released by the poxvirus into the blood. Fever is the body’s universal way of fighting infection. Elevated body temperature not only directly destroys viruses, but also promotes the production of a special protein - interferon. It is he who fights the pathogen after it penetrates the cell.

The immune system recognizes the poxvirus as a foreign agent and starts the process of producing protective antibody proteins. Their source is lymphocytes - one of the types of white blood cells. However, this process is by no means instantaneous. It takes from three days to a week for immune cells to form antibodies. The entry of a large number of defenders into the blood starts the healing process. Antibodies against smallpox persist for 10 years after exposure to poxvirus.

Antibodies protect the body from infections

Signs of smallpox

Currently, smallpox is not recorded. The last case was noted in African Somalia in 1979. Cowpox and monkeypox have similar symptoms. These diseases differ from smallpox only in the degree of severity of manifestations.

Any infection needs time to conquer living space inside the body, called the incubation period, which lasts from the moment the virus enters until the first manifestations of the disease. In the case of smallpox, it ranges from nine to fourteen days, rarely extending to twenty-two days.

After the incubation period, the prodrome begins. At this time, the virus enters the vascular bed. The following symptoms are noted:

• fever;
• aches in muscles and joints;
• loss of appetite;
• weakness;
• pain in the lower back;
• red spots on the skin of the groin area and inner surface hips These elements resemble the skin rash of measles or scarlet fever.

The prodrome lasts from two to four days. Then the disease progresses to new stage development. A characteristic rash in the form of blisters appears on the skin. They have a number distinctive features. Elements appear first on the face, then on the torso and limbs. The palms and soles also become the site of rashes.

The rash of smallpox is characterized by multilocularity and umbilical retraction in the center of the vesicle

A pattern of distribution of the rash is observed: there are few elements on the body, while on the limbs and face the number increases significantly. The bubbles themselves have a characteristic appearance: round shape and an umbilical depression in the center. Bulk elements consist of several cavities located under the shell. When pierced, such a bubble does not collapse.

The period of rash lasts several days. It is followed by a logical continuation of the disease. The contents of the vesicles with an umbilical depression suppurate, and the fever intensifies. Yellowish purulent contents are visible through the shell of the rash elements. Pus melts the septa inside the vesicles, after which they become single-chamber. After a few days, the elements of the rash open up and black crusts appear in their place, which later turn into noticeable scars. Recovery occurs on the twentieth to thirtieth day of illness.

Recovery from smallpox is accompanied by the appearance of scars on the skin

Diagnosis and treatment of smallpox

The diagnosis of smallpox is based on characteristic features illnesses - fever and skin rashes. The virus can be detected by examining the contents of the bubbles under a microscope. Antibody testing is of limited value because signs of the disease appear much earlier than protective proteins in the blood.

It is extremely necessary to distinguish smallpox from chickenpox. In the second case, the rash has a number of characteristic features: single-chamber vesicles, distributed evenly over the skin, do not have an umbilical depression and do not affect the palms and soles.

Treatment of smallpox is the task of an experienced infectious disease doctor. Appointed pharmacological agents several groups: relieving fever, fighting viruses, preventing suppuration of blisters. Similar tactics are used in the case of smallpox, as well as monkey and cowpox.

Drugs for the treatment of smallpox - table

Drugs for the treatment of smallpox - photo gallery

Nise - a modern antipyretic drug Nurofen contains ibuprofen
Remantadine effectively fights the virus Acyclovir is an effective antiviral drug
Ampicillin - a penicillin antibiotic Cefotaxime - an antibiotic from the cephalosporin group Miramistin - modern antiseptic for treating affected areas of the skin Paracetamol is used in children to eliminate fever

Complications and prognosis

During the period of its powerful influence, smallpox often led to deaths. Epidemics of this dangerous disease claimed the lives of every fourth sick person, regardless of age. White smallpox had a milder prognosis, and death was extremely rare. The cause of adverse effects is infectious-toxic shock. This condition is the most severe complication of any infection, including smallpox. A large amount of the virus circulates in the blood, releasing toxins.

However, their more significant source is the contents of festering rash elements. Bacteria, dead white blood cells and their fragments enter the vascular bed from the epidermis. All these substances lead to serious disruption of the circulatory system. The walls of blood vessels stop facilitating the movement of blood, which causes the blood pressure level to drop critically. The vascular system stops supplying tissues with blood and oxygen. Infectious-toxic shock is a serious disruption of the body’s vital functions, requiring emergency resuscitation care.

Prevention

Vaccination against smallpox has a long history. In Russia, the example was the imperial family. The vaccination was carried out in a primitive way: scratches were applied to the skin, after which contact occurred with the contents of smallpox vesicles taken from a sick person.

In the twentieth century, a vaccine against smallpox was developed. IN post-war period general vaccination against the disease began. Developed countries supplied immune drugs to developing countries. Vaccination was carried out by injection into the outer area of ​​the shoulder. A characteristic smallpox element appeared in this place, healing with the formation of a scar. By the end of the eighties of the twentieth century, WHO declared the eradication of smallpox. Currently there is no vaccination available.

The vaccine injection site is marked with a characteristic scar

Chickenpox vaccination is gaining momentum. Imported drugs create reliable and virtually lifelong immunity. The vaccine is approved for use by adults and children over one year of age. The drug is administered to children under 13 years of age once into the subcutaneous fatty tissue of the shoulder. For adults, a two-time injection is prescribed with an interval of one and a half to three months.

Smallpox is currently perhaps the only infectious disease that has been completely eradicated from planet Earth. This situation became possible only thanks to the discovery of the vaccination method and the general vaccination of the population.

Smallpox infection occurs in the small blood vessels of the skin and in the mouth and throat, where the virus lives before spreading. On the skin, smallpox causes a characteristic maculopapular rash, followed by fluid-filled blisters. V. major is a more serious disease and has an overall mortality rate of 30-35 percent. V. minor causes a milder form of the disease (also known as alastrim, cottonpox, white pox, and Cuban itch) that kills about 1 percent of its victims. Long-term complications of V. major infection include characteristic scarring, usually on the face, in 65 to 85 percent of survivors. Blindness resulting from corneal ulceration and scarring, and limb deformities due to arthritis and osteomyelitis, were less common complications, occurring in approximately 2 to 5 percent of cases. Smallpox is believed to have originated in human populations around 10,000 BC. e. The earliest physical evidence of this is pustular eruptions on the mummy of Egypt's pharaoh Ramses V. The disease killed about 400,000 Europeans annually during the last years of the 18th century (including five reigning monarchs), and was responsible for a third of all cases of blindness. Among all those infected, 20-60 percent of adults and more than 80 percent of infected children died from the disease. In the 20th century, smallpox killed an estimated 300-500 million people. In 1967, the World Health Organization (WHO) estimated that smallpox infected 15 million people and killed two million in one year. Following vaccination campaigns in the 19th and 20th centuries, the WHO certified the global eradication of smallpox in 1979. Smallpox is one of only two infectious diseases to be eradicated, the other being rinderpest, which was eradicated in 2011.

Classification

Signs and symptoms

Common smallpox

Modified smallpox

Malignant smallpox

Hemorrhagic smallpox

Cause

Pathogens

Broadcast

Diagnostics

Prevention

Treatment

Forecast

Complications

Story

The appearance of the disease

Eradication

After liquidation

Society and culture

Germ warfare

Known cases

Traditions and religion

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Smallpox

Smallpox is an infectious disease caused by one of two variants of the virus, Variola major and Variola minor. The disease is also known by its Latin names Variola or Variola vera, derived from the word varius (“spotted”) or varus (“pimple”). The disease was originally known in English as "smallpox" or "red plague"; The term "smallpox" was first used in England in the 15th century to distinguish the disease from the "great smallpox" (syphilis). The last naturally occurring case of smallpox (Variola minor) was diagnosed on October 26, 1977.

