Nursing Paper Example on Smallpox

Smallpox, caused by the variola virus, is a highly contagious and potentially deadly disease that historically led to widespread epidemics. Although eradicated in 1980 following an intense global vaccination campaign, smallpox remains of interest due to its potential as a bioterrorism threat.

Nursing Paper Example on Smallpox

Etiology and Pathophysiology

Variola Virus

Smallpox is caused by the variola virus, a member of the Orthopoxvirus genus. The virus has two main strains: variola major and variola minor, with variola major being the more virulent form, often causing death in 30% of cases (Fenner et al., 1988). Variola minor, also known as alastrim, has a significantly lower fatality rate, usually less than 1% (CDC, 2016).

Mechanism of Infection

The variola virus enters the body through respiratory droplets and replicates in the lymph nodes before spreading to the bloodstream in a primary viremia phase. It then infects cells in the skin, causing the characteristic pustular rash (Moss, 2007). The virus spreads to internal organs, leading to a secondary viremia, which is associated with more severe systemic symptoms and widespread rash formation.

Transmission

Modes of Transmission

Smallpox is primarily transmitted through inhalation of airborne droplets from coughs, sneezes, or close contact with infected individuals. The virus can also spread through direct contact with body fluids or contaminated objects, such as bedding or clothing (Henderson et al., 1999). Rarely, airborne transmission occurs in enclosed spaces, increasing the potential for outbreaks in densely populated areas.

Incubation and Infectivity

The incubation period for smallpox ranges from 7 to 17 days. During this time, the infected person is not contagious. Infectivity begins with the onset of fever and increases as the characteristic rash develops. Individuals remain infectious until all scabs fall off, usually about three weeks after the onset of symptoms.

Clinical Features

Prodromal Phase

The initial symptoms of smallpox, known as the prodromal phase, include high fever, malaise, severe headache, and back pain. This phase typically lasts 2–4 days and marks the beginning of infectiousness.

Rash Development and Disease Progression

Following the prodromal phase, a distinctive rash appears, first on the face and extremities, before spreading to the trunk. The rash progresses in stages:

Macules: Small, flat lesions appear on the skin.
Papules: Lesions become raised and palpable.
Vesicles: Fluid-filled blisters form.
Pustules: Blisters fill with pus and develop a dimpled appearance.
Scabs: Pustules eventually scab over and fall off, often leaving scars (CDC, 2016).

Types of Smallpox

Ordinary Smallpox: The most common form, characterized by extensive rash and a high fatality rate.
Modified Smallpox: Milder form seen in vaccinated individuals.
Flat Smallpox: Severe variant with confluent, flat lesions and a high fatality rate.
Hemorrhagic Smallpox: Rarest and deadliest form, characterized by bleeding in the skin and mucous membranes, often fatal within a week (Fenner et al., 1988).

Diagnosis

Clinical and Laboratory Diagnosis

Diagnosis of smallpox relied heavily on clinical features, as the disease presented with a distinctive rash pattern. Confirmation was typically done using laboratory tests such as polymerase chain reaction (PCR) to detect variola DNA or electron microscopy to visualize the virus. In the past, these tests were performed in specialized laboratories due to the high infectivity and biohazard risk of the variola virus (CDC, 2016).

Historical Context and Eradication

Impact and Epidemics

Smallpox has affected humans for thousands of years, with historical records documenting its presence in ancient civilizations across Asia, Africa, and Europe. Major epidemics resulted in high mortality and disfiguring scars among survivors, profoundly influencing societies and altering population structures.

The Eradication Campaign

The World Health Organization (WHO) launched an ambitious global eradication program in 1967, implementing mass vaccination, surveillance, and containment strategies worldwide. This program achieved success when the last naturally occurring case was reported in Somalia in 1977. In 1980, the WHO declared smallpox eradicated, marking the first successful eradication of a human infectious disease (Henderson, 2009).

Post-Eradication and Bioterrorism Concerns

Following eradication, the only known stocks of variola virus remained in two secure laboratories in the United States and Russia. Concerns about the potential use of variola virus as a biological weapon led to ongoing research into antiviral therapies and improved diagnostic tools to manage any future outbreak risk (Moss, 2011).

Treatment and Prevention

Treatment Options

Since there is no cure for smallpox, treatment primarily focused on symptom relief and managing complications. Supportive care, including hydration, fever management, and wound care, was essential for patient survival. In recent years, antiviral drugs like tecovirimat have been developed and are approved to treat smallpox in case of an outbreak, though human efficacy data is limited (FDA, 2018).

Vaccination

Vaccination played a central role in smallpox prevention and eradication. The smallpox vaccine, made from the related vaccinia virus, is highly effective in preventing infection and reducing disease severity if given shortly after exposure. Vaccination is no longer routine, but stockpiles are maintained for emergency use due to bioterrorism concerns (CDC, 2016).

Current Research and Surveillance

Ongoing research on smallpox focuses on improving vaccines and antiviral treatments to address bioterrorism risks. New vaccine formulations, such as modified vaccinia Ankara (MVA), are being developed to provide safer alternatives with fewer side effects, particularly for immunocompromised individuals (Kennedy et al., 2019). Additionally, enhanced diagnostic techniques aim to detect orthopoxvirus infections rapidly in case of an emergency.

Conclusion

Smallpox was a devastating disease with severe morbidity and mortality until its eradication in 1980. The global vaccination campaign and vigilant containment measures led to one of humanity’s greatest public health achievements. However, concerns about bioterrorism have kept smallpox in the realm of scientific and public health focus. Advances in antiviral therapies, diagnostic tools, and vaccine development ensure preparedness should the need for response arise. Understanding the history, clinical features, and eradication of smallpox underscores the importance of vigilance in infectious disease control and the potential of public health interventions.

References

Centers for Disease Control and Prevention (CDC). (2016). History of smallpox. https://www.cdc.gov/smallpox/history/history.html

Fenner, F., Henderson, D. A., Arita, I., Jezek, Z., & Ladnyi, I. D. (1988). Smallpox and its eradication. Geneva: World Health Organization. https://apps.who.int/iris/handle/10665/39485

Food and Drug Administration (FDA). (2018). FDA approves the first drug with an indication for treatment of smallpox. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-indication-treatment-smallpox

Henderson, D. A. (2009). Smallpox: The death of a disease. Prometheus Books. https://books.google.com/books?id=DJ_8Uw5V_LkC

Henderson, D. A., Inglesby, T. V., Bartlett, J. G., et al. (1999). Smallpox as a biological weapon: Medical and public health management. JAMA, 281(22), 2127–2137. https://jamanetwork.com/journals/jama/fullarticle/189864

Kennedy, R. B., Ovsyannikova, I. G., & Poland, G. A. (2019). Smallpox vaccines for biodefense. Vaccine, 37(6), 748-754. https://doi.org/10.1016/j.vaccine.2018.12.040

Moss, B. (2007). Poxvirus entry and membrane fusion. Virology, 344(1), 48-54. https://doi.org/10.1016/j.virol.2005.09.037

Moss, B. (2011). Smallpox vaccines: Targets of protective immunity. Immunological Reviews, 239(1), 8-26. https://doi.org/10.1111/j.1600-065X.2010.00978.x

Nursing Paper Example on Smallpox