For many centuries, humanity has suffered from such a highly infectious infectious diseaselike smallpox or smallpox, it claimed tens of thousands of lives every year. This terrible disease was epidemic in nature and affected entire cities and continents. Fortunately, scientists were able to unravel the causes of the symptoms of smallpox, which allowed them to create effective protection from them in the form of smallpox vaccination. Today, pathology is one of the defeated infections, which was reported back in 1980. This happened thanks to the universal vaccination under the auspices of the WHO. Such measures made it possible to eradicate the virus and prevent millions of deaths, potentiated by it, all over the planet, therefore, vaccinations are not currently carried out.

What is smallpox?

Smallpox is one of the most ancient infectious diseases of viral origin. The disease is characterized by a high level of infectiousness and is in most cases fatal or leaves rough scars on the body as a reminder of itself. There are two main infectious agents: the more aggressive Variola major and the less pathogenic Variola minor. The mortality rate when the first variant of the virus is affected is as much as 40-80%, while its small form leads to death in only three percent of the total number of patients.

Smallpox is considered a particularly contagious disease, it is transmitted by airborne droplets and by contact. It is distinguished by pronounced intoxication, as well as the appearance of a rash on the skin and mucous membranes, has a cyclical development and transforms into sores. When infected, patients note the following symptoms:

• polymorphic rashes all over the body and mucous membranes, which go through the stages of spots, papules, pustules, crusts and scarring;
• a sharp increase in body temperature;
• pronounced signs of intoxication with body aches, nausea, headaches;
• deep scars remain on the skin in case of recovery.

Despite the fact that doctors managed to completely defeat smallpox among the human population back in the distant 1978-1980, recently there have been more and more reports of cases of the disease in primates. This cannot but cause excitement, since the virus can easily spread to a person. Considering that the last vaccination against smallpox was made back in 1979, today we can confidently assert the possibility of a new wave of the epidemic, since those born after 1980 do not have vaccine immunity from smallpox at all. Medical workers do not cease to raise the question of the advisability of resuming compulsory vaccination against smallpox infection, which will prevent new outbreaks of the deadly disease.

History

Smallpox is believed to have originated several thousand years BC on the African continent and in Asia, where it passed to humans from camels. The first mentions of a smallpox epidemic date back to the fourth century, when the disease raged across China, and the sixth century, when it killed half of the Korean population. Three hundred years later, the infection reached the Japanese Islands, where 30% of the local residents then died out. In the 8th century, smallpox was recorded in Palestine, Syria, Sicily, Italy and Spain.

Since the 15th century, smallpox has been rampant throughout Europe. According to general information, about a million inhabitants of the Old World died from smallpox every year. Doctors of that time argued that everyone should get sick with this disease. It would seem that people have resigned themselves to smallpox.

Smallpox in Russia

Until the 17th century, there was no written mention of smallpox in Russia, but this is not proof that it did not exist. It is assumed that smallpox raged mainly in the European part of the state and affected the lower strata of society, therefore it was not indulged in general publicity.

The situation changed when, in the middle of the 18th century, the infection spread deep into the distance of the country, right up to the Kamchatka Peninsula. At this time, she became well known to the nobility. The fear was so great that members of the family of the British monarch George I. For example, in 1730, the young Emperor Peter II died of smallpox. Peter III also contracted an infection, but survived, until his death, struggling with complexes that arose against the background of understanding his ugliness.

The first attempts at control and the creation of a vaccine

Humanity has tried to fight the infection from the very beginning of its appearance. Often, sorcerers and shamans were involved in this, prayers and conspiracies were read, it was even recommended to dress the sick in red clothes, since it was believed that this would help lure the disease out.

The first effective way to combat the disease was the so-called variolation - a primitive vaccination against smallpox. This method quickly spread throughout the world and reached Europe in the 18th century. Its essence was to take a biomaterial from the pustules of successfully ill people and inject it under the skin of healthy recipients. Naturally, such a technique did not give 100% guarantees, but it allowed several times to reduce the incidence and mortality from smallpox.

Early methods of fighting in Russia

The initiator of vaccinations in Russia was the Empress Catherine II herself. She issued a decree on the need for mass vaccination and, by her own example, proved its effectiveness. The first vaccination against smallpox in the Russian Empire was made back in 1768, by an English doctor specially invited for this, Thomas Dimsdale.

After the empress suffered mild smallpox, she insisted on variolation of her own husband and heir to the throne, Pavel Petrovich. A few years later, Catherine's grandchildren were vaccinated, and the doctor Dimsdale received a life pension and the title of baron.

How did everything develop further?

Rumors spread very quickly about the smallpox vaccination given to the Empress. And within a few years, vaccination has become a fashion trend among russian nobility... Even those subjects who had already had an infection wanted to be vaccinated, so the process of immunizing the aristocracy at times reached the point of absurdity. Catherine herself was proud of her deed and more than once wrote about this to her relatives abroad.

Mass-scale vaccination

Catherine II was so carried away by variolation that she decided to inoculate the rest of the country's population. This primarily concerned students in cadet corps, soldiers and officers of the imperial army. Naturally, the technique was far from perfect, and often led to the death of vaccinated patients. But, of course, it allowed to reduce the rate of spread of infection throughout the state and prevented thousands of deaths.

Jenner's shot

Scientists have been constantly improving the method of vaccination. At the beginning of the 19th century, variolation was overshadowed by the more advanced technique of the Englishman Jenner. In Russia, the first such vaccination was given to a child from an orphanage, he was administered the vaccine by Professor Mukhin in Moscow. After a successful vaccination, the boy Anton Petrov received a pension and was given the surname Vaccines.

After this incident, vaccinations began to be given everywhere, but not on a mandatory basis. Only since 1919, vaccination became mandatory at the legislative level and involved the compilation of lists of vaccinated and unvaccinated children in each region of the country. As a result of such measures, the government was able to minimize the number of outbreaks of infection; they were registered exclusively in remote areas.

It's hard to believe, but back in 1959-1960, an outbreak of smallpox was registered in Moscow. She struck about 50 people, three of whom died as a result. What was the source of the disease in the country, where they successfully fought with it for decades?

Smallpox was brought to Moscow by the domestic artist Kokorekin from, where he had the honor to be present at the burning of a deceased person. Returning from a trip, he managed to infect his wife and mistress, as well as 9 representatives of the medical staff of the hospital to which he was brought, and 20 more people. Unfortunately, it was not possible to save the artist from death, but subsequently the entire population of the capital had to inject a vaccine against the disease.

Vaccination aimed at ridding humanity of infection

Unlike Europe, the population of the Asian part of the continent and Africa did not know about an effective smallpox vaccine until almost the middle of the 20th century. This provoked new infections in the backward regions, which, due to the growth of migration flows, threatened the civilized world. For the first time, doctors of the USSR undertook to initiate the massive introduction of a vaccine to all people on the planet. Their program was supported at the WHO summit, the participants adopted a corresponding resolution.

The massive introduction of the vaccine began in 1963, and already 14 years later, not a single case of smallpox has been reported in the world. Three years later, humanity announced the victory over the disease. Vaccination has lost its importance and has been discontinued. Accordingly, all inhabitants of the planet born after 1980 do not have immunity from infection, which makes them vulnerable to the disease.

May 14, 2008 marks 312 years since one significant event not only in medicine, but also in world history: on May 14, 1796, the English physician and researcher Edward Jenner (1749-1823) performed the first procedure that would later revolutionize medicine by opening a new preventive direction. It is about smallpox vaccination. This disease has an unusual fate. For tens of thousands of years, she collected a bloody tribute from humanity, taking millions of lives. And in the 20th century, literally in 13-15 years, it was wiped off the face of the earth and only two collectible samples were left.

Rash pattern

As contacts between the ancient states increased, smallpox began to move through Asia Minor towards Europe. Ancient Greece was the first among European civilizations on the path of illness. In particular, the famous "Athenian plague", which reduced in 430-426 BC. the population of the city-state by a third, according to some scientists, could well be an epidemic of smallpox. In fairness, we note that there are also versions about bubonic plague, typhoid fever and even measles.

In the years 165-180, smallpox passed through the Roman Empire, by the years 251-266 it crept up to Cyprus, then returned back to India, and until the 15th century only fragmentary information is found about it. But from the end of the 15th century, the disease was firmly entrenched in Western Europe.