Smallpox infection occurs in the small blood vessels of the skin and in the mouth and throat, where the virus lives before spreading. On the skin, smallpox causes a characteristic maculopapular rash, followed by fluid-filled blisters. V. major is a more serious disease and has an overall mortality rate of 30-35 percent. V. minor causes a milder form of the disease (also known as alastrim, cottonpox, white pox, and Cuban itch) that kills about 1 percent of its victims. Long-term complications of V. major infection include characteristic scarring, usually on the face, in 65 to 85 percent of survivors. Blindness resulting from corneal ulceration and scarring, and limb deformities due to arthritis and osteomyelitis, were less common complications, occurring in approximately 2 to 5 percent of cases. Smallpox is believed to have originated in human populations around 10,000 BC. e. The earliest physical evidence of this is pustular eruptions on the mummy of Egypt's pharaoh Ramses V. The disease killed about 400,000 Europeans annually during the last years of the 18th century (including five reigning monarchs), and was responsible for a third of all cases of blindness. Among all those infected, 20-60 percent of adults and more than 80 percent of infected children died from the disease. In the 20th century, smallpox killed an estimated 300-500 million people. In 1967, the World Health Organization (WHO) estimated that smallpox infected 15 million people and killed two million in one year. Following vaccination campaigns in the 19th and 20th centuries, the WHO certified the global eradication of smallpox in 1979. Smallpox is one of only two infectious diseases to be eradicated, the other being rinderpest, which was eradicated in 2011.

Classification

There were two clinical forms of smallpox. Variola major was the severe and most common form, associated with a more extensive rash and higher fever. Variola minor was a rarer and much less severe disease, with mortality rates of 1 percent or less. Subclinical (asymptomatic) variola virus infections occurred but were not widespread. In addition, a form called variola sine eruptione (smallpox without rash) has been observed in vaccinated individuals. This form was marked by fever after the usual incubation period and could only be confirmed by antibody studies or, less commonly, by virus isolation.

Signs and symptoms

The incubation period between transmission of the virus and the first obvious symptoms of the disease is about 12 days. Once inhaled, the variola major virus invades the oropharynx (mouth and throat) or the lining of the respiratory tract, migrates to regional lymph nodes, and begins to multiply. In the initial growth phase, the virus appears to move from cell to cell, but around day 12, lysis of many infected cells occurs and the virus is found in large quantities in the blood (this is called viremia), and the second wave of multiplication occurs in the spleen, bone marrow and lymph nodes. Initial or prodromal symptoms are similar to other viral illnesses such as influenza and colds: fever of at least 38.3 °C (101 °F), muscle aches, malaise, headache and prostration. Because the disease often affects the gastrointestinal tract, nausea and vomiting and back pain are common. The prodromal stage, or the stage before the rash appears, usually lasts 2-4 days. By 12-15 days, the first visible lesions appear - small reddish spots called enanthems - on the mucous membranes of the mouth, tongue, palate and throat, and the temperature drops almost to normal. These lesions quickly enlarge and rupture, releasing large amounts of virus into the saliva. The smallpox virus preferentially attacks skin cells, causing the characteristic pimples (called macules) associated with the disease. A rash develops on the skin 24-48 hours after the appearance of lesions on the mucous membranes. Typically, macules first appear on the forehead, then quickly spread to the entire face, proximal limbs, trunk, and finally to the distal limbs. The process takes no more than 24-36 hours, after which no new damage appears. At the moment, the development of variola major infection can be varied, as a result of which four types of smallpox have been identified based on Rao's classification: regular, modified, malignant (or flat) and hemorrhagic. Historically, the overall mortality rate from smallpox has been about 30 percent; however, malignant and hemorrhagic forms are usually associated with death.

Common smallpox

Ninety percent or more of the cases of smallpox among unvaccinated persons were of the common type. In this form of the disease, on the second day of the rash, the macules take on the appearance of raised papules. On the third or fourth day, the papules fill with opalescent fluid, becoming vesicles. This fluid becomes opaque and cloudy within 24-48 hours, giving the vesicles the appearance of pustules; however, the so-called pustules are filled with tissue rather than pus. By the sixth or seventh day, all skin lesions become pustules. After seven to ten days, the pustules mature and reach their maximum size. The pustules are raised high, usually round, hard and hard to the touch. Pustules are deeply rooted in the dermis, giving them the appearance of a small ball in the skin. Fluid slowly seeps out of the pustule, and by the end of the second week, the pustules deflate and begin to dry out, forming crusts. By days 16-20, crusts have formed over all lesions that have begun to crumble, leaving depigmented scars. Smallpox usually produces a discrete rash in which pustules stand out separately from each other on the skin. The most dense distribution of the rash is on the face; on the limbs it is denser than on the body; and denser on the distal part of the limbs than on the proximal one. The disease in most cases affects the palms of the hands and soles of the feet. Sometimes the blisters form a confluent rash that begins to separate the outer layers of skin from the underlying flesh. Patients with confluent pox often remain sick even after a crust has formed over the lesions. In a case series study, the mortality rate for confluent smallpox was 62 percent.

Modified smallpox

Regarding the nature of the rash and the speed of its development, varioloid occurred mainly in previously vaccinated people. In this form, prodromal illness still occurs but may be less severe than the normal type. During the evolution of the rash, fever is usually not present. Skin lesions tend to be smaller and develop more rapidly, are more superficial, and may not exhibit the characteristics of more typical pockmarks. Varioloid is rarely fatal. This form of smallpox is more easily confused with chickenpox.

Malignant smallpox

In malignant smallpox (also called flatpox), the lesions remain almost flush with the skin, whereas in the common type of smallpox, raised vesicles form. It is not known why some people develop this type of lesion. Historically, this type of lesion accounted for 5 to 10 percent of cases, and the majority (72 percent) involved children. Malignant smallpox was accompanied by a severe prodromal phase that lasted 3-4 days, prolonged high fever and severe symptoms of toxicosis, as well as an extensive rash on the tongue and palate. Skin lesions mature slowly and on the seventh or eighth day they become flat and, as it were, “buried” into the skin. Unlike the normal type of smallpox, the vesicles contain little fluid, are soft and velvety to the touch, and may contain hemorrhages. Malignant smallpox is almost always fatal.

Hemorrhagic smallpox

Hemorrhagic smallpox is a severe form, which is accompanied by extensive hemorrhage into the skin, mucous membranes and gastrointestinal tract. This form occurs in about 2 percent of infections and occurs mostly in adults. With hemorrhagic smallpox, no blisters form on the skin, it remains smooth. Instead, bleeding occurs under the skin, making it charred and black, hence this form of the disease is also known as smallpox. In the early form of the disease, on the second or third day, hemorrhage under the conjunctiva of the eye turns the whites of the eyes dark red. Hemorrhagic smallpox also produces dusky erythema, petechiae, and hemorrhages in the spleen, kidneys, peritoneum, muscles, and, less commonly, the epicardium, liver, testes, ovaries, and bladder. Between the fifth and seventh days of illness, it often occurs sudden death when only a few minor skin lesions are present. A more advanced form of the disease occurs in patients who survive for 8-10 days. Hemorrhages appear in the early eruptive period, and the rash is flat and does not develop beyond the vesicular stage. Patients in the early stage of the disease exhibit a decrease in coagulation factors (eg, platelets, prothrombins, and globulin) and an increase in circulating antithrombins. In patients in late stage significant thrombocytopenia is observed; however, clotting factor deficiencies are less severe. Some late-stage patients also demonstrate elevated antithrombin. This form of smallpox occurs in 3 to 25 percent of deaths, depending on the virulence of the smallpox strain. Hemorrhagic smallpox usually leads to death.

