Be alert to contagious smallpox

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

Biological warfare and bioterrorism is the intentional use of organisms to harm or kill people. Smallpox probably was the first used as a biological weapon during the French and Indian Wars (1754-1767). Soldiers distributed blankets that had been used by smallpox patients with the intent of initiating outbreaks among American Indians.

Smallpox, was eradicated from the world in 1977. Three years later, the World Health Assembly recommended an end to routine vaccination.

Smallpox is caused by the variola virus. The incubation period is about 12 days (range from seven to 17 days). During this period, the person looks and feels healthy and cannot infect others.

Initial symptoms include a high fever, fatigue, and head and back aches. A reddish rash appears first. It progresses to pocks (vesicles) that begin on the face and spread to the membranes in the mouth (oral mucosa), hands, forearms, lower extremities and finally the trunk two to three days later.

Lesions become pus-filled and begin to crust early in the second week. Scabs develop and then separate and fall off after about three to four weeks. The majority of patients with smallpox recover, but death occurs in up to 30 percent of cases.

Persons with smallpox are most infectious during the first week of illness, because that is when the largest amount of virus is present in saliva.

Smallpox can spread rapidly from person to person when infected people sneeze, spraying fine droplets of the virus into the air, or through direct contact such as kissing. The disease can also be transmitted by contaminated clothes and bedding, though the risk of infection from this source is much lower. Insects play no role in transmission.

Because a virus causes smallpox, antibiotics won't treat the infection.

There are no other drugs to treat smallpox. There is no proven treatment for smallpox but research to evaluate new antiviral agents is ongoing.

Patients with smallpox can benefit from supportive therapy (intravenous fluids, medicine to control fever or pain, etc.) and antibiotics for any secondary bacterial infections that occur. As a parent, there are no special precautions for your children's health. If your child develops a fever, take your child to your family doctor for a checkup. Remember that a child is more likely to develop flu or a cold than anthrax or smallpox.

Patients diagnosed with smallpox should be physically isolated. Isolation is essential to break the chain of transmission. All persons who have or will come into close contact with them should be vaccinated.

In December 1999, a World Health Organization advisory committee on the variola virus concluded that, although vaccination is the only proven public health measure available to prevent and control a smallpox outbreak, current vaccine supplies are extremely limited.

On Sept. 20, 2000, the Center for Disease Control and Prevention (CDC) entered into an agreement with OraVax (Cambridge, MA) to produce a new smallpox vaccine. Like the vaccine used to eradicate smallpox, the new vaccine will contain live vaccinia virus.

OraVax will coordinate full clinical testing of the vaccine and submit a licensing application to the U.S. Food and Drug Administration for the prevention of smallpox in adults and children. Forty million doses of the new vaccine will be produced initially, with anticipated delivery of the first full-scale production lots in 2004. The vaccine will be held in reserve as part of the national stockpile and be released only in the event of a confirmed case of smallpox or when vaccination against vaccinia virus is warranted.

Smallpox virus is officially retained at only two facilities in the world: at CDC in the United States and the State Research Center of Virology and Biotechnology in Novosibirsk, Russia.

Research teams from both institutions are coordinating activities to avoid duplication and gain the maximum amount of information possible before final destruction of the virus. In times of war there are no winners with winning defined only as those who lose the least. Unfortunately when children die they loose the wonderment of living before they have even started to live.

Life is precious, love your child today like there is no tomorrow.