Most historians believe that smallpox was brought to the New World at the beginning of the 16th century by the Spanish conquistadors, starting with Hernán Cortés (1485-1547) and his followers. Disease ravaged the Mayan, Inca and Aztec settlements. Epidemics did not subside and after the beginning of colonization, in the 18th century, practically not a single decade passed without an outbreak of smallpox on the American continent.

In the 18th century in Europe, the infection claimed more than four hundred thousand lives annually. In Sweden and France every tenth newborn died from smallpox. Several European reigning monarchs, including the Holy Roman Emperor Joseph I (Joseph I, 1678-1711), Louis I of Spain (Luis I, 1707-1724), the Russian Emperor Peter II (1715-1730), fell victim to smallpox in the same century. , Queen of Sweden Ulrika Eleonora (1688-1741), King of France Louis XV (Louis XV, 1710-1774).

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Smallpox infection occurs in the small blood vessels of the skin and in the mouth and throat, where the virus lives before spreading. On the skin, smallpox causes the characteristic maculopapular rash, followed by fluid-filled blisters. V. major is the more serious disease and has an overall mortality rate of 30 to 35 percent. V. minor causes a milder form of the disease (also known as alastrim, cottonpox, white pox, and Cuban itch), which kills about 1 percent of its victims. Long-term complications of V. major infection include characteristic scars, usually on the face, in 65 to 85 percent of survivors. Blindness due to corneal ulceration and scarring, and limb deformities due to arthritis and osteomyelitis, were less common complications, seen in about 2-5 percent of cases. Smallpox is believed to have originated in human populations around 10,000 BC. e. The earliest physical evidence of this is pustular eruptions on the mummy of Egypt's pharaoh Ramses V. The disease claimed the lives of about 400,000 Europeans annually during the last years of the 18th century (including five reigning monarchs), and was responsible for a third of all cases of blindness. Among those infected, 20-60 percent of adults and more than 80 percent of infected children have died from the disease. In the 20th century, smallpox claimed the lives of approximately 300-500 million people. In 1967, the World Health Organization (WHO) estimated that 15 million people were infected with smallpox in a year and two million died. Following a vaccination campaign in the 19th and 20th centuries, WHO certified the global eradication of smallpox in 1979. Smallpox is one of two infectious diseases that have been eradicated, the other being rinderpest, eradicated in 2011.

Classification

Signs and symptoms

Common smallpox

Modified smallpox

Malignant smallpox

Hemorrhagic smallpox

Cause

Causative agents

Broadcast

Diagnostics

Prevention

Treatment

Forecast

Complications

History

Disease onset

Eradication

After liquidation

Society and culture

Bacteriological warfare

Notable cases

Tradition and religion

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Smallpox

Smallpox is an infectious disease caused by one of two variants of the virus, Variola major and Variola minor. The disease is also known as latin names Variola or Variola vera, derived from the word varius ("spotted") or varus ("pimple"). The disease was originally known in English as "smallpox" or "red plague"; the term "smallpox" was first used in England in the 15th century to distinguish disease from "great smallpox" (syphilis). The last natural case of smallpox (Variola minor) was diagnosed on October 26, 1977.

Smallpox infection occurs in the small blood vessels of the skin and in the mouth and throat, where the virus lives before spreading. On the skin, smallpox causes the characteristic maculopapular rash, followed by fluid-filled blisters. V. major is the more serious disease and has an overall mortality rate of 30 to 35 percent. V. minor causes a milder form of the disease (also known as alastrim, cottonpox, white pox, and Cuban itch), which kills about 1 percent of its victims. Long-term complications of V. major infection include characteristic scars, usually on the face, in 65 to 85 percent of survivors. Blindness due to corneal ulceration and scarring, and limb deformities due to arthritis and osteomyelitis, were less common complications, seen in about 2-5 percent of cases. Smallpox is believed to have originated in human populations around 10,000 BC. e. The earliest physical evidence of this is pustular eruptions on the mummy of Egypt's pharaoh Ramses V. The disease claimed the lives of about 400,000 Europeans annually during the last years of the 18th century (including five reigning monarchs), and was responsible for a third of all cases of blindness. Among those infected, 20-60 percent of adults and more than 80 percent of infected children have died from the disease. In the 20th century, smallpox claimed the lives of approximately 300-500 million people. In 1967, the World Health Organization (WHO) estimated that 15 million people were infected with smallpox in a year and two million died. Following a vaccination campaign in the 19th and 20th centuries, WHO certified the global eradication of smallpox in 1979. Smallpox is one of two infectious diseases that have been eradicated, the other being rinderpest, eradicated in 2011.

Classification

There were two clinical forms smallpox. Variola major was the severe and most common form associated with a more extensive rash and more high temperature... Variola minor was a rarer and much less severe condition, with mortality rates of 1 percent or less. Subclinical (asymptomatic) variola virus infections have occurred but were not widespread. In addition, a form called variola sine eruptione (smallpox without rash) was observed in vaccinated individuals. This form was noted with fever after the usual incubation period and could only be confirmed by antibody studies or, less commonly, by virus isolation.

Signs and symptoms

The incubation period between transmission of the virus and the first obvious symptoms of the disease is about 12 days. After inhalation, the variola major virus invades the oropharynx (mouth and throat) or the lining of the respiratory tract, migrates to regional lymph nodes, and begins to multiply. In the initial phase of growth, the virus appears to move from cell to cell, but around the 12th day, many infected cells are lysed and the virus is found in large quantities in the blood (this is called viremia), and the second wave of multiplication occurs in the spleen , bone marrow and lymph nodes... Initial or prodromal symptoms are similar to other viral illnesses such as flu and colds: fever of at least 38.3 ° C (101 ° F), muscle aches, malaise, headache, and prostration. Because the disease often affects the gastrointestinal tract, nausea and vomiting and back pain are common. The prodromal stage, or the stage prior to the onset of the rash, usually lasts 2-4 days. By 12-15 days, the first visible lesions appear - small reddish spots called enanthemas - on the mucous membranes of the mouth, tongue, palate and throat, and the temperature drops to almost normal. These lesions rapidly enlarge and rupture, releasing large amounts of the virus into the saliva. The smallpox virus predominantly attacks skin cells, causing the characteristic acne (called macula) associated with this condition. The rash develops on the skin 24 to 48 hours after the onset of lesions on the mucous membranes. Typically, the macula first appears on the forehead, then quickly spreads to the entire face, proximal limbs, trunk, and finally to the distal limbs. The process takes no more than 24-36 hours, after which no new damage appears. At the moment, the development of variola major infection can be varied, as a result of which four types of smallpox disease have been identified based on Rao's classification: common, modified, malignant (or flat), and hemorrhagic. Historically, the crude death rate from smallpox has been around 30 per cent; however, malignant and hemorrhagic forms are usually fatal.

Common smallpox

Ninety percent or more of the cases of smallpox among unvaccinated individuals were of the common type. With this form of the disease, on the second day of the rash, the macules take on the appearance of raised papules. On the third or fourth day, the papules fill with an opalescent fluid, becoming vesicles. This fluid becomes cloudy and cloudy within 24-48 hours, which gives the vesicles the appearance of pustules; however, the so-called pustules are filled with tissue, not pus. By the sixth or seventh day, all skin lesions become pustules. After seven to ten days, the pustules mature and reach their maximum size. The pustules are raised high, usually round, stiff, and hard to the touch. The pustules are deeply rooted in the dermis, giving them the appearance of a small ball in the skin. Fluid slowly seeps out of the pustule, and by the end of the second week, the pustules descend and begin to dry out, forming crusts. By 16-20 days, crusts have formed over all lesions that have begun to crumble, leaving depigmented scars. Smallpox usually produces a discrete rash in which pustules separate from the skin. The most dense distribution of the rash is on the face; on the limbs it is denser than on the body; and tighter on the distal than on the proximal. The disease in most cases affects the palms of the hands and feet. Sometimes the blisters form a coalescing rash that begins to separate the outer layers of the skin from the underlying flesh. Patients with confluent smallpox often remain ill even after crusting over the lesions. In a case series study, the fatality rate for confluent smallpox was 62 percent.