Cause

Pathogens

Smallpox is caused by infection with the variola virus, which belongs to the genus Orthopoxviruses, family Poxviridae, and subfamily Chordopoxvirinae. The date of appearance of smallpox is unknown. The virus most likely originated from a rodent virus 68,000-16,000 years ago. One clade was the major strains of smallpox (a more clinically severe form of smallpox) that spread from Asia 400–1600 years ago. The second clade included both alastrim minor (phenotypically mild smallpox), described on the American continents, and isolates West Africa, which originated from an ancestral strain 1400-6300 years before the present. This clade further branched into two subclades at least 800 years ago. The second estimate is that the separation of smallpox from Taterapox occurred 3000-4000 years ago. This is consistent with archaeological and historical evidence for the emergence of smallpox as a human disease, suggesting a relatively recent origin. However, assuming that the mutation rate is close to that of herpesviruses, the time of divergence of smallpox from Taterapox is estimated to date back to 50,000 years ago. While this is consistent with other published estimates, it can be assumed that the archaeological and historical evidence is quite incomplete. More accurate estimates of the mutation rates of these viruses are needed. Smallpox is a large brick-shaped virus ranging in size from approximately 302-350 nm to 244-270 nm, with a single linear double-stranded DNA genome of 186 kilobases in size, containing a hairpin loop at each end. The two classic types of smallpox are variola major and variola minor. Four orthopoxviruses cause infections in humans: variola, vaccinia, cowpox and monkeypox. The smallpox virus infects only humans in nature, although primates and other animals have been infected in the laboratory. Vaccinia, cowpox, and monkeypox viruses can infect humans and other animals in the wild. The life cycle of poxviruses is complicated by the presence of several infectious forms, with different mechanisms of entry into the cell. Poxviruses are unique among DNA viruses in that they replicate in the cytoplasm of the cell rather than in the nucleus. To replicate, poxviruses produce various specialized proteins not produced by other DNA viruses, the most important of which is virus-associated DNA-dependent RNA polymerase. Both enveloped and non-enveloped virions are infectious. The virus envelope consists of modified Golgi membranes containing viral specific polypeptides, including hemagglutinin. Infection with variola major or variola minor confers immunity against both types of smallpox.

Broadcast

Transmission occurs through inhalation of the variola virus through the air, usually in the form of droplets released from the mouth, nose, or pharyngeal lining of an infected person. The virus is transmitted from one person to another primarily through prolonged face-to-face contact with an infected person, usually within 6 feet (1.8 m), but can also be transmitted through direct contact with infected body fluids or contaminated objects (fomites) such as bedding or clothing. In rare cases, smallpox has been spread by an airborne virus in indoors such as buildings, buses and trains. The virus can cross the placenta, but the incidence of congenital smallpox is relatively low. Smallpox is not a prodromal infectious disease and virus shedding is usually delayed until the rash appears, often accompanied by lesions in the mouth and pharynx. The virus can be transmitted throughout the illness, but most often occurs during the first week of the rash. Infectivity decreases after 7-10 days when scabs form over the lesions, but the infected person is contagious until the last pock falls off. Smallpox is highly contagious, but usually spreads more slowly and less widely than some other viral diseases, perhaps because transmission requires close contact and occurs after the rash appears. The overall rate of infection also depends on the short duration of the infectious stage. In temperate climates, smallpox infections were highest in winter and spring. In tropical areas, seasonal variations were less obvious and the disease was present throughout the year. The age distribution of smallpox infections depends on acquired immunity. Immunity after vaccination declines over time and probably disappears within thirty years. It is not known whether smallpox is transmitted by insects or animals.

Diagnostics

Smallpox is a disease with an acute onset of fever equal to or greater than 38.3°C (101°F) followed by a rash characterized by hard, deep-seated vesicles or pustules at one stage of development with no other apparent cause. If a clinical case is observed, smallpox is confirmed using laboratory tests. Microscopically, poxviruses produce characteristic cytoplasmic inclusions, the most important of which are known as Guarnieri bodies, which are also sites of viral replication. Guarnieri bodies are easily identified in hematoxylin and eosin-stained skin biopsies and appear as pink clumps. They are found in almost all poxvirus infections, but the absence of Guarnieri bodies does not indicate the absence of smallpox. The diagnosis of orthopoxvirus infection can also be quickly made using electron microscopic examination of pustular fluid or crusts. However, all orthopoxviruses exhibit an identical brick-shaped virion shape by electron microscopy. However, if particles with the characteristic morphology of herpes viruses are observed, this can eliminate smallpox and other orthopoxvirus infections. Accurate laboratory identification of variola virus involves growing the virus on the chorioallantoic membrane (part of a chick embryo) and observing the resulting lesions under specific temperature conditions. Strains can be characterized using polymerase chain reaction(PCR) and restriction fragment length polymorphism (RFLP). Serological tests and enzyme immunoassays(ELISAs) measuring specific immunoglobulins and variola virus antigens have also been developed to aid in the diagnosis of infection. Chickenpox was commonly confused with smallpox. Chickenpox can be distinguished from smallpox in several ways. Unlike smallpox, chickenpox does not usually affect the palms and soles of the feet. In addition, chickenpox pustules are of different sizes due to differences in the timing of the pustule eruption: smallpox pustules are all almost the same size, since the viral effect progresses more evenly. There are many laboratory methods for the detection of chickenpox in the evaluation of suspected cases of smallpox.

Prevention

The earliest procedure used to prevent smallpox was inoculation (known as variolation), which was probably used in India, Africa and China long before the practice was introduced in Europe. However, the idea that grafting originated in India has been questioned as few of the ancient Sanskrit medical texts describe the process of grafting. Records of smallpox vaccination in China can be found as early as the late 10th century, and the procedure was widely practiced in the 16th century during the Ming Dynasty. If successful, the inoculation produced powerful immunity to smallpox. However, because a person was infected with the smallpox virus, a severe infection could develop and the person could transmit smallpox to others. Variolation was associated with a mortality rate of 0.5-2 percent, significantly less than the disease's mortality rate of 20-30 percent. Lady Mary Montagu Wortley observed smallpox inoculation during her stay in the Ottoman Empire and wrote detailed accounts of the practice in her letters, and enthusiastically promoted the procedure in England after her return there in 1718. In 1721, Cotton Mather and his colleagues caused controversy in Boston by inoculating hundreds of people. In 1796, Edward Jenner, a physician in Berkeley, Gloucestershire, rural England, discovered that immunity to smallpox could be obtained by inoculating a person with cowpox material. Cowpox is a poxvirus from the same family as smallpox. Jenner named the material used for the vaccine after the root word vacca, which is Latin for cow. The procedure was much safer than variolation and was not associated with the risk of smallpox transmission. Vaccination to prevent smallpox was practiced throughout the world. In the 19th century, the cowpox virus used for vaccination against smallpox was replaced by the vaccinia virus. The vaccinia virus belongs to the same family as the variola and cowpox viruses, but is genetically distinct from both. The origin of the vaccinia virus is unknown. The current composition of the smallpox vaccine is a live preparation of the infectious vaccinia virus. The vaccine is administered using a forked needle, which is immersed in the vaccine solution. The needle is used to prick the skin (usually the forearm) several times over a period of several seconds. If successful, a red and itchy bump will develop at the site of the vaccine within three or four days. In the first week, the lump turns into a large blister, which fills with pus and begins to leak. During the second week, the blister begins to dry out and scabs form. The scabs fall off in the third week, leaving a small scar. Antibodies induced by vaccinia vaccine are cross-protective against other orthopoxviruses, such as simianpox virus and variola viruses. Neutralizing antibodies can be detected 10 days after the first vaccination, and seven days after the second vaccination. The vaccine was effective in preventing smallpox infection in 95 percent of those vaccinated. Vaccination against smallpox provides a high level of immunity for three to five years, after which immunity declines. If a person is vaccinated again later, immunity lasts even longer. Studies of smallpox cases in Europe during the 1950s and 1960s found that the mortality rate among persons vaccinated less than 10 years before exposure to the virus was 1.3 percent; it was 7 percent among those vaccinated 11–20 years before infection and 11 percent among those vaccinated 20 or more years before infection. In contrast, 52 percent of unvaccinated individuals died. There are side effects and risks associated with smallpox vaccination. In the past, approximately 1 in 1,000 people vaccinated for the first time experienced serious but not life-threatening reactions, including toxic or allergic reactions at the vaccination site (erythema), spread of the vaccinia virus to other parts of the body, and transmission of the virus to other persons. Potentially life-threatening reactions occurred in 14 to 500 people out of every 1 million people vaccinated for the first time. Based on past experience, it is estimated that 1 or 2 in 1 million people (0.000198 percent) receiving the vaccine may die as a result, most commonly due to vaccine-induced encephalitis or severe vaccine site necrosis (called progressive vaccinia). Given these risks, as smallpox was effectively eradicated and the number of naturally occurring cases fell below the number of vaccine-induced illnesses and deaths, routine childhood vaccination was discontinued in 1972 in the United States and in the early 1970s in most European countries. Routine vaccination of health care workers was discontinued in the United States in 1976 and among active-duty military personnel in 1990 (although military personnel deployed to the Middle East and Korea are still vaccinated). By 1986, routine vaccination had ceased in all countries. Currently, vaccination is primarily recommended for laboratory workers at risk of occupational exposure.

