Introduction
Smallpox is an infectious and deadly disease caused by the Variola virus. It is a deadly and highly contagious disease that has plagued humanity for centuries. Smallpox was one of the most feared diseases in human history, killing up to 30% of those infected before it was declared eradicated in 1980 (Shchelkunova & Shchelkunov, 2022).
The origin of Smallpox is still unknown, but it is thought to have been endemic in humans since ancient times. The earliest evidence of Smallpox dates back to the 3rd century BCE in Egypt (CDC, 2019). Smallpox is spread through contact with an infected person or contaminated objects such as clothing or bedding.
The virus can also be spread by inhaling droplets from an infected person’s cough or sneeze. With this, Smallpox is considered an airborne disease. Smallpox is a disease that is still prevalent to date. Thus, the topic is vital in gathering updated information that can be useful in combating the disease in the future. Therefore, this assessment seeks to explore an in-depth analysis of Smallpox, its various causes and symptoms, and highlight some measures that can be undertaken to handle the disease.
Origin of Smallpox
Though its specific origin is unknown, Smallpox is believed to have been present in humans since ancient times. Smallpox is first evidenced in Egypt during the 3rd century BCE. Smallpox enormously affected European history from the Roman Empire to the 20th century (Shchelkunova & Shchelkunov, 2022). The death of an estimated 400,000 Europeans each year during the 18th century may have been caused by Smallpox or other infectious diseases (CDC, 2019). Historical analysis indicates that the disease spread in the 6th century through trade between Korea and China, which facilitated its transmission to Japan (CDC, 2019).
In the 7th century, Arab expansion spread to Portugal, Africa, and Spain. In the 11th and 15th centuries, the disease was spread by the religious crusades and the Portuguese individuals who visited West Africa (CDC, 2019). Research suggests that the 18th-century spread was spearheaded by Great Britain, which passed it to Australia. The trend shows a disease that quickly spreads from one country to another.
Some of the early control measures could have been more effective. Statistically, 3 out of 10 persons diagnosed with the disease died (Russo et al., 2020). The survivors were left with severe scars, which at times were life-threatening.
One of the earliest control methods was variolation, which proved effective (CDC, 2019). Variolation is a process in which the smallpox virus is transferred from the pustules of a vaccinated individual to the skin of a non-immune person. The method was used in China and India to prevent Smallpox. However, it was not widely accepted and was subsequently forgotten in the West. As a result, the practice of variolation was lost, and the disease continued to spread.
Modern vaccination was introduced by Edward Jenner in 1796 and is credited with being the first successful vaccine. In 1798, male children between 10 months and two years of age were vaccinated with cowpox. The following year, the procedures were extended to include adults.
England, Scotland, and Ireland became the first countries to receive smallpox vaccinations from Jenner’s method in 1802 (CDC, 2019). Vaccination spread throughout Europe after Jenner’s success, but was ineffective at controlling the disease. As a result, vaccination campaigns were introduced by Louis Pasteur, who recommended vaccination as a way to protect infants against Smallpox, as it had only recently been proven that adults could also receive immunity through vaccination.
Causes of Smallpox
Research by Russo et al. (2020, p. 333) affirmed that the Variola virus causes Smallpox. This type of poxvirus can cause either a mild or severe infection. Smallpox can be transmitted through droplets of fluid (containing the virus) that are coughed or sneezed into the air and then breathed into other people’s lungs. The increased incidence of Smallpox can be attributed to several factors, including trading networks that facilitated its spread, genetic changes in the virus, and its diminishing effectiveness due to natural selection.
Signs and Symptoms of Smallpox
The signs and symptoms of Smallpox typically appear 12 to 14 days after exposure, usually during the incubation phase of the disease. At this stage, the disease is not contagious, and the person does not feel signs of being sick (Shchelkunova & Shchelkunov, 2022). The second stage is the initial symptoms stage, which lasts 2 to 4 days after the incubation phase. In this step, some symptoms include light skin, fever, chills, sore throat, malaise, body aches, and headache. The disease is contagious (but not very deadly) at this stage. Even so, an individual usually needs help to undertake their normal activities effectively.
The early rash is the next stage that lasts for four days; at this stage, the individual is highly contagious. The individual develops rashes with red spots in the mouth and the tongue. The symptoms are followed by the appearance of a characteristic rash that often starts on the face and spreads to other parts of the body (CDC, 2019).
The rash can begin as small red spots that progress to raised bumps filled with pus-like fluid (pustules). The pustules then crust over and form scabs before finally falling off. Severe cases of the disease may also cause complications such as pneumonia, blindness, or even death.