Modified smallpox

With regard to the nature of the rash and the rate of its development, varioloid occurred mainly in previously vaccinated people. In this form, prodromal disease still occurs, but may be less severe than the normal type. During the evolution of the rash, fever is usually not present. Skin lesions are generally smaller and develop more rapidly, are more superficial, and may not show the characteristics of the more typical smallpox. Varioloid is rarely fatal. This form of smallpox is more easily confused with chickenpox.

Malignant smallpox

In malignant smallpox (also called smallpox), the lesions remain almost flush with the skin, while in normal smallpox, raised vesicles form. It is not known why some people develop this type of lesion. Historically, this type of lesion has accounted for 5-10 percent of cases, and the majority (72 percent) were associated with children. Malignant smallpox was accompanied by a severe prodromal phase that lasted 3-4 days, prolonged high fever and severe symptoms of toxicosis, and an extensive rash on the tongue and palate. Skin lesions mature slowly and on the seventh or eighth day they become flat and, as it were, "buried" in the skin. Unlike the common type of smallpox, the vesicles contain little fluid, are soft and velvety to the touch, and may contain hemorrhages. Malignant smallpox is almost always fatal.

Hemorrhagic smallpox

Hemorrhagic pox is a severe form that is accompanied by extensive hemorrhage in the skin, mucous membranes, and gastrointestinal tract. This form develops in about 2 percent of infections and occurs mainly in adults. With hemorrhagic smallpox, the skin does not blister, it remains smooth. Instead, bleeding occurs under the skin, making it charred and black, hence this form of the disease is also known as smallpox. In the early form of the disease, on the second or third day, hemorrhage under the conjunctiva of the eye makes the whites of the eyes dark red. Hemorrhagic smallpox also produces dark erythema, petechiae, and hemorrhages in the spleen, kidneys, peritoneum, muscles, and, less commonly, the epicardium, liver, testes, ovaries, and bladder. Sudden death often occurs between the fifth and seventh days of illness, when only a few minor skin lesions are present. A more advanced form of the disease occurs in patients who survive for 8-10 days. Hemorrhages appear in the early eruptive period, and the rash is flat and does not develop beyond the vesicular stage. In patients with an early stage of the disease, a decrease in blood clotting factors (eg, platelets, prothrombin and globulin) and an increase in circulating antithrombin are found. Patients in the late stage have significant thrombocytopenia; however, coagulation factor deficiency is less severe. Some late-stage patients also show increased antithrombin. This form of smallpox occurs in 3-25 percent of deaths, depending on the virulence of the smallpox strain. Hemorrhagic smallpox is usually fatal.

Cause

Causative agents

Smallpox is caused by infection with the variola virus, which belongs to the genus Orthopoxviruses, the Poxviridae family and the Chordopoxvirinae subfamily. The date of the appearance of smallpox is unknown. The virus most likely originated from a rodent virus 68,000-16,000 years ago. One clade was the main smallpox strains (a more clinically severe form of smallpox) that spread from Asia 400-1600 years ago. The second clade included both alastrim minor (phenotypically soft smallpox), described in the American continents, and West African isolates, which descended from an ancestral strain 1400-6300 years to the present. This clade further branched out into two subclades at least 800 years ago. According to a second estimate, the separation of smallpox from Taterapox occurred 3000-4000 years ago. This is consistent with the archaeological and historical evidence for the emergence of smallpox as a human disease, suggesting a relatively recent origin. However, assuming that the mutation rate is close to the herpesvirus mutation rate, the time of the divergence of smallpox from Taterapox is estimated to be 50,000 years ago. While this is consistent with other published estimates, it can be assumed that the archaeological and historical evidence is very incomplete. More accurate estimates of the mutation frequency in these viruses are needed. Smallpox is a large, brick-shaped virus ranging in size from about 302-350 nm to 244-270 nm, with a single linear double-stranded DNA genome, 186 kb in size, containing a hairpin loop at each end. The two classic types of smallpox are variola major and variola minor. Four orthopoxviruses cause infections in humans: variola, vaccinia, cowpox, and monkeypox. The smallpox virus naturally infects only humans, although primates and other animals have been infected in laboratory conditions. The vaccinia, cowpox and monkeypox viruses can infect humans and other animals in nature. The life cycle of poxviruses is complicated by the presence of several infectious forms, with different mechanisms of entry into the cell. Poxviruses are unique among DNA viruses in that they replicate in the cytoplasm of the cell rather than in the nucleus. To replicate, poxviruses produce a variety of specialized proteins that are not produced by other DNA viruses, the most important of which is virus-associated DNA-dependent RNA polymerase. Both enveloped and non-enveloped virions are contagious. The viral envelope consists of modified Golgi membranes containing viral specific polypeptides, including hemagglutinin. Infection with variola major or variola minor confers immunity against both types of smallpox.

Broadcast

Transmission occurs by inhalation of variola virus through the air, usually in droplets from the mouth, nose or throat of an infected person. The virus spreads from one person to another primarily through prolonged face-to-face contact with an infected person, usually 6 feet (1.8 m) away, but can also be transmitted through direct contact with infected body fluids or infected objects (fomites) such as bedding or clothing. On rare occasions, smallpox was spread by an airborne virus in enclosed spaces such as buildings, buses and trains. The virus can cross the placenta, but the incidence of congenital smallpox is relatively low. Smallpox is not an infectious disease in the prodromal period and viral shedding is usually delayed until a rash appears, often with damage to the mouth and throat. The virus can be transmitted throughout the illness, but most often it occurs during the first week of the rash. Infectivity decreases after 7-10 days when scabs form over the lesions, but the infected person is contagious until the last pock is gone. Smallpox is highly contagious, but usually spreads more slowly and less widely than some other viral diseases, possibly because transmission requires close contact and occurs after the rash appears. General indicator infection also depends on the short duration of the infectious stage. In temperate areas, smallpox infections were highest in winter and spring. In tropical areas, seasonal variations were less evident and the disease was present throughout the year. The distribution of smallpox infections by age depends on the acquired immunity. Immunity after vaccination declines over time, and probably disappears within thirty years. It is not known if smallpox is transmitted by insects or animals.

Diagnostics

Smallpox is an illness with an acute onset of fever equal to or greater than 38.3 ° C (101 ° F) and then a rash characterized by hard, deep vesicles or pustules at one stage of development without another apparent reason... If a clinical case is observed, smallpox is confirmed by laboratory tests. Microscopically, poxviruses produce characteristic cytoplasmic inclusions, the most important of which are known as Guarnieri bodies, which are also sites of viral replication. Guarnieri bodies are easily identified in hematoxylin and eosin stained skin biopsies and are pink clots. They are found in almost all poxvirus infections, but the absence of Guarnieri bodies is not a sign of the absence of smallpox. The diagnosis of orthopoxvirus infection can also be made quickly by electron microscopic examination of pustular fluid or crusts. However, all orthopoxviruses exhibit identical brick-like virions on electron microscopy. However, if particles with characteristic herpesvirus morphology are observed, smallpox and other orthopoxvirus infections can be eliminated. Accurate laboratory identification of variola virus involves growing the virus on a chorioallantoid membrane (part of a chicken embryo) and examining the resulting lesions under specific temperature conditions. Strains can be characterized by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Serologic tests and enzyme-linked immunosorbent assays (ELISA), which measure specific immunoglobulins and variola virus antigens, have also been developed to help diagnose infection. Chickenpox is commonly confused with smallpox. Chickenpox can be distinguished from smallpox in several ways. Unlike smallpox, chickenpox usually does not affect palms or soles. In addition, chickenpox pustules have different sizes due to differences in the timing of pustule eruption: smallpox pustules are all almost the same size, as the viral effect progresses more evenly. There are many laboratory methods for the detection of chickenpox when evaluating suspected smallpox cases.

