Abstract

In conclusion, smallpox was a very demanding viral disease the affected the entire world.  It was such a largely widespread disease, that was around for a very long time, that it was a huge thing when smallpox became eradicated.  The different stages of signs and symptoms were discussed, as there are six of them.  With the early rash stage being the most contagious and is the point in which the smallpox starts to spread throughout the majority of the body during this stage.  As people were infected with smallpox, they were given a vaccination.  But still to this day there are many people that get the smallpox vaccination if they are going to parts around the world that still could be thought as having the potential of a smallpox outbreak.  As there is also antiviral drugs for smallpox as well, they are kept for the instance that there is a mass outbreak, as they were not yet tested on humans that are infected with smallpox.  They have only been tested on humans that are healthy.  It was also discussed that there was there were many ways that were tested on humans to try and find a vaccination for smallpox.  It was found that Jenner was the man that had first discovered the first vaccination that had begun the global eradication. Lastly, it was discussed that there is no current need for smallpox treatments, however it has been actively discussed that there could be a potential that smallpox could be an agent of bioterrorism.

Smallpox

In this paper, smallpox will be discussed.  It will be discussed as to what the nature of the disease is, along with what the symptoms, prevention and treatment of the disease is as well.  As smallpox was eradicated, it will be discussed as to how smallpox did affect the population.  Along with how smallpox came to be eradicated in the world.  There is a vaccination for smallpox, as well as antiviral drugs that will be discussed.

It has been thought by many that smallpox has been around for a very long time.  It’s thought that smallpox goes way back to the Egyptian Empire around the 3

^rd

century BCE.  Since then, smallpox has been a viral disease that has been eradicated.  In 1977 is when it was eradicated globally.  It was an acute contagious viral disease that was caused by the variola virus.  As smallpox spread from one person to another, “most people with smallpox recovered, but about 3 out of 10 people with the disease died” (CDC).

There are different stages of the signs and symptoms of smallpox that one will go through if they are unfortunately infected with the disease.  These stages have different signs and symptoms within each one.  The order of these stages is as follows: incubation period, initial symptoms, early rash, pustular rash and scabs, scabs fall off, and then no scabs.  The incubation period stage is the first stage.  There are typically no signs or symptoms within this stage that would make one feel that they are infected with the smallpox virus.  During this stage, the body is usually infected for about an average of one week or two weeks before it can tell that it is in fact sick.  At this point, a person is not contagious.  The initial symptoms stage is the second stage.  During this stage, one will start to feel some symptoms: high fever, head and body aches, sometimes vomiting, and normal day to day things will begin to feel hard to do. This can last from two to four days and it is not always contagious during this point.  The next stage is known to be the worst stage, the early rash stage.  About halfway through the stages now, this is the most contagious time during the smallpox viral infection.  Many different things happen during this short stage that only tends to last about four days long.  One will start to see small red spot on their tongue and mouth, that will resemble what looks to be a rash.  Unfortunately, these spots turn into sores and they begin to spread more in the mouth and in the throat.  But this is not where it stops, the sores start to spread outside of the mouth and onto the skin.  Typically, within about twenty-four hours, the entire body will be covered.  The only benefit of this would be that the fever will decrease and one might start to not feel the “sick” symptoms anymore.  These sores will start to look bad as they are beginning to fill with opaque liquid. This liquid in the sores can cause the fever to come back and it will remain with the person until a scab starts to form over these bumps.  The next stage is called the pustular rash and scabs stage.  One will still be contagious during this stage that can last about up to ten days.  This stage is called pustular rash because the sores start to become pustules.  This means that it looks like someone has peas under their skin, because the sores have raised and they are now particularly round and firm.  About halfway through this stage there will be scabs that begin to form over almost all the sores.  Although scabs are starting to form, one will still be contagious during this stage.  There is not too much that seems to happen in the next stage.  This stage is called scabs fall off.  What happens during this stage is just that, the scabs begin to fall off.  This stage can last up to about six days and one will still be contagious.  Finally, there is the no scab stage.  During this stage, all the sores will have scabbed and fallen off and the person is not contagious anymore.  In total, these stages equal to about four weeks that a person will be infected with the smallpox virus.  Now that all the signs and symptoms have been introduced, we can discuss how to prevent and treat this disease.

There are many people that get the smallpox vaccine so that their body can develop an immunity to smallpox.  For example, a military member will get a smallpox vaccine, along with many other vaccinations, so that they can be safe from certain viruses and disease that are located around the world.  The vaccinations for smallpox consists of a live vaccinia virus.  Therefore, you will get a bump on your arm after being vaccinated that you have to take safe care of to prevent the virus from spreading.  These vaccinations can protect someone from getting smallpox for about three to five years.  After the three to five years, there is a booster that can be given to someone if they will need longer protection.  It has been proven that the smallpox vaccine has been 95% effective.

There is a vaccine to prevent and control smallpox, along with an antiviral drug that can treat and prevent smallpox from getting any worse.  However, there is isn’t effective treatment that has been proven to treat people that have smallpox.  There are different stages to getting the vaccination before the it will not help you any longer.  You can get the vaccine “before contact with the virus, the vaccine can protect you from getting sick.  Within 3 days of being exposed to the virus, the vaccine might protect you from getting the disease.  If you still get the disease, you might get much less sick than an unvaccinated person would.  Within 4 to 7 days of being exposed to the virus, the vaccine likely gives you some protection from the disease. If you still get the disease, you might not get as sick as an unvaccinated person would” (CDC).  The only time that the vaccine will not help you, is when you have already developed the smallpox rash.  As smallpox has been eradicated, the smallpox vaccine is not always available to the public.  In preparation for the instance that the smallpox virus did come back, there is enough vaccinations, one for every person, in the United States.