Treatment

Vaccination against smallpox within three days of exposure will prevent or significantly reduce the severity of smallpox symptoms in the vast majority of people. Vaccination within four to seven days of exposure may provide some protection against the disease or may change the severity of the disease. In addition to vaccination, treatment for smallpox is primarily supportive and includes wound care and infection control, fluid resuscitation, and possible mechanical ventilation. Flat and hemorrhagic pox are treated with treatments used to treat shock, such as fluid resuscitation. People with semi-confluent and confluent smallpox may have therapeutic problems similar to patients with extensive skin burns. There is no drug currently approved to treat smallpox. However, antiviral treatments have improved since the last major smallpox epidemics, and research suggests that the antiviral drug cidofovir may be useful as a therapeutic agent. The drug, however, must be administered intravenously and can cause serious kidney toxicity.

Forecast

The overall case fatality rate for the common type of smallpox is about 30 percent, but varies depending on the distribution of smallpox: common-type confluent smallpox is fatal in about 50-75 percent of cases, common-type semiconfluent smallpox is fatal in about 25-50 percent of cases, in those cases when the rash is discrete, the mortality rate is less than 10 percent. The overall mortality rate for children under 1 year of age is 40-50 percent. Hemorrhagic and flat types have the highest mortality rates. The mortality rate for the flat type is 90 percent or more, and almost 100 percent in cases of hemorrhagic smallpox. The case fatality rate for variola minor is 1 percent or less. There is no evidence of chronic or recurrent variola virus infection. In fatal cases of common smallpox, death usually occurs between the tenth and sixteenth days of illness. The cause of death from smallpox is not known, but it is now known that the infection affects multiple organs. Circulating immune complexes, suppressive viremia or an uncontrolled immune response may be contributing factors. In early hemorrhagic smallpox, death occurs suddenly about six days after the fever develops. The cause of death in hemorrhagic cases involves heart failure, sometimes accompanied by pulmonary edema. In late hemorrhagic cases, high and persistent viremia, severe platelet loss, and poor immune response are often cited as causes of death. In smallpox, death is similar to that of burns, with loss of fluid, protein and electrolytes in such quantities that the body is unable to replace them, and fulminant sepsis.

Complications

Complications from smallpox occur most often in respiratory system and range from simple bronchitis to fatal pneumonia. Respiratory complications usually develop by the eighth day of illness and can be either viral or bacterial in origin. Secondary bacterial skin infection is a relatively rare complication of smallpox. When this happens, the fever usually remains elevated. Other complications include encephalitis (1 in 500 patients), which is more common in adults and can cause temporary disability; permanent scars, primarily on the face; and complications related to the eyes (2 percent of all cases). Pustules can form on the eyelid, conjunctiva, cornea, leading to complications such as conjunctivitis, keratitis, corneal ulcer, iritis, iridocyclitis and atrophy optic nerve. Blindness occurs in approximately 35 to 40 percent of eyes affected by keratitis and corneal ulcers. Hemorrhagic smallpox can lead to subconjunctival and retinal hemorrhage. In 2 to 5 percent of children younger age with smallpox, virions reach joints and bones, causing osteomyelitis variolosa. The lesions are symmetrical, and are most common in the elbows, tibia and fibula, and, characteristically, cause separation of the epiphysis and periosteal reactions. Swollen joints limit movement, and arthritis can lead to limb deformities, ankylosis, abnormal bone formation, loose joints, and short fingers.

Story

The appearance of the disease

The earliest reliable clinical signs of smallpox can be found in the medical literature from ancient india, describing smallpox-like diseases (as early as 1500 BC), in the Egyptian mummy of Ramses V, who died more than 3,000 years ago (1145 BC) and in China (1122 BC .e.). It has been suggested that Egyptian traders brought smallpox to India during the 1st millennium BC, where it remained as an endemic human disease for at least 2,000 years. Smallpox was probably introduced into China during the 1st century AD from the southwest, and was introduced from China to Japan in the 6th century. In Japan, an epidemic of 735-737 is believed to have killed a third of the population. At least seven religious deities have been dedicated to smallpox, such as the god Sopona in the Yoruba religion. In India, the Hindu goddess of smallpox, Sitala Mata, was worshiped in temples across the country. The timing of smallpox's emergence in Europe and southwest Asia is less clear. Smallpox is not clearly described in the Old or New Testaments of the Bible, nor in the literature of the Greeks or Romans. While some sources describe the Plague of Athens, which reportedly originated in "Ethiopia" and Egypt, or the plague that occurred in 396 BC. Carthage's siege of Syracuse with smallpox, many scholars agree that it is very unlikely that a disease as serious as variola major would have escaped Hippocrates' description had it existed in the Mediterranean region during his lifetime. While the Antonine Plague, which swept through the Roman Empire in 165-180 AD, may have been caused by smallpox, Saint Nicasius of Reims became the patron saint of smallpox victims for allegedly surviving the disease in 450, and Saint Gregory Tours described a similar outbreak in France and Italy in 580, using the term "smallpox" for the first time; other historians suggest that Arab armies were the first to transport smallpox from Africa to southwestern Europe during the 7th and 8th centuries. In the 9th century, the Persian physician Razi made one of the most authoritative descriptions of smallpox and was the first person to differentiate smallpox from measles and chickenpox in his Kitab fi al-jadari wa-al-hasbah ("Book of Smallpox and Measles"). During the Middle Ages, smallpox began to periodically enter Europe, but did not take root there until population increased and population movements became more active during the era of the Crusades. By the 16th century, smallpox had become well known in most of Europe. With the introduction of smallpox into populated areas in India, China and Europe, it mainly affected children. Periodic epidemics killed about 30 percent of infected individuals. The continued existence of smallpox in Europe was of particular historical significance, as successive waves of European exploration and colonization were associated with the spread of the disease to other parts of the world. By the 16th century, smallpox had become important reason morbidity and mortality in much of the world. There are no reliable descriptions of smallpox-like diseases in the Americas before the arrival of Europeans in the 15th century AD. Smallpox was introduced to the Caribbean island of Hispaniola in 1509, and to the mainland in 1520, when Spanish settlers from Hispaniola arrived in Mexico, bringing smallpox with them. Smallpox killed the entire local Indian population and was important factor in the conquest of the Aztecs and Incas by the Spaniards. The discovery of the east coast of North America in 1633 at Plymouth, Massachusetts, was also accompanied by devastating outbreaks of smallpox among the Native American population and then among the native colonists. Case fatality rates during outbreaks in Native American populations were 80-90%. Smallpox was introduced into Australia in 1789 and again in 1829. Although the disease was never endemic on the continent, it was a leading cause of death in Aboriginal populations between 1780 and 1870. By the mid-18th century, smallpox had become a major endemic disease throughout the world, except in Australia and a few small islands. In Europe, smallpox was the leading cause of death in the 18th century, killing approximately 400,000 Europeans each year. Up to 10 percent of Swedish children died from smallpox each year, and in Russia the child mortality rate could be even higher. The widespread use of variolation in several countries, notably Britain and its North American colonies, and China, somewhat reduced the incidence of smallpox among the wealthy classes in the second half of the 18th century, but the real reduction did not occur until vaccination became common practice at the end of the 19th century. Improved vaccines and booster vaccination practices led to significant reductions in the number of cases in Europe and North America, but smallpox remained largely uncontrolled and widespread throughout the world. A much milder form of smallpox, variola minor, was discovered in the United States and South Africa in the late 19th century. By the mid-20th century, variola minor coexisted alongside variola major in many parts of Africa. Patients with variola minor experience only mild systemic disease, are often outpatients throughout the course of their illness and can therefore more easily spread the disease. Infection v. minor induces immunity against the more deadly smallpox, variola major. Thus, as v. minor spread throughout the United States, Canada, South America and Great Britain, it became the dominant form of smallpox, causing a further decline in mortality rates.