Prevention

The earliest procedure used to prevent smallpox is vaccination (known as variolation), which was probably used in India, Africa, and China long before the practice was introduced in Europe. However, the idea that vaccination originated in India has been challenged as few of the ancient Sanskrit medical texts describe the vaccination process. Reports of smallpox vaccinations in China can be found as far back as the late 10th century, and the procedure was widely practiced in the 16th century, during the Ming Dynasty. If successful, the vaccine produced potent immunity to smallpox. However, because a person was infected with the variola virus, a severe infection could develop and the person could transmit smallpox to others. Variation was associated with a mortality rate of 0.5-2 percent, significantly less than the disease-related mortality rate of 20-30 percent. Lady Mary Montague Wortley oversaw the smallpox vaccination during her time in the Ottoman Empire and wrote detailed accounts of the practice in her letters, and enthusiastically facilitated the procedure in England after her return there in 1718. In 1721, Cotton Mather and his colleagues sparked controversy in Boston by inoculating hundreds of people. In 1796, Edward Jenner, a physician in Berkeley, Gloucestershire, rural England, discovered that immunity to smallpox could be obtained by inoculating a person with cowpox material. Cowpox is a poxvirus from the same family as smallpox. Jenner named the material used for the vaccine after the root of the word vacca, which means cow in Latin. The procedure was much safer than variolation and was not associated with the risk of smallpox transmission. Vaccination to prevent smallpox has been practiced throughout the world. In the 19th century, the vaccinia virus used to vaccinate against smallpox was replaced by the vaccinia virus. The vaccinia virus belongs to the same family as variola and vaccinia viruses, but is genetically different from both. The origin of the vaccinia virus is not known. The smallpox vaccine is currently a live preparation of the infectious vaccinia virus. The vaccine is administered using a bifurcated needle that is immersed in the vaccine solution. The needle is used to prick the skin (usually in the forearm) several times over several seconds. If successful, redness and an itchy bump develops at the vaccine site within three or four days. In the first week, the bump turns into a large blister that fills with pus and begins to flow out. During the second week, the blister begins to dry out and scabs form. The scabs subside in the third week, leaving a small scar. The vaccinia vaccine-induced antibodies are cross-protective against other orthopoxviruses such as simian pox virus and variola viruses. Neutralizing antibodies can be detected 10 days after the first vaccination, and seven days after the revaccination. The vaccine was effective in preventing smallpox infection in 95 percent of those vaccinated. Smallpox vaccination provides high level immunity for three to five years, after which the immunity decreases. If a person is vaccinated again later, immunity lasts even longer. Studies of smallpox cases in Europe in the 1950s and 1960s indicated that the mortality rate among those vaccinated less than 10 years before exposure to the virus was 1.3 percent; it was 7 percent among those vaccinated 11–20 years before infection and 11 percent among those vaccinated 20 or more years before infection. In contrast, 52 percent of unvaccinated individuals died. There are side effects and risks associated with smallpox vaccination. In the past, about 1 in 1000 people vaccinated for the first time have experienced serious, but not life-threatening, reactions, including toxic or allergic reactions at the vaccination site (erythema), spread of vaccinia virus to other parts of the body, and transmission of the virus other persons. Potentially life-threatening reactions occurred in 14-500 people out of every 1 million people first vaccinated. Based on past experience, it is estimated that 1 or 2 people out of 1 million (0.000198 percent) who receive the vaccine may die as a result, most often due to post-vaccination encephalitis or severe vaccine necrosis (called progressive vaccinia). Given these risks, since smallpox was effectively eradicated and the number of natural cases fell below the number of vaccine-induced diseases and deaths, routine childhood vaccination was discontinued in 1972 in the United States and in the early 1970s in most European countries. Routine vaccination of health-care workers was discontinued in the United States in 1976, and among conscripts in 1990 (although military personnel infiltrating the Middle East and Korea are still being vaccinated). By 1986, routine vaccinations had ceased in all countries. Currently, vaccination is primarily recommended for laboratory workers at risk of occupational exposure.

Treatment

Smallpox vaccination within three days of exposure will prevent or significantly reduce the severity of smallpox symptoms in the vast majority of people. Vaccination for four to seven days after exposure may provide some protection against illness or may alter the severity of illness. In addition to vaccination, treatment for smallpox is primarily supportive and includes wound care and infection control, fluid therapy, and possible mechanical ventilation. Smallpox and hemorrhagic pox are treated with therapies used to treat shock, such as fluid therapy. Individuals with semi-confluent and confluent smallpox may have similar therapeutic problems to those with extensive skin burns. There is no drug currently approved for treating smallpox. However, antiviral therapies have improved since the last major smallpox epidemics, and research suggests that the antiviral drug cidofovir may be useful as a therapeutic agent. The drug, however, must be given intravenously and can cause severe kidney toxicity.

Forecast

The overall case fatality rate for the common type of smallpox is about 30 percent, but varies according to the distribution of smallpox: common type of confluent is fatal in about 50-75 percent of cases, common smallpox is fatal in about 25-50 percent of cases, in those cases when the rash is discrete, the mortality rate is less than 10 percent. The overall mortality rate for children under 1 year old is 40-50 percent. Hemorrhagic and flat types have the highest mortality rates. Mortality in flat type is 90 percent or more, and almost 100 percent in cases of hemorrhagic smallpox. Variola minor mortality is 1 percent or less. There are no signs of chronic or recurrent variola virus infection. In fatal cases of common smallpox, death usually occurs between the tenth and sixteenth days of illness. The cause of death from smallpox is not known, but the infection is now known to affect several organs. Circulating immune complexes that suppress viremia or an uncontrolled immune response may be contributing factors. In early hemorrhagic smallpox, death occurs suddenly about six days after the onset of fever. The cause of death in hemorrhagic cases involves heart failure, sometimes accompanied by pulmonary edema. In late hemorrhagic cases, high and persistent viremia, severe platelet loss and poor immune response are often cited as causes of death. In smallpox, deaths are similar to those in burns, with loss of fluids, protein and electrolytes, in such quantities that the body is unable to replace them, and transient sepsis.

Complications

Complications from smallpox occur most commonly in the respiratory system and range from simple bronchitis to fatal pneumonia. Respiratory complications usually develop by the eighth day of illness and can be either viral or bacterial in origin. Secondary bacterial infection skin is a relatively rare complication of smallpox. When this occurs, the fever usually remains elevated. Other complications include encephalitis (1 in 500 patients), which is more common in adults and can lead to temporary disability; permanent scars, primarily on the face; and eye complications (2 percent of all cases). Pustules can form on the eyelid, conjunctiva, and cornea, leading to complications such as conjunctivitis, keratitis, corneal ulcers, iritis, iridocyclitis, and optic atrophy. Blindness develops in about 35-40 percent of eyes affected by keratitis and corneal ulcers. Hemorrhagic smallpox can lead to subconjunctival and retinal hemorrhages. In 2 to 5 percent of young children with smallpox, virions reach the joints and bones, causing osteomyelitis variolosa. The lesions are symmetrical, most common in the elbows, tibia and fibula, and characteristically cause epiphysis splitting and periosteal reactions. Swollen joints limit movement, and arthritis can lead to limb deformities, ankylosis, malformed bones, loose joints, and short toes.

