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Variola Virus

Variola Virus. Photo Courtesy of CDC/Public Health Image Library 1. History. Ancient scourge – many millions killed Global eradication in 1977. Photo Courtesy of National Archives. Photo Courtesy of World Health Organization 2. Bioweapon Potential. Precedence

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Variola Virus

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  1. Variola Virus Photo Courtesy of CDC/Public Health Image Library1

  2. History • Ancient scourge – many millions killed • Global eradication in 1977

  3. Photo Courtesy of National Archives

  4. Photo Courtesy of World Health Organization2

  5. Bioweapon Potential • Precedence • Prior use in French-Indian War • Produced by USSR

  6. Bioweapon Potential • Reality of the risk • Viral stocks exist • Non-immune population

  7. Photo Courtesy of CDC3

  8. Epidemiology • No animal reservoir/vector • Mortality 25-30% • Person-to-person transmission • Via respiratory droplets • Household and face-to-face contacts • High risk of nosocomial spread • Secondary attack rate 25-40% • Up to 20 contacts infected per case

  9. Photo Courtesy of World Health Organization4

  10. Epidemiology • Aerosol route of transmission • Likely in bioterrorism setting

  11. Virology • Orthopoxviridae DNA Viruses • Variola variants • Variola major – high mortality • Variola minor – low mortality, 20th Century • Vaccinia • Current smallpox vaccine

  12. Virology • Orthopoxviridae DNA Viruses • Other pox viruses • Cowpox • Monkeypox

  13. Pathogenesis Virus contacts respiratory mucosa Carried to lymph nodes Primary viremia Organ seeding WBCs infected Dermal invasion Vesicle Sepsis

  14. Clinical Features • Incubation Stage • Asymptomatic • 10-12 days (range 7-17)

  15. Clinical Features • Prodromal Stage • Sudden nonspecific flu-like illness • High fevers • Headache • Backache • Prostration • 2-5 days duration

  16. Clinical Features • Eruptive Stage • Characteristic rash • Centrifugal location • Grouping • Depth of lesions

  17. Photo Courtesy of World Health Organization5

  18. Clinical Features • Distribution of the rash

  19. Photo Courtesy of World Health Organization6

  20. Photo Courtesy of World Health Organization7

  21. Photo Courtesy of National Archives

  22. Photo Courtesy of National Archives

  23. Photo Courtesy of World Health Organization8

  24. Photo Courtesy of World Health Organization9

  25. Photo Courtesy of World Health Organization10

  26. Photo Courtesy of World Health Organization11

  27. Photo Courtesy of World Health Organization12

  28. Photo Courtesy of World Health Organization13

  29. Photo Courtesy of World Health Organization14

  30. Photo Courtesy of World Health Organization15

  31. Photo Courtesy of World Health Organization16

  32. Photo Courtesy of World Health Organization17

  33. Photo Courtesy of CDC/James Hicks18

  34. Photo Courtesy of CDC19

  35. Clinical Features • Severity of the classical rash • Discrete (<10% mortality) • Semi-confluent (25-50%) • Confluent (50-75%)

  36. Discrete Smallpox Photo Courtesy of National Archives

  37. Semi-Confluent Smallpox Photo Courtesy of World Health Organization20

  38. Confluent Smallpox Photo Courtesy of National Archives

  39. Smallpox Complications • Eye infection or blindness • Arthritis • Encephalitis • Secondary bacterial infections

  40. Differential Diagnosis • Varicella (chickenpox) • Monkeypox • Drug eruptions • Generalized vaccinia • Multiple insect bites • Molluscum contagiosum • Secondary syphilis • Viral exanthems (e.g. HHV-6, Cocksackie, etc)

  41. Chickenpox Photo Courtesy of World Health Organization21

  42. Monkey Pox Photo Courtesy of CDC22

  43. Erythema Multiforme Photo Courtesy of New England Journal of Medicine23

  44. Generalized Vaccinia Photo Courtesy of CDC24

  45. Generalized Vaccinia Photo Courtesy of CDC25

  46. Molluscum Contagiosum Photo Courtesy of American Academy of Pediatrics26

  47. Secondary Syphilis Photo Courtesy of American Academy of Pediatrics27

  48. Hand-Foot-Mouth Disease(Enterovirus Infection) Photo Courtesy of American Academy of Pediatrics28

  49. Differential Diagnosis • Chickenpox (varicella virus) • Distribution of rash • Grouping of lesions • Asynchronous development • Vesicle appearance • Shallow • Short Prodrome

  50. Chickenpox Photo Courtesy of World Health Organization29

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