It is essential to note that Smallpox can be confused with other viral diseases that cause similar symptoms, such as chickenpox (CDC, 2019). It is essential to consult a doctor immediately when any of the mentioned signs and symptoms are noticed. Such a step ensures that an individual undertakes a differential diagnosis, thereby ensuring the correct ailment is treated with the required urgency.
Pathogenesis of Smallpox
Pathogenesis refers to the process by which a disease develops and progresses. For Smallpox, the Variola virus enters through the respiratory tract and multiplies in the lymph nodes. The virus then enters the bloodstream and spreads to other parts of the body, causing a characteristic rash (Shchelkunova & Shchelkunov, 2022).
The rash can cause tissue destruction, leading to scabs and scars. In severe cases, it can also lead to death due to organ failure or overwhelming sepsis (infection). Understanding the pathogenesis of Smallpox is essential in developing effective treatments and prevention methods.
The virus is highly contagious and causes inflammation of the lining of a person’s intestines, lungs, and skin. According to Russo et al. (2020), this leads to vesicles that burst either due to their own pressure or in response to irritation by other cells. This, in turn, causes the release of newly infected viral particles.
Also, the virus might be transferred by touching contaminated materials, including contaminated clothing and bedding or body fluids. Respiratory secretions and pustular fluid containing the virus are the most infectious body fluids (Russo et al., 2020). The virus is then spread through droplet infection: microscopic droplets released into the air by infected individuals when they cough or sneeze. Breathing in these droplets is the primary way Smallpox is passed from person to person.
Epidemiology Evaluation of Smallpox
While evaluating Smallpox, it is vital to understand the epidemiological pattern of the disease. The virus is seriously contagious and can spread rapidly in certain conditions (Russo et al., 2020). It is estimated that one infected person can spread the virus to up to 10 other people. In addition, Smallpox has an incubation period of 12 to 14 days, which means that people may be infected without showing any symptoms, yet still spread the virus. Moreover, Smallpox is endemic in certain parts of the world, including Africa and Asia.
The disease can be fatal or lead to severe disfigurement in many infected individuals. A global vaccination program led by the World Health Organisation and the United States during the 1970s successfully eliminated Smallpox (Shchelkunova & Shchelkunov, 2022). Such efforts have proved effective in ensuring that the disease is not found anywhere today.
Prevention Mechanism for Smallpox
Dealing with a disease like Smallpox requires that effective preventive measures be evolved to ensure sustained control. The statement implies that a uniform vaccination program effectively eliminates the disease. The principal method of preventing Smallpox is through vaccination, with a vaccine that has been in use since 1796 (Russo et al., 2020).
Individuals vaccinated are protected from developing Smallpox if they come into contact with the virus. The vaccine is made from a live but weakened form of the smallpox virus called vaccinia (‘cowpox’). Vaccination consists of infecting an individual with the vaccinia virus, which stimulates the body to produce antibodies against Smallpox.
Diagnosis Assessment for Smallpox
Hutson et al. (2021) affirm that the diagnosis process deals with determining whether a person has or has not been infected with the disease. In addition to looking at the signs and symptoms, specific tests can be conducted to determine if an individual has been infected. If a person is suspected of having Smallpox, they are immediately isolated and treated via conventional antibiotic treatment (CDC, 2019). This can limit the spread of the virus throughout society.
Additionally, it is often vital to ensure that proper confirmation takes place within a short timeframe to prevent the further spread of the disease within society to those who have not been infected yet but may be exposed inadvertently. Hence, there are often tests that can be carried out on blood and tissue samples to determine if the person has been infected with the virus.
The diagnosis process for Smallpox is based on a combination of clinical signs and symptoms, as well as laboratory testing. The presence of the smallpox rash, fever, headache, and muscle aches is usually enough to make a diagnosis. However, confirmatory testing can be helpful in some instances, such as when there is a history of contact with an infected person.
It can also help when the infection is suspected to be caused by a bioterrorist attack. In these cases, laboratory tests may include PCR (polymerase chain reaction) and ELISA (enzyme-linked immunosorbent assay) (Taube et al., 2022). Undertaking smallpox diagnosis is vital because it helps to ensure that affected individuals receive the appropriate treatment and that public health measures are taken to prevent further spread. Additionally, it is crucial to monitor the effectiveness of public health interventions and track any new cases of infection.
The differential diagnosis for Smallpox includes rashes caused by other factors, such as chickenpox, shingles, and syphilis. Other forms of the disease, such as Monkeypox, are also dissimilar to Smallpox and can thus be differentiated (Taube et al., 2022). The caregivers should be able to determine the exact form of the disease and prescribe treatments and preventive measures that suit each patient.