Eradication

English physician Edward Jenner demonstrated the effectiveness of cowpox in protecting people from smallpox in 1796, after which various attempts were made to eradicate smallpox regionally. The introduction of the vaccine to the New World took place in Trinity, Newfoundland in 1800 by Dr. John Clinch, Jenner's childhood friend and medical colleague. As early as 1803, the Spanish crown organized the Balmis expedition to transport vaccine to the Spanish colonies in the Americas and the Philippines, and also developed mass vaccination programs. The U.S. Congress passed the Vaccination Act of 1813 to ensure that a safe smallpox vaccine was available to the American public. By about 1817 there was a very powerful government program vaccinations. IN British India A program was launched to distribute smallpox vaccination through Indian vaccinators, under the direction of European officials. However, British vaccination efforts in India and Burma in particular were hampered by persistent local mistrust of vaccination, despite strict legislation and improvements in vaccine effectiveness. By 1832, the United States federal government created a smallpox vaccination program for Native Americans. The United Kingdom banned vaccinations in 1842 and later launched a compulsory vaccination program. The British government made smallpox vaccination mandatory following an Act of Parliament in 1853. In the United States, smallpox vaccination was introduced from 1843 to 1855, first in Massachusetts and then in other states. Although some did not like these measures, coordinated efforts against smallpox continued, and the disease continued to decline in rich countries. By 1897, smallpox had been largely eradicated from the United States. In a number of countries Northern Europe smallpox was eradicated by 1900, and by 1914 the incidence in most industrialized countries had fallen to relatively low levels. Vaccination continued in industrialized countries until the mid to late 1970s to protect against reinfection. Australia and New Zealand – these are two exceptions; None of these countries had smallpox epidemics or extensive vaccination programs; instead, these countries introduced protection from contact with other countries and strict quarantine. The first widespread (including half the globe) attempt to eradicate smallpox was undertaken in 1950 by the Pan American Health Organization. The campaign was successful in eradicating smallpox from all American countries except Argentina, Brazil, Colombia and Ecuador. In 1958, Professor Viktor Zhdanov, Deputy Minister of Health of the USSR, called for a global initiative to eradicate smallpox at the World Health Assembly. The proposal (Resolution WHA11.54) was adopted in 1959. At that time, 2 million people died from smallpox every year. Overall, however, progress toward eradicating smallpox has been disappointing, especially in Africa and the Indian subcontinent. In 1966, the Smallpox Control Unit was formed under the leadership of the American Donald Henderson. In 1967, the World Health Organization intensified the global smallpox eradication program, contributing $2.4 million a year to the effort, and adopted a new method of disease surveillance promoted by Czech epidemiologist Karel Raška. In the early 1950s, an estimated 50 million cases of smallpox occurred worldwide each year. In order to eradicate smallpox, it was necessary to stop the spread of each outbreak by isolating cases and vaccinating everyone living nearby. This process is known as vaccination by creating a ring around the site of the disease (creating a buffer zone). The key to this strategy is monitoring cases in the community (surveillance) and containing the disease. The initial challenge that the WHO team faced was the lack of reporting of smallpox cases, as many cases occurred without the knowledge of the authorities. The fact that humans are the only reservoir for smallpox infection, and that there are no carriers, played a significant role in the eradication of smallpox. WHO established a network of consultants to help countries establish surveillance and contain the disease. In the early days, vaccine donations came primarily from the Soviet Union and the United States, but by 1973, more than 80 percent of all vaccines were produced in developing countries. The last major European outbreak of smallpox occurred in 1972 in Yugoslavia, after a pilgrim from Kosovo returned from the Middle East, where he contracted the virus. The epidemic infected 175 people, resulting in 35 deaths. The authorities declared martial law, forced quarantine, and took measures to widely revaccinate the population, enlisting the help of WHO. Two months later, the outbreak was over. Previously, a smallpox outbreak occurred in May-July 1963 in Stockholm, Sweden, brought from the Far East by a Swedish sailor. It was fought through quarantine measures and vaccination of the local population. By the end of 1975, smallpox persisted only in the Horn of Africa. In Ethiopia and Somalia, where there were few roads, conditions were very difficult. Civil war, famine and refugees made the task even more difficult. In early to mid-1977, these countries undertook an intensive surveillance and containment and vaccination program led by Australian microbiologist Frank Fenner. As the campaign neared its goal, Fenner and his team played important role in confirmation of liquidation. The last natural case of indigenous smallpox (Variola minor) was diagnosed in Ali Maow Maalin, a hospital cook in Merka, Somalia, on October 26, 1977. The last natural case of the more deadly Variola major was discovered in October 1975 in a two-year-old Bangladeshi girl, Rahima Banu. Global eradication of smallpox was certified, based on intensive verification activities in various countries, by a committee of eminent scientists on December 9, 1979, and subsequently endorsed by the World Health Assembly on May 8, 1980. The first two proposals for the resolution: “Having reviewed the development and results of the global smallpox eradication program initiated by WHO in 1958 and intensified since 1967... we solemnly declare that the world and its peoples have won freedom from smallpox, which has been the most devastating epidemic disease in many countries since its earliest time leading to death, blindness and physical disabilities and which only ten years ago was widespread in Africa, Asia and South America."- World Health Organization, Resolution WHA33.3

After liquidation

The last cases of smallpox in the world occurred in an outbreak of two cases (one of which was fatal) in Birmingham, UK, in 1978. Medical photographer Janet Parker was infected at the University of Birmingham Medical School and died on 11 September 1978, after which Professor Henry Bedson , a scientist in charge of smallpox research at the university, committed suicide. All known stocks of smallpox were subsequently destroyed or transferred to two WHO-designated reference laboratories - the US Centers for Disease Control and Prevention and the Russian State Scientific Center for Virology and Biotechnology Vector. The WHO first recommended eradication of the virus in 1986 and then set an eradication date of December 30, 1993. The date was then moved to June 30, 1999. Due to resistance from the US and Russia, in 2002 the World Health Assembly decided to allow the temporary storage of virus stocks for specific research purposes. Destruction of existing stockpiles would reduce the risk associated with ongoing smallpox research. Supplies are not needed to respond to smallpox outbreaks. Some scientists argue that the reserves could be useful in developing new vaccines, antiviral drugs and diagnostic tests. However, in 2010, a review by a panel of public health experts appointed by the WHO concluded that no underlying public health purpose justified the storage of smallpox virus in the United States and Russia. The latter view is often supported in the scientific community, especially among veterans of the WHO smallpox eradication program. In March 2004, smallpox scabs were discovered in an envelope in a Civil War-era medical book in Santa Fe, New Mexico. The envelope was marked as containing vaccination scabs and given to scientists at the Centers for Disease Control and Prevention with the opportunity to study the history of smallpox vaccination in the United States. In July 2014, several vials of smallpox virus were discovered in an FDA laboratory located at the National Institutes of Health in Bethesda, Maryland.

