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Small pox is back !!! Kolkata ( formerly Calcutta - home of the Bengali babus), West Bengal, India. And Bangladesh. In the Indian subcontinent.

Although naturally occurring smallpox has been eradicated( not quite true - see above), there is still heightened concern that the variola virus might be used as an agent of bioterrorism. In the first documented case of biological warfare, in the 18th century, contaminated blankets used by smallpox patients were distributed among Native American Indians by the British with the intent of initiating outbreaks. A smallpox epidemic occurred, killing more than 50% of affected tribes. If a strain of the variola virus could be obtained, it could be manufactured easily and disseminated widely in an aerosol release. A release of smallpox could escalate to a catastrophic global epidemic unless effective control measures can be implemented quickly.

Smallpox has been identified by the Centers for Disease Control (CDC) as a “Category A” agent, meaning it has been given high priority due to its potential threat to national security. The following references provide information on the use of smallpox as a bioweapon and associated issues to be considered during a smallpox outbreak.

• Emergency Preparedness & Response: Smallpox. Centers for Disease Control and Prevention (CDC). Contains extensive smallpox information, including fact sheets, overviews, FAQs, diagnosis and evaluation, infection control, laboratory testing, surveillance and investigation, selected publications, and education and training materials.
• Inglesby, Thomas V., et al. “Smallpox as a Biological Weapon: Medical and Public Health Management.” Journal of the American Medical Association (JAMA) 281.22(1999, June 9): 2281-2290. Considers the prospect of an aerosol release of variola virus, and provides information on epidemiology, infection signs and symptoms, diagnosis and monitoring, vaccination, medical treatment, infection control, environmental decontamination, and more.
• Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare: Chapter 27 - Smallpox. Office of the Surgeon General, Department of the Army, (1997), 114 KB PDF, 21 pages. Provides a thorough review of smallpox, including its history and epidemiology, as well as biological warfare and clinical issues.
• USAMRIID’s Medical Management of Biological Casualties Handbook, Fifth Edition. US Army Medical Research Institute of Infectious Diseases (USAMRIID), (2004, August). Provides links to PDF documents that contain information from this publication, known as the “Bluebook”, and recommendations regarding medical response to a biological warfare attack on a civilian or military population. Specific information on a number of potential bioterrorist agents is supplied, including smallpox.
• Variola major (Smallpox): Bioterrorism Information and Resources. Infectious Diseases Society of America (IDSA). Includes a comprehensive clinical manual on smallpox, as well as other documents and resources.
• BW Agents: Smallpox. University of Pittsburgh Medical Center (UPMC), Center for Biosecurity, (2005). Provides links to fact sheets, FAQs, and other references.
• Smallpox. Saint Louis University (SLU), School of Public Health, Institute for Bio-Security. Provides links to quick reference material, education and training resources, news and journal articles, and other documents on smallpox.
• Smallpox and Bioterrorism. Michigan Department of Community Health, Bureau of Epidemiology, Division of Communicable Disease and Immunization, 118 KB PDF, 2 pages. Covers key facts related to smallpox and bioterrorism, including disease facts, risk, and treatment.
• Variola Virus (Smallpox). Texas Department of Health. Provides information on symptoms, diagnosis, and treatment available in the event smallpox virus is used as a bioterrorist weapon.

Questions about smallpox

 Small pox is back !!! Kolkata ( formerly Calcutta - home of the Bengali babus), West Bengal, India. And Bangladesh. In the Indian subcontinent.

What should I know about smallpox?

Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus (an orthopoxvirus), and marked by fever and a distinctive progressive skin rash. In 1980, the disease was declared eradicated following worldwide vaccination programs. However, in the aftermath of the events of September and October, 2001, the U.S. government is taking precautions to be ready to deal with a bioterrorist attack using smallpox as a weapon. As a result of these efforts: 1) There is a detailed nationwide smallpox preparedness program to protect Americans against smallpox as a biological weapon. This program includes the creation of preparedness teams that are ready to respond to a smallpox attack on the United States. Members of these teams – health care and public health workers - are being vaccinated so that they might safely protect others in the event of a smallpox outbreak. 2) There is enough smallpox vaccine to vaccinate everyone who would need it in the event of an emergency.

How serious is the smallpox threat?
The deliberate release of smallpox as an epidemic disease is now regarded as a possibility, and the United States is taking precautions to deal with this possibility.

How dangerous is the smallpox threat?
Smallpox is classified as a Category A agent by the Centers for Disease Control and Prevention. Category A agents are believed to pose the greatest potential threat for adverse public health impact and have a moderate to high potential for large-scale dissemination. The public is generally more aware of category A agents, and broad-based public health preparedness efforts are necessary. Other Category A agents are anthrax, plague, botulism, tularemia, and viral hemorrhagic fevers.