History

Disease onset

The earliest reliable clinical signs of smallpox can be found in the medical literature from ancient India describing smallpox-like diseases (as early as 1500 BC), in the Egyptian mummy of Ramses V, who died more than 3000 years ago (1145 BC) and in China (1122 BC) e.). It has been suggested that Egyptian traders brought smallpox to India during the 1st millennium BC, where it remained as an endemic human disease for at least 2000 years. Smallpox was probably introduced to China during the 1st century AD from the southwest, and was introduced from China to Japan in the 6th century. In Japan, the 735-737 epidemic is believed to have killed a third of the population. At least seven religious deities have been dedicated to smallpox, such as the god Sopona in the Yoruba religion. In India, the Hindu goddess of smallpox, Sitala Mata, was worshiped in temples throughout the country. The timing of smallpox in Europe and Southwest Asia is less clear. Smallpox is not clearly described in either the Old or New Testaments of the Bible, or in the literature of the Greeks or Romans. While some sources describe the Plague of Athens, which reportedly originated in "Ethiopia" and Egypt, or a plague that raised in 396 BC. the siege by Carthage of Syracuse with smallpox, many scholars agree that it is highly unlikely that a disease as serious as variola major would have escaped Hippocrates' description if it had existed in the Mediterranean region during his lifetime. While the plague of Antoninus, which swept through the Roman Empire in AD 165-180, may have been caused by smallpox, Saint Nikasius of Reims became the patron saint of smallpox victims for allegedly surviving the disease in 450, and Saint Gregory Toursky described a similar outbreak in France and Italy in 580, first using the term "smallpox"; other historians suggest that Arab armies were the first to transport smallpox from Africa to Southwestern Europe during the 7th and 8th centuries. In the 9th century, the Persian physician Razi made one of the most authoritative descriptions of smallpox and was the first person to differentiate smallpox from measles and chickenpox in his Kitab fi al-jadari wa-al-hasbah (Book of Smallpox and Measles). During the Middle Ages, smallpox began to periodically penetrate Europe, but did not take root there until the population increased and population movement became more active during the era of the Crusades. By the 16th century, smallpox had become well known throughout most of Europe. With the introduction of smallpox into populated areas in India, China, and Europe, it has mainly affected children. Periodic epidemics have killed about 30 percent of those infected. Smallpox's permanent existence in Europe was of particular historical importance, as successive waves of exploration and colonization by Europeans were associated with the spread of the disease to other parts of the world. By the 16th century, smallpox had become an important cause of morbidity and mortality in much of the world. There are no reliable descriptions of smallpox-like diseases in the Americas before the arrival of Europeans in the 15th century AD. Smallpox was introduced to the Caribbean island of Hispaniola in 1509, and to the mainland in 1520, when Spanish settlers from Hispaniola arrived in Mexico, bringing smallpox with them. Smallpox killed the entire local Indian population and was an important factor in the Spanish conquest of the Aztecs and Incas. The discovery of the east coast of North America in 1633 in Plymouth, Massachusetts was also accompanied by devastating outbreaks of smallpox among the Indian population and then among the native colonists. The case fatality rates during outbreaks in Native American populations were 80-90%. Smallpox was introduced to Australia in 1789 and again in 1829. Although the disease was never endemic on the continent, it was the leading cause of death in aboriginal populations in 1780-1870. By the mid-18th century, smallpox had become the main endemic disease worldwide, with the exception of Australia and a few small islands. In Europe, smallpox was the leading cause of death in the 18th century, with about 400,000 Europeans killed each year. Up to 10 percent of Swedish children die of smallpox every year, and in Russia, child mortality could be even higher. The widespread use of variolation in several countries, notably Britain and its North American colonies and China, somewhat reduced the incidence of smallpox among the wealthy classes of the population during the second half of the 18th century, but no real decline occurred until vaccination became common practice. at the end of the 19th century. Improved vaccines and revaccination practices led to significant reductions in cases in Europe and North America, but smallpox remained virtually uncontrolled and was widespread throughout the world. A much milder form of smallpox, variola minor, was discovered in the United States and South Africa in the late 19th century. By the mid-20th century, variola minor coexisted along with variola major in many parts of Africa. Patients with variola minor experience only mild systemic disease and are often in outpatient throughout the disease, and therefore they can spread the disease more easily. Infection v. minor induces immunity against the more deadly smallpox variola major. Thus, as v. minor spread across the United States, Canada, South America and the United Kingdom, it became the dominant form of smallpox, causing further reductions in mortality.

Eradication

The English physician Edward Jenner demonstrated the effectiveness of vaccinia in protecting people from smallpox in 1796, after which various attempts were made to eradicate smallpox on a regional scale. The introduction of the vaccine to the New World took place in Trinity, Newfoundland, in 1800 by Dr. John Clinch, a childhood friend and medical colleague of Jenner's. Back in 1803, the Spanish Crown organized the Balmis Expedition to transport vaccines to Spanish colonies in the Americas and the Philippines, and developed mass vaccination programs. The U.S. Congress passed the Vaccination Act of 1813 to ensure the availability of a safe smallpox vaccine to the American public. By about 1817, there was a very powerful government vaccination program in the Dutch East Indies. In British India, a smallpox vaccination program has been launched, through Indian vaccinators, led by European officials. However, British vaccination efforts in India and Burma in particular have been hampered by persistent local mistrust of vaccination despite tough legislation and improved vaccine efficacy. By 1832, the United States federal government had established a smallpox vaccination program for Native Americans. In 1842, the United Kingdom banned vaccinations and later launched a mandatory vaccination program. The British government introduced compulsory smallpox vaccination after the passage of an Act of Parliament in 1853. Smallpox vaccination was introduced in the United States from 1843 to 1855, first in Massachusetts and then in other states. While some did not like these measures, coordinated efforts against smallpox continued, and the disease continued to decline in rich countries. By 1897, smallpox was largely eradicated in the United States of America. Smallpox had been eradicated in a number of Nordic countries by 1900, and by 1914, the incidence in most industrialized countries had dropped to relatively low levels. Vaccination continued in industrialized countries until the mid to late 1970s to protect against recontamination. Australia and New Zealand are two exceptions; None of these countries had smallpox epidemics or extensive vaccination programs for the population; instead, these countries introduced protection against contact with other countries and strict quarantines. The first widespread (half the world) attempt to eradicate smallpox was in 1950 by the Pan American Health Organization. The campaign was successful in eradicating smallpox in all American countries with the exception of Argentina, Brazil, Colombia and Ecuador. In 1958, Professor Viktor Zhdanov, USSR Deputy Minister of Health, called on the World Health Assembly to launch a global initiative to eradicate smallpox. The proposal (Resolution WHA11.54) was adopted in 1959. At that time, 2 million people died from smallpox every year. Overall, however, progress towards smallpox eradication has been disappointing, especially in Africa and the Indian subcontinent. In 1966, the Smallpox Control Unit was formed, under the leadership of the American Donald Henderson. In 1967, the World Health Organization stepped up the global smallpox eradication program, contributing $ 2.4 million a year to the effort, and adopted new method disease surveillance, promoted by Czech epidemiologist Karel Raska. In the early 1950s, there were an estimated 50 million cases of smallpox worldwide each year. In order to eradicate smallpox, it was necessary to stop the spread of each outbreak by isolating cases and vaccinating everyone nearby. This process is known as ring-shaped vaccination (buffering). The key to this strategy is community case monitoring (surveillance) and disease containment. The initial challenge faced by the WHO team was insufficient reporting of smallpox cases, as many cases proceeded without the knowledge of the authorities. The fact that humans are the only reservoir for smallpox infection, and that carriers do not exist, played a significant role in smallpox eradication. WHO has established a network of consultants to assist countries in establishing surveillance and disease containment. In the beginning, vaccine donations were provided primarily by the Soviet Union and the United States, but by 1973 more than 80 percent of all vaccines were produced in developing countries. The last major European smallpox outbreak occurred in 1972 in Yugoslavia, after a pilgrim from Kosovo returned from the Middle East where he contracted the virus. The epidemic infected 175 people, resulting in 35 deaths. The authorities declared martial law, forced quarantine, and took measures to widely revaccinate the population, with the help of WHO. After two months, the outbreak was over. Before that, an outbreak of smallpox was observed in May-July 1963 in Stockholm, Sweden, it was brought from the Far East by a Swedish sailor. It was fought with the help of quarantine measures and vaccination of the local population. By the end of 1975, smallpox persisted only in the Horn of Africa. In Ethiopia and Somalia, where there were few roads, conditions were very difficult. Civil war, famine and refugees made the task even more difficult. In early to mid-1977, these countries underwent an intensive surveillance and containment and vaccination program led by Australian microbiologist Frank Fenner. As the campaign drew closer to its goal, Fenner and his team were instrumental in confirming the liquidation. The last natural case of indigenous smallpox (Variola minor) was diagnosed in Ali Maow Maalin, a hospital cook in Merka, Somalia, on October 26, 1977. The last natural case of the more deadly Variola major was in October 1975 in a two-year-old girl from Bangladesh, Rahima Banu. Global smallpox eradication was certified, based on intensive verification activities in various countries, by a panel of eminent scientists on December 9, 1979 and subsequently approved by the World Health Assembly on May 8, 1980. The first two proposals for the resolution: “Having reviewed the development and results of the global smallpox eradication program, initiated by WHO in 1958 and activated since 1967 ... we solemnly declare that the world and its peoples have won freedom from smallpox, which has been the most devastating disease in the form of an epidemic in many countries since the earliest time leading to death, blindness and physical defects and which only ten years ago was widespread in Africa, Asia and South America. " - World Health Organization Resolution WHA33.3

After liquidation

The last cases of smallpox worldwide occurred in an outbreak of two cases (one of which was fatal) in Birmingham, UK, in 1978. Medical photographer Janet Parker contracted at the University of Birmingham Medical School and died on 11 September 1978, followed by Professor Henry Bedson , the scientist in charge of smallpox research at the university committed suicide. All known smallpox stocks were subsequently destroyed or transferred to two WHO-designated reference laboratories - the US Centers for Disease Control and Prevention and the Russian State Research Center for Virology and Biotechnology Vector. WHO first recommended the destruction of the virus in 1986, and then set the date of destruction to 30 December 1993. The date was then pushed back to June 30, 1999. Due to opposition from the United States and Russia, in 2002 the World Health Assembly decided to allow temporary storage of the virus stocks for specific research purposes. Destruction of existing stocks will reduce the risk associated with ongoing smallpox research. No supplies are needed to respond to smallpox outbreaks. Some scientists argue that the stock could be useful in the development of new vaccines, antiviral drugs and diagnostic tests. However, a 2010 review by a group of public health experts appointed by WHO concluded that no major public health goal justifies keeping variola virus in the United States and Russia. The latter point of view is often held by the scientific community, especially among veterans of the WHO Smallpox Eradication Program. In March 2004, smallpox scabs were found in an envelope in the medical book of the times civil war in Santa Fe, New Mexico. The envelope was marked as containing vaccine scabs and handed over to scientists at the Centers for Disease Control and Prevention with the opportunity to study the history of smallpox vaccination in the United States. In July 2014, several vials of smallpox virus were found in an FDA laboratory at the National Institutes of Health premises in Bethesda, Maryland.