Pre-recovery management involves stabilizing an individual who may have been exposed to the smallpox virus. This is done by treating them with antibiotics, fluids, and other supportive measures. The caregivers often use this time to isolate the patient from other people and continue ongoing diagnostic tests. This aims to ensure that a person does not worsen their condition before any definitive diagnosis has been made (CDC, 2019).
Post-recovery management includes monitoring and providing care for someone who has recovered from Smallpox. This goal may also include preventing infections from occurring by monitoring individuals who have been vaccinated.
Post-exposure management is also intended to prevent a person from determining that they have been exposed to the smallpox virus. Specific diagnostic tests determine whether an exposure has occurred (CDC, 2019). Healthcare workers and clinical staff must be prepared to perform these tests when diagnosing and treating individuals who may have been infected with the virus. After being treated with antibiotics, it is sometimes possible for somebody who has developed Smallpox to develop complications such as pneumonia or meningitis. Hence, there is a need to provide adequate care for these persons and manage these conditions to ensure they do not worsen.
Before the implementation of vaccination campaigns, as with all diseases, fears and misconceptions often arose due to a lack of understanding of the disease itself (Taube et al., 2022). Because there were not many cases reported in Europe at this point, it was thought that this disease was not expected. Thus, it led to a need for more awareness about its effects, leading to many false beliefs about the disease. It was also due to misconceptions about the symptoms and progression of Smallpox.
Treatment for Smallpox
When dealing with a disease such as Smallpox, it is essential to understand how the medical community treats it. Currently, there is no specific treatment for Smallpox, but the treatment is focused on supportive care, which can help reduce symptoms and prevent death.
Vaccination
The recommended treatment for smallpox infection is vaccination within three days of contraction. This decreases mortality rates from 30–35 percent to less than 1 percent in cases stemming from a population with a high vaccination rate (Hutson et al., 2021). Treatment consists of antibiotics, including tetracycline and penicillin, for those not vaccinated. However, antimicrobial resistance is likely to be a significant issue as the disease becomes common again.
Anti-Viral Drugs Usage
Various drugs may be used to treat the disease when contracted, and the World Health Organization has been collaborating with countries around the globe to ensure these drugs are available and easy to administer (Hutson et al., 2021). This includes using various anti-virals such as brincidofovir, tecovirimat, and cidofovir.
With the growing advancement in technology, it is possible to develop new substances that can target and infect the virus. For example, a nucleoside analog could block or prevent the virus from replicating and further infecting a patient (Taube et al., 2022). This substance would prevent the virus from reproducing in vivo, significantly limiting the disease’s spread. Other methods include using monoclonal antibodies that can specifically bind to viral material and prevent the formation of new viruses.
Brincidofovir (TEMBEXA)
The treatment drug was approved in June 2021 by the Federal Drug Administration (FDA) for the treatment of Smallpox in patients 12 years and older who have been previously vaccinated for the disease and are suffering from the development of rash and show symptoms of the disease (CDC, 2019). This drug is an oral anti-viral compound composed of CMX001 and CMX003, initially developed to treat adenovirus infections in children. It has been approved only under a ‘treatment use’ application by the FDA, so it must be administered under clinical supervision. Conversely, people who have undergone bone marrow transplants can experience side effects such as diarrhea, abdominal pain, and vomiting.
Tecovirimat (TPOXX)
The drug was approved in July 201 by the FDA. The drug tends to hinder the growth of the virus and has been effective in treating other diseases similar to Smallpox, specifically in animals (CDC, 2019). The drug has minor side effects and is used to treat Smallpox in people who have not been vaccinated. It is also under investigation to test whether it can combat the adverse effects of vaccinia virus vaccination.
Cidofovir
The drug is also under investigation to test whether it can combat instances of Smallpox. It has not been tested in persons suffering from Smallpox, but has been applied to healthy persons and those with other viral diseases (CDC, 2019). The tests are still being undertaken to understand the overall effectiveness and the toxicity level associated with the drug.
The above drugs are examples of anti-virals that are applicable for the treatment and management of Smallpox. They also provide effective treatment for the common diseases associated with Smallpox (CDC, 2019). Extra care is required when administering these drugs due to the effectiveness of their treatment and side effects (CDC, 2019).
A wide variety of treatments are being used worldwide for Smallpox. These include anti-inflammatory drugs, steroids, intravenous immunoglobulin, and other antibodies (Hutson et al., 2021). As mentioned previously, vaccinations develop immunity against Smallpox, which means that patients’ immune systems cannot be affected by this disease when vaccinated. Thus, they take precautions to avoid getting sick. Anti-virals, however, do not affect the patient’s immune system, which specifically targets this disease.