Society and culture

Germ warfare

The British used smallpox as a biological weapon during the siege of Fort Pitt during the French and Indian War (1754-1763) against France and its Indian allies. The actual use of the smallpox virus was officially authorized. British officers, including leading British generals, ordered, authorized, and paid for the use of the smallpox virus against Native Americans. According to historians, "there is no doubt that British military authorities approved of attempts to spread smallpox among their enemies" and that "it was a deliberate British policy to infect Indians with smallpox." The effectiveness of efforts to spread the disease is unknown. There is also evidence that smallpox was used as a weapon during American war for independence (1775-1783). According to a theory put forward in the Journal of Australian Studies (JAS) by an independent researcher in 1789, British marines used smallpox against indigenous tribes in New South Wales. This has also been discussed previously in the Bulletin of the History of Medicine and by Davidham Day in his book Claiming a Continent: A New History of Australia. Prior to the JAS article, this theory was disputed by some scientists. Jack Carmody argued that the cause of the outbreak was most likely chickenpox, which at the time was sometimes identified as a mild form of smallpox. Although it was noted that there were no reports of smallpox among the colonists during the 8-month voyage of the First Fleet and the following 14 months, and that since smallpox has an incubation period of 10-12 days, it is unlikely to have been present during the First Fleet, in It is now known that the likely source was bottles of smallpox virus carried by surgeons of the First Fleet and, in fact, there were reports of smallpox among colonists. During World War II, scientists from the United Kingdom, the United States, and Japan (Unit 731 of the Imperial Japanese Army) were involved in research to produce biological weapons from the variola virus. Plans for large-scale production were never fully realized because scientists believed the weapon would not be very effective due to the widespread availability of the vaccine. In 1947, the Soviet Union established a smallpox-based biological weapons plant in the city of Zagorsk, 75 km northeast of Moscow. An outbreak of weaponized smallpox occurred during testing at a facility on an island in the Aral Sea in 1971. Pyotr Burgasov, a former chief sanitary officer of the Soviet army and a senior scientist in the Soviet biological weapons program, described the incident: “Vozrozhdeniya Island in the Aral Sea tested the most powerful recipes for smallpox. Suddenly I was informed about mysterious cases of death in Aralsk. A research ship of the Aral Fleet approached the island at a distance of 15 km (although it was forbidden to come closer than 40 km). The ship's laboratory assistant took plankton samples twice a day from the upper deck. Smallpox preparation – 400 gr. of which were blown up on the island - infected her. After returning home to Aralsk, she infected several people, including children. They all died. I suspected the reason for this and called the Chief of the General Staff of the Ministry of Defense and asked to prohibit the Alma-Ata-Moscow train from stopping in Aralsk. As a result, the spread of the epidemic throughout the country was prevented. I called Andropov, who was the head of the KGB at the time, and told him about the exceptional recipe for smallpox obtained on Vozrozhdenie Island.” Others say the first patient may have become infected while visiting Uyala or Komsomolsk-on-Ustyurt, two cities where the ship was moored. In response to international pressure, in 1991 soviet government allowed a joint US-British inspection team to visit four of its main facilities at Biopreparat. The inspectors were met with hostility and were eventually kicked out of the site. In 1992, Soviet defector Ken Alibek stated that the Soviet biological weapons program at Zagorsk produced large quantities—as many as twenty tons—of biological weapons in the form of the smallpox virus (possibly, according to Alibek, to counter vaccines), along with refrigerated warheads for delivering the weapons. Alibek's stories about the former Soviet smallpox program have never been independently verified. In 1997, the Russian government announced that all remaining smallpox samples would be transferred to the Vector Institute in Koltsovo. With the collapse of the Soviet Union and the unemployment of many of the weapons program's scientists, U.S. government officials expressed concern that smallpox and its bioweapons expertise could become available to other nations or terrorist groups that might wish to exploit the virus. as a means of biological warfare. The specific accusations leveled against Iraq in this regard, however, turned out to be erroneous. Concern has been expressed about the possibility of recreating the virus from existing digital genomes through artificial gene synthesis for use in biological warfare. Inserting synthesized smallpox DNA into existing related smallpox viruses could theoretically be used to recreate the virus. The first step to mitigating this risk presumably lies in destroying remaining stocks of the virus in a manner that clearly criminalizes possession of the virus.

Known cases

In 1767, 11-year-old composer Wolfgang Amadeus Mozart survived a smallpox outbreak in Austria that killed Holy Roman Empress Maria Josepha, who became the second wife of Holy Roman Emperor Joseph II, who died of the disease, as did Archduchess Maria Josepha. Notable historical figures who contracted smallpox: Hunkpapa Indian chief Sitting Bull, Emperor Ramses V of Egypt, Kangxi Emperor (survived), Shunzhi Emperor and Tongzhi Emperor of China, Date Masamune of Japan (lost an eye due to disease). Cuitlahuac, the 10th Tlatoani (ruler) of the Aztec city of Tenochtitlan, died of smallpox in 1520, shortly after its introduction to the Americas, and Inca Emperor Huayna Capac died of smallpox in 1527. More modern public figures affected by this disease include Guru Har Krishan, 8th Guru of the Sikhs, in 1664, Peter II of Russia in 1730 (died), George Washington (survived), King Louis XV in 1774 (died) and Maximilian III, Elector of Bavaria in 1777. Many prominent families around the world often had multiple people who were infected and/or died from the disease. For example, several of Henry VIII's relatives survived the disease but were left scarred and scarred. These included his sister Margaret, Queen of Scots, his fourth wife Anne of Cleves, and his two daughters: Mary I of England in 1527 and Elizabeth I of England in 1562 (as an adult, she often tried to disguise the pockmarks with makeup). His great-niece Mary Stuart became infected in childhood, but she did not have any visible scarring. In Europe, mortality from smallpox often played a large role in dynastic succession. Henry VIII's only surviving son, Edward VI, died of complications shortly after apparently recovering from his illness, thereby nullifying Henry's efforts to secure the throne with a male heir (his two immediate successors were women, both of whom survived smallpox). Louis XV of France took over the throne from his great-grandfather Louis XIV through a series of fatal cases of smallpox or measles among his relatives who should have taken the throne earlier. Louis himself died of illness in 1774. William III lost his mother to the disease when he was just ten years old in 1660, and made his uncle Charles his legal guardian: her death from smallpox indirectly set off a chain of events that eventually led to the family's permanent displacement Stuart from the British throne. William III's wife, Mary II of England, died of smallpox. In Russia, Peter II died of illness at the age of 15. In addition, before becoming Russian Emperor, Peter III was infected with the virus and suffered greatly from it. He still has noticeable scars from his illness. His wife, Catherine the Great, was saved, but fear of the virus clearly took its toll on her. She was so afraid for the safety of her son and heir, Paul, that she did not allow him to go out to large crowds of people, trying to isolate him. In the end, she decided to get herself vaccinated by the Scottish doctor Thomas Dimmesdale. At the time, vaccination was considered a controversial method at the time, but Catherine did not get sick. Later, her son Pavel was also vaccinated. Catherine wanted to spread inoculation throughout her empire, declaring: “My goal was, through my example, to save from death many of my subjects who, not knowing the meaning of this technique, and fearing it, were left in danger.” By 1800, approximately 2 million vaccinations had been administered in the Russian Empire. In China, the Qing dynasty had extensive protocols to protect the Manchus from Beijing's endemic smallpox. US Presidents George Washington, Andrew Jackson and Abraham Lincoln had smallpox and recovered from it. Washington contracted smallpox after visiting Barbados in 1751. Jackson developed the disease after he was captured by the British during American Revolution, and although he recovered, his brother Robert died. Lincoln became infected during his presidency, possibly from his son Tad, and was quarantined shortly after receiving a Gettysburg address in 1863. The famous theologian Jonathan Edwards died of smallpox in 1758 after being inoculated. Soviet leader Joseph Stalin contracted smallpox at the age of seven. His face was scarred from this disease. His photographs were later retouched to make the pockmarks less noticeable. The Hungarian poet Kölcsey, who wrote the Hungarian national anthem, lost his right eye due to smallpox.