If I am concerned about a smallpox attack, can I go to my doctor and get the smallpox vaccine?
At the moment, the smallpox vaccine is not available for members of the general public. In the event of a smallpox outbreak, however, there is enough smallpox vaccine to vaccinate everyone every person in the United States.

The Disease

What are the symptoms of smallpox?
The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. A rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar.

If someone comes in contact with smallpox, how long does it take to show symptoms?
After exposure, it takes between 7 and 17 days for symptoms of smallpox to appear (average incubation time is 12 to 14 days). During this time, the infected person feels fine and is not contagious.

Is smallpox fatal?
The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many smallpox survivors have permanent scars over large areas of their body, especially their face. Some are left blind.

How is smallpox spread?
Smallpox normally spreads from contact with infected persons. Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Indirect spread is less common. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Smallpox is not known to be transmitted by insects or animals.

If smallpox is released in aerosol form, how long does the virus survive?
The smallpox virus is fragile. In laboratory experiments, 90% of aerosolized smallpox virus dies within 24 hours; in the presence of ultraviolet (UV) light, this percentage would be even greater. If an aerosol release of smallpox occurs, 90% of virus matter will be inactivated or dissipated in about 24 hours.

How many people would have to get smallpox before it is considered an outbreak?
One confirmed case of smallpox is considered a public health emergency.

Is smallpox contagious before the smallpox symptoms show?
A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person becomes most contagious with the onset of rash. The infected person is contagious until the last smallpox scab falls off.

Is there any treatment for smallpox?
Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for smallpox, but research to evaluate new antiviral agents is ongoing. Early results from laboratory studies suggest that the drug cidofovir may fight against the smallpox virus; currently, studies with animals are being done to better understand the drug’s ability to treat smallpox disease (the use of cidofovir to treat smallpox or smallpox reactions should be evaluated and monitored by experts at NIH and CDC). Patients with smallpox can benefit from supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

Smallpox (also known by the Latin names Variola or Variola vera) is a highly contagious disease unique to humans.Smallpox is caused by either of two virus variants named Variola major and Variola minor. The deadlier form, V. major, has a mortality rate of 3–35%, while V. minor causes a milder form of disease called alastrim and kills ~1% of its victims. Long-term side-effects for survivors include the characteristic skin scars. Occasional side effects include blindness due to corneal ulcerations and infertility in male survivors.

 Small pox is back !!! Kolkata ( formerly Calcutta - home of the Bengali babus), West Bengal, India. And Bangladesh. In the Indian subcontinent.

Smallpox was responsible for an estimated 300–500 million deaths in the 20th century. As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease and that two million died in that year. After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in 1977. To this day, smallpox is the only human infectious disease to have been completely eradicated from nature. However, there are recent reports of smallpox in Asia as reported by the Times of India(June 2007).

India Friday termed the West Bengal’s alert over return of smallpox, 30 years after it was eradicated from the global map, as a false alarm.

The West Bengal government Thursday had issued a warning in all its districts along the Bangladesh-Myanmar border. West Bengal Director of Health Services Sanchita Bakshi said border security agencies have been asked to monitor if anyone is entering India with fever and rashes, one of the symptoms of the disease.

‘There is no need to panic as this is a false alarm,’ Health Secretary Naresh Dayal told reporters in New Delhi.

Dayal said, his ministry had interacted with the World Health Organisation (WHO), which assured them that there is no outbreak of smallpox either in Bangladesh or Myanmar.

Authorities in the health ministry said the whole scare germinated after a message from the government to a few border states about a possible outbreak of smallpox in neighbouring Bangladesh.

Cherian Varghese, a senior health coordinator of WHO-India, said that vigilance is always good but there is no such outbreak in Bangladesh. ‘We have no knowledge of it. Neither people nor authorities should not worry,’ he told IANS.

West Bengal government meanwhile informed Netaji Subhash Chandra Bose International (NSCBI) airport authorities about the reported danger and asked to screen the passengers arriving from Bangladesh and Myanmar.

State health department sources said any passenger arriving with fever and rashes from these two countries would be quarantined and tested.

A high alert has been sounded in the Indo-Bangladesh border districts. However, Bangladesh authorities have not yet confirmed any case of smallpox and said they have been investigating the situation.

Smallpox is a contagious human disease, which is believed to have been eradicated from India over three decades ago. The World Health Organisation (WHO) declared India a smallpox free country in 1977. The last case of smallpox in India was reported in May 1975 in Bihar when around 1,400 people were infected.

Smallpox is caused by the attack of two types of viral strains - variola major and variola minor. The early symptoms of the disease are high temperature, body ache and headache. In a few days, red spots appear in the mouth and tongue and break open into sores. Later the spots become fluid-filled bumps that turn into pustules.