Society and culture

Bacteriological warfare

The British used smallpox as a biological weapon in the siege of Fort Pitt during the French and Indian Wars (1754-1763) against France and its Indian allies. The actual use of the variola virus has been officially authorized. British officers, including leading British generals, ordered, authorized and paid for the use of the smallpox virus against Native Americans. According to historians, "there is no doubt that the British military authorities approved of the attempts to spread smallpox among the enemies," and that "it was a deliberate policy of Great Britain to infect Indian smallpox." The effectiveness of efforts to spread the disease is unknown. There is also evidence that smallpox was used as a weapon during the American War of Independence (1775-1783). According to a theory put forward in the Journal of Australian Studies (JAS) by an independent researcher in 1789, the British Marines used smallpox against indigenous tribes in New South Wales. This has also been discussed previously in the Bulletin of the History of Medicine and by David Day in his book Claiming a Continent: A New History of Australia. Prior to the JAS article, this theory was challenged by some scholars. Jack Carmody argued that the cause of the outbreak was most likely chickenpox, which at the time was sometimes identified as a mild form of smallpox. Although it was noted that during the 8-month voyage of the First Fleet and in the following 14 months there were no reports of smallpox among the colonists, and that, since smallpox has an incubation period of 10-12 days, it is unlikely that it was present during the First Fleet, in It is now known that the probable source was the variola virus bottles owned by the First Fleet surgeons and, in fact, there was a report of smallpox among the colonists. During World War II, scientists from the United Kingdom, the United States and Japan (Unit 731 of the Imperial Japanese Army) were involved in research into the production of biological weapons from the variola virus. The plans for large-scale production were never fully implemented, as scientists believed that the weapon would not be very effective due to the widespread availability of the vaccine. In 1947, a smallpox-based biological weapons plant was established in the Soviet Union in the city of Zagorsk, 75 km northeast of Moscow. An outbreak of weaponized smallpox occurred during tests at a facility on an island in the Aral Sea in 1971. Pyotr Burgasov, a former chief medical officer of the Soviet army and a senior researcher for the Soviet biological weapons program, described the incident: “The strongest smallpox recipes were tested on Vozrozhdenie Island in the Aral Sea. Suddenly I was informed about the mysterious deaths in Aralsk. The research ship of the Aral Fleet approached the island at a distance of 15 km (although it was forbidden to come closer than 40 km). The ship's laboratory assistant took plankton samples twice a day from the upper deck. Smallpox preparation - 400 gr. of which they were blown up on the island - infected her. After returning home to Aralsk, she infected several people, including children. They all died. I suspected the reason for this and called the Chief of the General Staff of the Ministry of Defense and asked to ban the Alma-Ata-Moscow train from stopping in Aralsk. As a result, the spread of the epidemic throughout the country was prevented. I called Andropov, who was the head of the KGB at the time, and told him about an exceptional recipe for smallpox obtained on Vozrozhdenie Island. " Others argue that the first patient may have contracted the infection while visiting Uyala or Komsomolsk-on-Ustyurt, two cities where the ship was docked. In response to international pressure, in 1991 the Soviet government allowed a joint US-British inspection team to visit four of its main facilities at Biopreparat. The inspectors were greeted unfriendly and were eventually kicked out of the facility. In 1992, Soviet defector Ken Alibek claimed that the Soviet biological weapons program in Zagorsk had produced large quantities - as many as twenty tons - of biological weapons in the form of the smallpox virus (possibly, according to Alibek, to counter vaccines), along with refrigerated warheads to deliver weapons. Alibek's stories about the activities of the former Soviet smallpox program have never been verified by independent experts. In 1997, the Russian government announced that all remaining smallpox samples would be transferred to the Vector Institute in Koltsovo. With the collapse of the Soviet Union and the unemployment of many scientists involved in the weapons program, US government officials have expressed concern that smallpox and its bioweapons expertise may become available to other states or terrorist groups that may wish to use the virus. as a means of biological warfare. The specific accusations against Iraq in this regard, however, have proven to be wrong. Concern was expressed about the possibility of reconstructing a virus from existing digital genomes by artificially synthesizing genes for use in biological warfare. The insertion of synthesized smallpox DNA into existing related smallpox viruses could theoretically be used to recreate the virus. The first step to mitigating this risk presumably lies in destroying the remaining stocks of the virus in a way that clearly criminalizes possession of the virus.

Notable cases

In 1767, 11-year-old composer Wolfgang Amadeus Mozart survived a smallpox outbreak in Austria that killed the Holy Roman Empress Maria Joseph, who became the second wife of Holy Roman Emperor Joseph II, who died of an illness like Archduchess Maria Joseph. Famous historical figures who contracted smallpox: the chief of the Hunkpapa Indian tribe Sitting Bull, Emperor Ramses V of Egypt, Emperor Kangxi (survived), Emperor Shunzhi and Emperor Tongzhi in China, Date Masamune from Japan (lost an eye due to illness). Cuitlahuac, the 10th Tlatoani (ruler) of the Aztec city of Tenochtitlan, died of smallpox in 1520, shortly after its appearance in the Americas, and the Inca emperor Huayna Capac died of smallpox in 1527. More modern public figures affected by the disease include Guru Har Krishan, 8th Guru of the Sikhs, in 1664, Peter II of Russia in 1730 (died), George Washington (survived), King Louis XV in 1774 (died) and Maximilian III, Elector of Bavaria in 1777. In many eminent families around the world, several people were often sick who were infected and / or died from the disease. For example, several relatives of Henry VIII survived the disease, but remained after it in injuries and scars. These include his sister Margaret, Queen of Scots, his fourth wife, Anne of Cleves, and his two daughters: Mary I of England in 1527 and Elizabeth I of England in 1562 (she often tried to mask pock marks with makeup as an adult). His great-niece Mary Stuart became infected in childhood but she didn't have any visible scars. In Europe, smallpox deaths often played a large role in dynastic succession. Henry VIII's only surviving son, Edward VI, died of complications shortly after apparently recuperating from an illness, thereby negating Henry's efforts to secure the throne with a male heir (his two closest successors were women, both of whom survived smallpox). Louis XV of France assumed the throne from his great-grandfather Louis XIV through a series of smallpox or measles deaths among his relatives who were to have taken the throne earlier. Louis himself died of illness in 1774. William III lost his mother to this illness when he was only ten years old, in 1660, and made his uncle Charles the legal guardian: her death from smallpox indirectly provoked a chain of events that ultimately led to the permanent displacement of the family Stewart of the British throne. William III's wife, Mary II of England, died of smallpox. In Russia, Peter II died of illness at the age of 15. In addition, before becoming the Russian emperor, Peter III was infected with the virus and suffered greatly from it. He left noticeable scars from his illness. His wife, Catherine the Great, was saved, but the fear of the virus clearly had an impact on her. She was so much afraid for the safety of her son and heir Paul, she did not allow him to go out to large crowds of people, trying to isolate him. In the end, she decided to get herself vaccinated by the Scottish doctor Thomas Dimsdale. At the time, vaccination was considered a controversial method at the time, however, Catherine did not fall ill. Later, her son Paul was also vaccinated. Catherine wanted to spread vaccinations throughout her empire, stating: "My goal was, through my example, to save from death many of my subjects, who, not knowing the significance of this technique and fearing it, were left in danger." By 1800, about 2 million vaccinations had been introduced in the Russian Empire. In China, the Qing dynasty had extensive protocols to protect the Manchus from Beijing's endemic smallpox. US Presidents George Washington, Andrew Jackson, and Abraham Lincoln all had smallpox and recovered from it. Washington contracted smallpox after a visit to Barbados in 1751. Jackson developed the disease after he was captured by the British during the American Revolution, and although he recovered, his brother Robert died. Lincoln contracted the infection during his presidency, possibly from his son Ted, and was quarantined shortly after receiving his Gettysburg address in 1863. Renowned theologian Jonathan Edwards died of smallpox in 1758 after being vaccinated. Soviet leader Joseph Stalin contracted smallpox at the age of seven. His face was scarred from the disease. His photographs were later retouched to make the pock marks less visible. The Hungarian poet Kölchei, who wrote the Hungarian national anthem, lost his right eye due to smallpox.