Traditions and religion

In various parts of the Old World, such as China and India, people worshiped various smallpox deities. In China, the goddess of smallpox is referred to as Tou-Shen Niang-Niang. Chinese believers actively tried to appease the goddess and pray for her mercy and called smallpox pustules " beautiful flowers", as a euphemism intended to avoid offending the goddess. Due to this, on New Year's Eve it was a custom that the children of the house would wear ugly masks while sleeping in order to hide their beauty and thereby avoid attracting the goddess who would be passing through the house that night. If there was a case of smallpox, shrines were created in the victims' homes to be worshiped during their illness. If the victim recovered, the shrines were carried away on a special paper stand or in a boat for burning. If the patient did not recover, the shrine was destroyed and cursed in order to drive the goddess out of the house. The first records of smallpox in India can be found in a medical book that dates back to 400 AD. In India, as in China, a goddess of smallpox was created. The Hindu goddess Sheetala was worshiped and feared during her reign. This goddess was believed to be both evil and good and had the ability to cause suffering to her victims when she was angry, as well as to calm the fevers of those already suffering. In the portraits the goddess is depicted with a broom in right hand, so that the disease moves to another place, and a pot of cool water, on the other hand, to calm the victims. Shrines were created that many native Indians, both healthy and sick, could worship in an attempt to protect themselves from the disease. Some Indian women, in an attempt to ward off Shitala, placed plates of chilled food and pots of water on the roofs of their houses. In cultures that did not have a specific deity to personify smallpox, there was nevertheless a common belief in smallpox demons, who were accordingly blamed for the spread of the disease. Such beliefs were common in Japan, Europe, Africa and other parts of the world. In almost all cultures where they believed in a demon, it was believed that he was afraid of the color red. This led to the invention of the so-called "red cure", where victims were dressed in red and their rooms were also decorated in red. The practice spread to Europe in the 12th century and was practiced by (among others) Charles V of France and Elizabeth I of England. Thanks to Finsen's research showing that red light reduced scarring, this belief continued into the 1930s.

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List of used literature:

"Smallpox is not a bad weapon." Interview with General Burgasov (in Russian). Moscow News. Retrieved 2007-06-18

Koplow, David (2003). Smallpox: The Fight to Eradicate a Global Scourge. Berkeley and Los Angeles, CA: University of California Press. ISBN 0-520-23732-3

Massie, Robert K. (2011). Catherine the Great: Portrait of as Woman, pp. 387–388. Random House, New York. ISBN 978-0-679-45672-8

Giblin, James C. When Plague Strikes: The Black Death, Smallpox, AIDS. United States of America: HarperCollins Publishers, 1995

Tucker, Jonathan B. Scourge: The Once and Future Threat of Smallpox. New York: Atlantic Monthly Press, 2001

Contents of the article

Smallpox- a particularly dangerous, highly contagious acute infectious disease, which is caused by a virus, characterized by airborne (dust) transmission, two-wave fever, severe intoxication, the staged appearance of a thick vesicular-pustular rash on the skin and mucous membranes, after which scars remain.

Historical data on smallpox

Smallpox has been known to mankind since ancient times. Descriptions of this disease are found in Egyptian papyri dating back to 3000 BC. e. In China, smallpox was known as Tien Hua (“heavenly flowers”). The first detailed description of smallpox was made by the Persian scientist Rhazes (9th century). The modern name of the disease “variola” was introduced by Bishop Marius of Avancho in the 7th century. The first doctor who described smallpox as a contagious disease was Avicenna (11th century).
In the VI century. smallpox was introduced into Europe. The indigenous population of America was especially affected by smallpox, where it was brought by the Spanish colonialists in 1507. At the same time, smallpox was first used as a bacteriological weapon - the colonialists hung it on trees, and also gave the natives clothes that were specially contaminated with smallpox pus and crusts. In the 18th century Smallpox killed about 1/10 of the world's population. In some years, smallpox killed 10-12 million people annually. The cause of blindness in 60-70% of cases was smallpox. In the XV-XVI centuries. smallpox spread throughout Ukraine.
The history of mankind's struggle with smallpox is as old as the disease itself. First effective method To prevent smallpox there was variolation - inoculation of a healthy person with smallpox in the hope of causing light form diseases. For this purpose, in Ancient China and India, smallpox crusts ground into powder were blown into the nostrils; they practiced introducing smallpox material into the body through cuts on the skin, by pulling an infected thread through the skin, through the patient’s clothes, etc. However, variolation did not find wide application and had no effect on overall morbidity and mortality. Variolation has sometimes led to fatal epidemic outbreaks among non-immune populations. In addition, other infectious diseases (plague, syphilis) were often transmitted from smallpox material.
An epochal discovery was vaccination, which was proposed in 1796 by the English provincial doctor E. Jenner. He used folk experience: after contracting cowpox, a person does not get smallpox. After twenty years of observations, May 14, 1796 p. Jenner decided on a bold experiment: from a milkmaid suffering from cowpox, he publicly inoculated the contents of a pustule into an eight-year-old boy. After 1.5 months, Jenner inoculated the same child with the contents of a pustule from a smallpox patient - the boy did not get sick. Jenner's method has found wide acceptance and use throughout the world. In 1919, our country adopted the first law on mandatory vaccinations against smallpox, which led to the complete eradication of smallpox. The leading role in the eradication of smallpox was played by the resolution adopted at the seventh plenary meeting of the WHO Assembly in 1958, which provided for the program proposed by the USSR for the complete eradication of smallpox. Large-scale coordinated work was launched, which ended in success - the last case of smallpox was registered on October 25, 1977 in Somalia, and in 1980, at the XXXIII session of the WHO Assembly, the eradication of smallpox from the globe was officially proclaimed.
The causative agent of smallpox was discovered by E. Pashen in 1906 as elementary bodies that were discovered by microscopy of preparations of the contents of pustules.

Etiology of smallpox

The causative agent of smallpox, Orthopoxvirus variolae, belongs to the genus Orthopoxvirus, family Poxviridae. It is highly resistant to drying. When dried, the crust can retain its pathogenicity for years. Museum strains of the smallpox virus are stored under international control in two research centers that collaborate with WHO - in Moscow and Atlanta (USA).

