Medical - Epidemiology: Smallpox
Description of Disease/History
Many believe variola, the virus responsible for smallpox, originated during the times of Ramses V of Egypt, around 1157 BC, "as evidenced by his scarred mummified remains" (Mackelprang, Mackelprang and Thirkill 119). The disease is permanently scarring to those infected, and very difficult to recover from. There are entire populations that were eradicated due to smallpox infestation during early history, and it was only until the mid 1900s when the last reported case was documented in the United States; Worldwide the last case was reported in 1977 (Mackelprang, Mackelprang and Thirkill 119).
Smallpox originates from a microscopic organism known as variola, which some describe as a "despised enemy of civilizations around the world" (Koplow 1). Smallpox was identified more than 30 years ago, and since then many believe it is among the leading killers of human beings, known to inflict on human beings pain, death and much suffering in the process (Koplow, 2003). During the 20th century reports suggest that more than 500 people became infected with small pox, and while there are now tools and treatments doctors can use to help save lives, it is still largely responsible for the deaths of millions of people every year (Koplow, 2003).
Smallpox is a virus, which is one of the reasons it is so volatile. Unlike many bacterial infections, people cannot combat smallpox using antibiotics, because antibiotics are only useful for killing bacteria and related infections. Currently according to records scientists are aware of, as of 2003 there were only two vials of the destructive organism held in isolation at the Centers for Disease Control and the Research Center of Virology in Russia (Koplow 2). Most prefer that the disease be completely annihilated, although this may be impossible because it is unknown whether terrorist groups or other agents may also have vials of the virus in hiding, preparing them for use as biological weapons. While this seems unlikely, there are factors that would prevent 100% extinction of the virus may not be possible because there are always advocates that suggest it is not alright to eradicate a virus no matter how deadly because that would artificially interfere with the natural organisms that live on the earth (Koplow 2). While it seems impossible that anyone would still want this disease to "hang around" there are groups that believe that if nature intended something, it should stay (Koplow 2).
How Spreads/Transmission/Causes & Risk Factors
Smallpox is a disease that has affected human beings since "antiquity" with the "invisible virus" infecting entire communities at a time, "proving fatal to nearly one-third of all victims" (Koplow 9). The more frequent signs and symptoms of the disease include a high fever that may last over a period of two weeks, accompanied by skin eruptions of blisters, and damage to the internal organs of those infected by the same blisters that erupted on the surface of the skin (Koplow 2003; Giblin, 1995). Typically it takes a person that is infected up to five or six weeks to become fully infected, and those that are infected are not "infections" for one to two weeks after exposure, after which time it is extremely contagious, from the moment a person demonstrates symptoms until "all scabs have fallen off the body" which may last four weeks (CDC, 2002; Mackelprang, Mackelprang and Thirkill, 2005).
Problems associated with death and viral "replication" include hemorrhaging, organ contamination, "coagulopathy and encephalitis" (Mackelprang, Mackelprang and Thirkill, 2005). Secondhand contact involving the touching of one's garments or towels used to clean can result in sickness.
Just having contact with a person infected could result in contagion. The last person known to be infected with the disease in the United States was in 1947, when a person traveled from Mexico and then into the United States; the individual in question has wandered throughout New York City before he was soon diagnosed with the deadly disease, which resulted in vaccination of people, which doctors felt was the best possible protection (Spiegel, Kavaler and Kucinski 392).
Smallpox is often considered one of the most "serious of the communicable diseases with a death rate of up to 40%" (Spiegel, Kavaler and Kucinski 392). In early history it was easily spread through direct or indirect communication with others as are most viruses. Smallpox results in tiny "lesions" that look like "pimples' that break out on the skin of those afflicted with the disease; other symptoms include pain in the back, fevers that do not subside and other subtle symptoms including sleep disturbances (Spiegel, Kavaler and Kucinski 392). While it is similar to measles with respect to appearance, the disease is far more deadly.
Test & Diagnosis
Many people with smallpox were initially diagnosed on symptoms alone, as smallpox was often spread pandemically. People afflicted could contaminate entire cities, thus entire cities were often quarantined to prevent further spread of the disease. Today there are no cases of smallpox that are known of, as the last official case was diagnosed in 1977, and none have been diagnosed since them. Typically diagnosis would involve an investigation of symptoms that would include the raised red lesions associated with the disease accompanied with back pain and high fever that would last throughout the course of the disease.
Many believe the only cure for smallpox is prevention, which is why so many people are fervently in favor of eradicating the disease entirely. While there was no cure for smallpox during early history, during the middle 1700s researchers learned that it was possible to use materials from the udders of cows that had smallpox to infect human beings minimally, so their bodies could build antibodies to the related "cowpox" and thus became less likely to contract deadly forms of smallpox (Spiegel, Davaler and Kucinski 392). From this discovery vaccinations became readily available although there was much controversy regarding the efficacy of the vaccine.
Smallpox as Weapon
Spiegel, Kavaler and Kucinski (2005) are but a few of many researchers that have spoken out against the threat of terrorist attacks involving biological weapons including smallpox. The authors note that such fears have become more prevalent since the attacks of 9/11, where some evidence suggested the possibility that vials of smallpox were available to terrorists groups (Spiegel, Kavaler and Kucinski 391). There is much evidence however, suggesting such fears are not supported by evidence, and many suggest that reports or threats made regarding smallpox are more the result of public hysteria or fear over the improbably likelihood that smallpox could be used on a wide scale basis to terrorize the world as we know it today (Spiegel, Kavaler and Kucinski, 2005).
There is evidence however that during the mid 1700s, during the time of the French and Indian Wars, there was some talk of using smallpox on tribes of Indians living in America, because the disease was still endemic in regions of the world including in Africa; many believed slave traders could have "inadvertently engaged in bioterrorism and contributed to the spreading of the disease in America" (Spiegel, Kavaler and Kucinski 392). However, much of the evidence suggests this spread was by accident rather than by purpose, as even terrorists recognize the debilitating effects resulting from the use of such a volatile virus on human life.
In modern society the prognosis would be much better than it would have been during the 18th century. There is available to doctors a vaccination that could prevent the disease from spreading should someone carrying the disease begin to spread it. There is however, much controversy as to whether the benefits of using the vaccine outweigh the risks involved with using the vaccine. Annas (2003) notes that the "benefits" of the vaccine are as yet, truly "unknown," because the CDC is hesitant to provide…