Tradition and religion

In various parts of the Old World, such as China and India, people worshiped various smallpox deities. In China, the goddess of smallpox is referred to as Tou-Shen Nyang-Niang. Chinese believers actively tried to appease the goddess and pray for her mercy and called the pustules smallpox " beautiful flowers", As a euphemism intended not to offend the goddess. In this regard, on New Year's Eve, it was such a custom that children at home put on ugly masks while sleeping in order to hide the beauty and thereby avoid the attraction of the goddess who would pass through the house that night. If there was a case of smallpox, shrines were created in the homes of the victims to be worshiped during illness. If the victim recovered, the shrines were taken away on a special paper stand or in a boat for burning. If the patient did not recover, the shrine was destroyed and cursed in order to drive the goddess out of the house. The earliest records of smallpox in India can be found in a medical book that dates back to 400 AD. In India, as in China, the goddess of smallpox was created. The Hindu goddess Shitala was worshiped and feared during her reign. It was believed that this goddess was both evil and kind and had the ability to inflict suffering on her victims, being in anger, as well as to calm fevers in those who were already suffering. In the portraits, the goddess is depicted with a broom in her right hand to move the disease to another place, and a pot of cool water, on the other hand, to calm the victims. Shrines were created that many indigenous people in India, both healthy and sick, could worship in an attempt to protect themselves from this disease. Some Indian women, in an attempt to ward off Shitala, placed plates of chilled food and pots of water on their rooftops. In cultures that did not have a special deity to represent smallpox, however, there was often a belief in smallpox demons, which were accordingly blamed for the spread of the disease. Such beliefs were common in Japan, Europe, Africa, and other parts of the world. In almost all cultures where the demon was believed, it was believed that he was afraid of red. This led to the invention of the so-called "red treatment", in which victims were dressed in red and their rooms were also decorated with red. The practice spread to Europe in the 12th century and was practiced by (among others) Charles V of France and Elizabeth I of England. Thanks to Finsen's research showing that red light reduces scarring, this belief persisted into the 1930s.

: Tags

List of used literature:

"Smallpox is not a bad weapon." Interview with General Burgasov (in Russian). Moscow News. Retrieved 2007-06-18

Koplow, David (2003). Smallpox: The Fight to Eradicate a Global Scourge. Berkeley and Los Angeles, CA: University of California Press. ISBN 0-520-23732-3

Massie, Robert K. (2011). Catherine the Great: Portrait of as Woman, pp. 387-388. Random House, New York. ISBN 978-0-679-45672-8

Giblin, James C. When Plague Strikes: The Black Death, Smallpox, AIDS. United States of America: HarperCollins Publishers, 1995

Tucker, Jonathan B. Scourge: The Once and Future Threat of Smallpox. New York: Atlantic Monthly Press, 2001

Attempts to prevent contagious diseases, in many ways reminiscent of the technique that was adopted in the 18th century, were undertaken in antiquity. In China, smallpox vaccination has been known since the 11th century. BC e., and it was carried out by inserting a piece of matter soaked in the contents of smallpox pustules into the nose healthy child... Sometimes dry smallpox crusts were also used. In one of the Indian texts of the 5th century, it was said about a method of combating smallpox: “Take smallpox matter with a surgical knife either from the udder of a cow or from the arm of an already infected person, make a puncture on the arm of another person until it bleeds, and when pus enters the body with blood, a fever is found. "

There were folk ways the fight against smallpox and in Russia. Since ancient times, in the Kazan province, smallpox scabs have been ground into powder, inhaled, and then steamed in a bath. For some, it helped, and the disease was mild, for others it all ended very sadly.

It was not possible to defeat smallpox for a long time, and it reaped a rich mournful harvest in the Old World, and then in the New. Smallpox has claimed millions of lives throughout Europe. Representatives of the reigning houses also suffered from it - Louis XV, Peter II. And there was no effective way to deal with this scourge.

Inoculation (artificial infection) was an effective way to combat smallpox. In the 18th century, it became fashionable in Europe. Whole armies, as was the case with the troops of George Washington, underwent mass inoculation. The top officials of states have shown themselves the effectiveness of this method. In France in 1774, the year Louis XV died of smallpox, his son Louis XVI was inoculated.

Shortly before this, under the influence of previous smallpox epidemics, Empress Catherine II turned to the services of an experienced British inoculant doctor Thomas Dimsdale. On October 12, 1768, he inoculated the empress and heir to the throne, future emperor Paul I. Dimsdale's inoculation was not the first to be done in the empire's capital. Before him, the Scottish doctor Rogerson had vaccinated the children of the British consul against smallpox, but this event did not receive any resonance, since it was not given the attention of the empress. In the case of Dimsdale, it was about the beginning of mass vaccination in Russia. In memory of this significant event, a silver medal was knocked out with the image of Catherine the Great, with the inscription “I set an example with myself” and the date of the significant event. The doctor himself, in gratitude from the empress, received the title of hereditary baron, the title of physician-in-chief, the rank of a full state councilor and a lifetime annual pension.

After successfully completing an exemplary inoculation in St. Petersburg, Dimsdale returned to his homeland, and in St. Petersburg, the work he had begun was continued by his compatriot Thomas Goliday (Holiday). He became the first doctor of the Smallpox (Ospoprivalny) house, where those who wished were vaccinated for free and were awarded a silver ruble with a portrait of the empress as a reward. Golidey lived in St. Petersburg for a long time, got rich, bought a house on the English Embankment and received a plot of land on one of the islands of the Neva delta, which, according to legend, was named after him, converted into a more understandable Russian word "Golodai" (now Dekabristov Island).

But long-term and full-fledged protection against smallpox still has not been created. Only thanks to the English doctor Edward Jenner, and the vaccination method discovered by him, did they manage to defeat smallpox. Thanks to his observation, Jenner collected information on the incidence of cowpox in milkmaids for several decades. An English physician concluded that the contents of young immature vaccinia pustules, which he called "vaccine", prevented smallpox from falling on the hands of thrush, that is, during inoculation. This led to the conclusion that artificial cowpox infection is a harmless and humane way to prevent smallpox. In 1796, Jenner conducted a human experiment, vaccinating an eight-year-old boy, James Phipps. Subsequently, Jenner discovered a way to preserve the graft material by drying the contents of the pustules and storing it in glass containers, which made it possible to transport the dry material to various regions.

The first vaccination against smallpox in Russia according to his method was made in 1801 by Professor Efrem Osipovich Mukhin to the boy Anton Petrov, who, with the light hand of Empress Maria Feodorovna, received the surname Vaccines.

The vaccination process at that time was significantly different from modern smallpox vaccination. The grafting material was the contents of the pustules of vaccinated children, a "humanized" vaccine, as a result of which there was a high risk of side infection with erysipelas, syphilis, etc. As a result, A. Negri proposed in 1852 to receive a smallpox vaccine from vaccinated calves.

At the end of the 19th century, advances in experimental immunology made it possible to study the processes that occur in the body after vaccination. Outstanding French scientist, chemist and microbiologist, founder of scientific microbiology and immunology Louis Pasteur concluded that the vaccination method can be applied to the treatment of other infectious diseases.