Epidemiology of smallpox

The source of infection is a sick person who is contagious from last days incubation period until the crusts fall off. The highest infectivity is observed on the 7-10th day of illness. Transmission mechanisms are airborne droplets, airborne dust, household contact and transplacental. Most often, smallpox infection occurs through airborne droplets. Susceptibility to smallpox is very high, the contagiousness index is 95%. After the illness, persistent immunity remains, although repeated cases of the disease have been described.

Pathogenesis and pathomorphology of smallpox

The pathogen enters the body through the mucous membrane of the upper respiratory tract, where it multiplies and later enters the regional lymph nodes. After 1-2 days, the pathogen enters the blood (primary viremia) and is introduced into all internal organs, where it multiplies within 10 days in the system of mononuclear phagocytes. Subsequently, repeated viremia occurs, which determines the clinical course of the initial period. The most characteristic changes occur in the skin and mucous membranes. The papillary and papillary layers of the skin are affected, leading to swelling and cellular infiltration. First, pockmarks form in the form of dense papules. Subsequently, the epithelial cells of the papillary layer of the skin liquefy, maintaining their membranes (balloon degeneration). Larger bubbles gradually appear, which, merging, form vesicles, which, due to the presence of residues in them epithelial cells become multi-chambered. The vesicles develop into pustules, which often lose their multilocularity and umbilical involvement. Vesicles are also formed on the mucous membranes of the mouth, upper respiratory tract, and genitals. Subsequently, the vesicles turn into superficial ulcers, which heal through epithelialization. The cornea of ​​the eye is often affected, leading to partial or complete loss of vision.

Smallpox Clinic

The incubation period for smallpox lasts on average 10-14 days, in some cases it can be reduced to 5 and extended to 22 days. In the past, smallpox has been reported in mild, moderate and severe forms.
The following clinical forms of smallpox are distinguished.
A. 1. Normal: resolution (discrete), drain, non-drain.
2. Hemorrhagic: smallpox purpura (red smallpox), hemorrhagic-pustular (black smallpox).
3. Flat: resolution (discrete), drain, pour-over.
4. Modified: varioloid, smallpox in vaccinated people, smallpox without rash, smallpox without fever (afebrile), smallpox pharyngitis.
B. Alyastrim (disease synonyms: white smallpox, Cuban smallpox, smallpox, milkpox).
B. Smallpox of animals (cows, sheep, monkeys) in humans.
D. Smallpox from vaccination.
During smallpox, four periods are distinguished: initial, rash, suppuration of the rash, drying out and falling off of the crusts.
The initial period lasts 3-4 days. The onset of the disease is acute, body temperature rises with chills to 39-40 ° C. The patient complains of headache, muscle pain, and sometimes vomiting. Very characteristic of the initial period are pains in the sacrum and coccyx. On the 1st-2nd day of illness, a prodromal rash is possible - red, scarlet-like, and in severe cases - hemorrhagic in nature. The typical localization of the rash is on the inner thighs and lower abdomen (Simon's triangle), as well as in areas of the pectoral muscles and shoulder blades. The prodromal rash lasts from several hours to two days and disappears without a trace. In some cases, especially in children, delusions and hallucinations are observed.
The period of rash is characterized by a decrease in body temperature, an improvement in general condition and the appearance on the body on the 3-4th day of the disease of a dense roseolous-papular rash. The rash is characterized by stages: first, papules appear on the face and scalp. On the second day, the rash spreads to the torso, and on the third, it extensively covers the limbs. After 1-2 days, the papules turn into multilocular vesicles with umbilical involvement in the center and a nearby zone of hyperemia and infiltration. The vesicles are similar to pearls and are concentrated on the distal parts of the extremities, including the palms and soles. The depressions and pits (umbilical, subclavian, axillary) are usually free of rash. A characteristic feature of the rash is its monomorphism in certain areas of the body. By the 9-10th day of illness, papules gradually turn into vesicles on all areas of the skin. Vesicles also cover the mucous membranes soft palate, pharynx, bronchi, esophagus, vagina, conjunctiva, over time they burst and turn into erosions and ulcers.
From the 9-10th day of illness, the period of suppuration of the vesicles begins. Yellow pustules form, and multilocularity often disappears. At the same time, swelling and infiltration of the skin increase. The patient's general condition deteriorates sharply, body temperature rises to 40 ° C (second wave), tachycardia, muffled heart sounds, blood pressure decreases, bad breath, liver and spleen are enlarged. Delirium, convulsions, and loss of consciousness are often observed. Lymphocytosis changes to neutrophilic leukocytosis. . Such a serious condition of the patient can last 5-7 days.
From the 12-14th day of illness, a period of drying out and falling off of the crusts begins. The pustules gradually subside, some leak pus, which dries and scabs form. Unbearable itching often occurs. The general condition of the patients improves, the body temperature gradually decreases, and from the 22-24th day of illness the scabs begin to fall off, scars remain in places of deep damage.
The duration of smallpox without complications is 5-6 weeks.
At severe forms perhaps the drainage of individual vesicles with the formation of large blisters, which later suppurate - the confluent form. Such forms are fatal in 40-50% of cases.
Hemorrhagic-pustular form Initially it is difficult. IN initial period the rash is predominantly petechial. During the period of suppuration due to the development hemorrhagic syndrome blood sweats into the pustules, they become dark blue or even black (black pox). Such cases usually end in death. Smallpox purpura has a particularly malignant and fulminant course, in which a hemorrhagic rash with massive hemorrhages in the skin and bleeding (red smallpox) appears already in the initial period, and patients die with signs of infectious-toxic shock.
In rare cases, vaccinated people develop an abortive form of smallpox (varioloid) with a poor papular rash, which quickly turns into a vesicular rash, and the vesicles dry out very quickly, often without transforming into pustules.
Alyastrim is caused by a variant of the variola virus and is characterized by a slight fever without significant intoxication. Elements of a vesicular rash do not have a zone of hyperemia around them (white pox), do not turn into pustules, and scars do not form after the crusts fall off. Registered in South American countries.
Complications. In severe cases, abscess, phlegmon, osteoarthritis, scars on the cornea, as well as encephalitis, meningitis, necrotizing myocarditis, pneumonia, etc. are possible.

Smallpox prognosis

In the case of severe hemorrhagic forms of smallpox, the mortality rate reaches 100%. The overall mortality rate is 20-40%.

Diagnosis of smallpox

The main symptoms of the clinical diagnosis of smallpox are the acute onset of the disease, two-wave fever, pain in the sacrum and coccyx, prodromal rash (resh) in Simon's triangle, stages of the rash and monomorphism of the rash in certain parts of the body, multilocular vesicles with subsequent suppuration. Great value has an epidemiological history.

Specific diagnosis of smallpox

The material for research is the contents of vesicles and pustules. They use virusoscopy (electron microscopy), virology (infection of chicken embryos), and also serological methods- RIGA, RTGA, precipitation reaction in gel, fluorescent antibody method.

Differential diagnosis of smallpox

Differential diagnosis carried out with monkeypox, chickenpox, hemorrhagic diathesis, herpetic disease, toxicoallergic dermatitis, Stevens-Johnson syndrome.

Treatment of smallpox

All patients and those suspected of having smallpox are subject to immediate hospitalization and isolation. For treatment, specific gamma globulin and metisazone are used, and detoxification therapy is carried out. In case of secondary bacterial complications, as well as for prevention, broad-spectrum antibiotics are prescribed.

Prevention of smallpox

All patients with smallpox are subject to strict isolation until the scabs completely fall off. Persons who have had contact with patients are isolated for 14 days and are subject to vaccination. Medical supervision is carried out throughout the isolation period.
With a purpose emergency prevention Anti-sickness immunoglobulin is used. Thanks to the eradication of smallpox worldwide, routine smallpox vaccination has been abolished, except for those working with virus culture.