Novel Disease Control Plan
Even though studies suggest that there has been a thorough eradication of the disease, Ilic et al. (2022) write that it is vital to consider the possibility of its emergence in the future. This implies that the international community is aware of the possible resurgence of the disease in the form of a biological weapon or attack. As a result, it is advisable to develop a novel plan to ensure reduced catastrophe.
Threat (Bioterrorism)
In the case of a bioterrorist attack, Ilic and Ilic et al. (2022) advocate for effective management and communication links that ensure efficient containment of the threat. The process can be conducted by having a central coordinating authority to which local governments can report outbreaks and request assistance from humans, materials, and facilities. This is because local governments are unable to deal with such an attack, as they lack adequate technology, funding, and resources (Ilic & Ilic, 2022). The central coordinating authority must ensure that it maintains communication links with local governments and, at the same time, be able to coordinate with the international community in the event of such an occurrence.
Another critical part of this plan is providing information about specific situations that may occur during an attack. This includes outbreaks in different regions and threats from different sources, such as chemical, biological, or radiological weapons attacks (Hutson et al., 2021). This information must be made available to the general public and organizations to provide a comprehensive understanding of what is happening. This will ensure adequate resources and personnel are available to combat the situation and assist in its containment.
Preparedness
Preparedness is also advisable as it is a necessary measure of action that can be undertaken when dealing with biological warfare threats. This will ensure an adequate supply of vaccines and other essential medications in the event of an outbreak (Ilic & Ilic, 2022). This is especially important since such an attack may occur unexpectedly and at any time, and the citizens will need more time to prepare themselves properly. Preparedness helps ensure that medical facilities, supplies, and personnel are readily available to effectively respond to the situation at hand.
Prompt Detection and Response
The final crucial aspect of this plan is a detailed plan for achieving rapid containment and eradication of disease outbreaks suspected of being caused by foreign sources (CDC, 2019). The prospect is that the authorities need a swift detection and response protocol to effectively combat security and health threats (CDC, 2019). This needs to be done with the World Health Organization and other relevant organizations to provide a more effective response and plan to combat such threats.
Developing an efficient, centralized coordinating authority is one of the most critical aspects of this plan, as it will ensure that all local governments have access to adequate information that will allow them to respond effectively when an outbreak occurs. Another part of this plan that is equally important is the creation of an effective communication network between the central coordinating body and all relevant parties, which ensures that any reports can easily be sent and received.
Conclusion
In summary, Smallpox is a highly infectious and sometimes fatal disease. The vaccination for Smallpox has drastically reduced the spread of the disease. According to the CDC, a successful global vaccination ensures the disease is eradicated (CDC, 2019).
Despite this, there are currently no approved treatments for the smallpox virus, so no specific and direct anti-viral medications can effectively treat the disease. The fast and effective treatment for this disease comes from vaccines and immunization procedures that successfully prevent infection with the smallpox virus. However, since the vaccine is highly effective, people must stay active with its use and continue to vaccinate, since it is believed that Smallpox will return in the future.
References
Centers for Disease Control and Prevention (CDC). (2019). Smallpox | CDC. Centers for Disease Control and Prevention. Web.
Hutson, C. L., Kondas, A. V., Mauldin, M. R., Doty, J. B., Grossi, I. M., Morgan, C. N., Ostergaard, S. D., Hughes, C. M., Nakazawa, Y., Kling, C., Martin, B. E., Ellison, J. A., Carroll, D. S., Gallardo-Romero, N. F., & Olson, V. A. (2021). Pharmacokinetics and efficacy of potential Smallpox therapeutic, Brincidofovir, in a lethal Monkeypox virus animal model.” mSphere, 6(1). Web.
Ilic, I., & Ilic, M. (2022). Historical review: Towards the 50th anniversary of the last major smallpox outbreak (Yugoslavia, 1972). Travel Medicine and Infectious Disease, 48, 102327. Web.
Russo, A. T., Grosenbach, D. W., Chinsangaram, J., Honeychurch, K. M., Long, P. G., Lovejoy, C., Maiti, B., Meara, I., & Hruby, D. E. (2020). An overview of tecovirimat for smallpox treatment and expanded anti-orthopoxvirus applications. Expert Review of Anti-infective Therapy, 19(3), 331–344. Web.
Shchelkunova, G. A., & Shchelkunov, S. N. (2022). Smallpox, Monkeypox, and other human Orthopoxvirus infections. Viruses, 15(1), 103. Web.
Taube, J. C., Rest, E. C., Lloyd-Smith, J. O., & Bansal, S. (2022). The global landscape of smallpox vaccination history and implications for current and future orthopoxvirus susceptibility: A modeling study. The Lancet Infectious Diseases, 1-8. Web.