There are some antiviral drugs that have been approved and/or tested for the treatment of smallpox.  Tecovirimat (TPOXX) is an FDA approved antiviral drug that has been approved for smallpox treatment since 2018.  This antiviral drug has been tested in a lab, in which it has been shown to be effective against the virus that causes smallpox.  Tecovirimat has been tested on animals, but it has not been tested on humans that are infected with smallpox.  It has only been given to healthy humans and it has been shown to be safe, there are just only a few side effects, as for anything that you take.  There is also Cidofovir and Brincidofovir, that has been deemed effective against the virus that causes smallpox.  It is fairly that same tests as Tecovirimat, as it has been tested on animals and only on animals, but not on humans who have been infected with smallpox.  The difference is that Cidofovir and Brincidofovir are not FDA approved as it is still being evaluated for the effectiveness and toxicity that it might have.  Although these have been not been tested on humans that are infected with smallpox, the CDC is still stockpiling these antiviral drugs so they can be considered if there is ever a smallpox outbreak.

As stated before smallpox has been eradicated, therefore there isn’t any evidence that smallpox is affecting anyone currently in the world.  However, there was a point in time when the world was largely infected with smallpox.  According to the World Health Organization (WHO), “most countries in Western Europe and North America had almost eliminated smallpox whilst the countries across South America, Africa and Asia, especially India, still recovered very large numbers” (Ochmann, 2019).


Appendix A is a graph that will show the number of cases of smallpox that were reported in 1950.

Global eradication seems to be a hard thing to achieve, but it was achieved by the discovery of variolation.  The first form that was discovered, was breathing in dried smallpox scabs by the nose.  “Another commonly practiced technique encompassed the injection of the liquid found inside the pustules of a smallpox patient underneath the skin of a healthy person. This would usually result in a milder infection of smallpox after which the person was immune against the disease” (Ochmann, 2019).  There was only one issue that arose with variolation.  This was that as a person was mildly infected with the disease, they then became a carrier and could infect someone with smallpox.  There was also no control over how infected someone would become.  They could either become mildly infected or they severely infected, there was no way to control it.  It wasn’t until Edward Jenner, that the first vaccination was created.  “In May 1796, Jenner inoculated a boy with cowpox, and then a few months later with the smallpox virus. When the boy did not develop any smallpox symptoms in response to being variolated, his hypothesis of the cowpox offering protection from smallpox was confirmed motivating his further research trials” (Ochmann, 2019).  You can imagine how hard it would be to get your findings to everyone that is struggling with this infection across the world.  Jenner was rejected and told not to pursue his findings.  That did not last for long when he started to become recognized in 1802.  After that, the vaccination had begun to spread.  After this, there was a major decline in the number of deaths there were due to smallpox.  Before the vaccination was discovered, there was an average of 7.6% of deaths in the world, due to smallpox.  After the vaccination started spreading throughout the world, there was an average drop of deaths in the world, that reached a low of .30% by 1902.

As this disease is eradicated, there is no current need for further treatments now.  However, there is always the chance that smallpox could be a potential agent of bioterrorism.  Just as anthrax was once used throughout the postal system, smallpox has the potential to also become a form of an attack.  “Among those agents identified by the Centers for Disease Control and Prevention as a ‘Class A Bioterrorist Threats’, smallpox is among the most dangerous (Whitley, 2003).  It is considered to be the most dangerous because there is no immunity to smallpox around the world.  Smallpox, unfortunately, would not be hard to spread.  Therefore, there would need to be a very large amount of vaccinations that would need to be available.  There are some places that have stockpiles of the vaccination just for this reason.

In conclusion, smallpox was a very demanding viral disease the affected the entire world.  It was such a largely widespread disease, that was around for a very long time, that it was a huge thing when smallpox became eradicated.  The different stages of signs and symptoms were discussed, as there are six of them.  With the early rash stage being the most contagious and is the point in which the smallpox starts to spread throughout the majority of the body during this stage.  As people were infected with smallpox, they were given a vaccination.  But still to this day there are many people that get the smallpox vaccination if they are going to parts around the world that still could be thought as having the potential of a smallpox outbreak.  As there is also antiviral drugs for smallpox as well, they are kept for the instance that there is a mass outbreak, as they were not yet tested on humans that are infected with smallpox.  They have only been tested on humans that are healthy.  It was also discussed that there was there were many ways that were tested on humans to try and find a vaccination for smallpox.  It was found that Jenner was the man that had first discovered the first vaccination that had begun the global eradication. Lastly, it was discussed that there is no current need for smallpox treatments, however it has been actively discussed that there could be a potential that smallpox could be an agent of bioterrorism.

References

• Centers for Disease Control and Prevention.
  
  What is Smallpox?
  
  Retrieved from: https://www.cdc.gov/smallpox/about/index.html
• Ochmann & Roser (2019).
  
  “Smallpox”.
  
  Retrieved from: https://ourworldindata.org/smallpox
• Whitley (2003).
  
  Smallpox: A Potential Agent of Bioterrorism.
  
  Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/12615298

Appendix A

Number of Smallpox Cases Reported in 1950