On the model of chicken cholera, Pasteur for the first time made an experimentally substantiated conclusion: "a new disease protects against the next." He defined the absence of recurrence of an infectious disease after vaccination as "immunity". In 1881 he discovered the anthrax vaccine. Subsequently, a rabies vaccine was developed to combat rabies. In 1885, Pasteur organized the world's first anti-rabies station in Paris. The second antirabies station was created in Russia by Ilya Ilyich Mechnikov, and began to appear throughout Russia. In 1888, a special institute for the fight against rabies and other infectious diseases was created in Paris with funds raised by international subscription, which later received the name of its founder and first leader. Thus, Pasteur's discoveries laid the scientific foundations for the fight against infectious diseases by vaccination.

I.I. Mechnikov and P. Ehrlich made it possible to study the essence of the organism's individual immunity to infectious diseases... Through the efforts of these scientists, a harmonious doctrine of immunity was created, and its authors I.I. Mechnikov and P. Ehrlich were awarded the Nobel Prize in 1908 (1908).

Thus, scientists of the late XIX - early XX centuries managed to study the nature of dangerous diseases and propose effective ways to prevent them. The fight against smallpox turned out to be the most successful, since the organizational foundations for the fight against this disease were also laid. The smallpox eradication program was proposed in 1958 by the USSR delegation at the XI Assembly of the World Health Organization and was successfully implemented in the late 1970s. joint efforts of all countries of the world. As a result, smallpox was defeated. All this made it possible to significantly reduce mortality in the world, especially among children, and increase the life expectancy of the population.

On June 12, 1958, the World Health Organization, at the suggestion of Soviet doctors, adopted a program for the global eradication of smallpox. For 21 years, doctors from 73 countries have jointly saved humanity from a viral infection, which has caused millions of victims.

The idea of \u200b\u200bthe program was simple: mass vaccination to block the smallpox virus from spreading until there is only one patient on Earth. Find him and quarantine him. When the chief sanitary inspector of the USSR Ministry of Health Viktor Mikhailovich Zhdanov proposed such an idea at the WHO session, this unknown was only 4 years old. When he was finally found, the boy grew up and became a skilled cook.

On June 12, 1958, no one knew yet where this last patient was found. There were 63 states in the world with smallpox outbreaks. All of these countries were developing countries. And although the idea of \u200b\u200bhelping them was expressed by the not very popular delegation of the Soviet Union, which was at knives with half the world, the resolution was adopted unanimously. There were two reasons for the consensus: financial and medical. First, smallpox was regularly brought from colonies to the countries of the first world, so that one had to spend a billion dollars a year on prevention. It's easier to take and vaccinate all of humanity, it will cost a hundred million, and it will only be needed once. Secondly, more people began to die from complications as a result of vaccination than from imported smallpox.

A smallpox patient is recovering: drying pustules on her face. The photo was taken by the employee of the Global Program, epidemiologist Valery Fedenev. India, 1975.

The Soviet Union was one of the founding states of the World Health Organization, but until 1958 demonstratively did not participate in its work. Now that relations with the outside world were improving, a program was needed that would cause universal approval. The political environment and the dreams of Soviet doctors coincided for a time. The USSR generously donated millions of doses of smallpox vaccine to WHO, and WHO called on world governments to inoculate their populations with this drug.

The first country to eliminate smallpox in this way was Iraq. The local Prime Minister Abdel-Kerim Qasem sought Khrushchev's friendship. In August 1959, a detachment of Soviet doctors flew to Baghdad. For two months, they traveled all over Iraq on UAZ sanitary loaves, distributing the vaccine and teaching local doctors how to use it. There were many women in the detachment, because in a Muslim country, male doctors were not allowed to vaccinate women and girls. Every now and then I had to put on hijabs, but in general the attitude was favorable. Until October 7, 1959, when the young Saddam Hussein shot at the prime minister's car and wounded him. At that time, Kassem survived, but unrest began, the epidemiologists were called back home. Iraqi doctors independently brought the matter to complete victory - later there was only one outbreak of the disease, and that was imported.

Viktor Mikhailovich Zhdanov (1914-1987), initiator of the WHO Global Smallpox Eradication Program, in the position of Director of the Institute of Virology of the USSR Academy of Medical Sciences, 1964.

The program had such a success wherever there was an intelligentsia of its own. Doctors enthusiastically accepted the help, explained to the population the importance of vaccination and made sure that no foci of infection remained. It happened in Iraq and Colombia, but there were only two dozen such states. After 10 years, the WHO admitted that in 43 countries there was no progress: there were officially 200 thousand sick people, but in reality, probably 10 times more. Adopted a new, intensive program - WHO specialists went to developing countries to organize there on the spot what they are not capable of local authorities... And events began in the spirit of the Strugatsky novels.

American epidemiologist Daniel Henderson, who successfully fought against smallpox introduced to the United States, became the director of the program. At 38, he was able to comprehend in five minutes of conversation a stranger and unmistakably determine whether it is worth accepting him into the team, and in what place. Henderson from Geneva has conducted the work around the world. He turned to new technologies, without which mass vaccination was too slow.

The US military provided WHO with needleless injectors - pneumatic, pedal-operated devices that injected vaccine under the skin. The idea came from a grease gun. Workers in French shipyards complained that they sometimes accidentally injected themselves with lubricant. If such a gun is loaded with a vaccine, one person per shift can easily vaccinate a thousand. No electricity required - only compressed air.

Such a device cost as a Volkswagen Beetle, but it worked wonders. He cleared smallpox from Brazil, West and South Africa - places where the population easily gathered at the call of Catholic missionaries, at the same time fulfilling the role of epidemiological surveillance. It was enough to promise the distribution of food, as the cry was the nomadic Indians from the Amazonian jungle and the pygmy cannibals from the Zairian humid forest.

Dr. Ben Rubin has come up with an even more powerful weapon - the bifurcation needle. In her bifurcated sting, a droplet of the drug was retained, only 0.0025 milliliters. For a reliable vaccination, it is enough to slightly prick the shoulder 10-12 times. The developer donated the rights to his needle to WHO. This saved millions and allowed volunteers to be recruited without any medical training.

Work on the WHO program in different parts of the world:

Top left - Europe, Yugoslavia, autonomous province of Kosovo, 1972. The woman shows the inspector - a military doctor - a post-weld scar.

Top right - South America, Brazil, 1970. The child is vaccinated with a needleless injector.

Bottom left - Africa. Vaccination program in Niger, 1969.

Bottom right - Africa, Ethiopia, 1974. A WHO Global Program Epidemiologist Jeep crosses a river on a wooden bridge designated as impassable for vehicles. This car has crossed this bridge 4 times. Approximately the same bridge collapsed under her wheels in another place - then the driver managed to turn on the gas, and the episode ended safely.

Photo from the WHO archive.

The Soviet scientist Ivan Ladny in Zambia destroyed one outbreak after another until he found a man who was spreading the smallpox virus to the whole country. It turned out to be a shaman doing variolation. His bamboo tube contained material from the festering scabs of a smallpox patient in easy form... For a fee, this rubbish was injected into an incision in the skin. She could induce immunity for many years, and could provoke a fatal disease. What to do with this shaman? Ladny suggested that he change - a set of a variolator for a bifurcation needle. The deal took place, and the shaman turned from an enemy into an assistant.

In 1970, Central Africa was considered free of infection, when suddenly this diagnosis was made to a 9-year-old boy in a remote village. Where could smallpox come from if it is transmitted only from one person to another? A sample of the material from the vesicles on the boy's body was sent to the WHO Collaborating Center in Moscow, where Svetlana Marennikova examined it under an electron microscope and established that it was a smallpox virus, but not natural, but a monkey, known since 1959. So we learned that people can get this infection from animals. Moreover, monkeypox was found in animals at the Moscow Zoo. Marennikova had to vaccinate animals, including stabbing a huge Amur tiger in the ear in a special pressure cage. But the most important thing in this discovery is that the variola virus has no other host than humans, which means that the virus can be isolated and left without prey.

The main breeding ground for smallpox in its most deadly form remained the Indian subcontinent - India, Pakistan, Bangladesh, Nepal. WHO Director-General Marcolin Kandau did not believe that anything could be eradicated in India at all and promised to eat the tire from a jeep if he was wrong. The fact is that the reporting in those parts was extremely fake. Local epidemiologists found their bearings quickly: they signed up for the WHO program, received good salaries in foreign currency, dismantled the jeeps allocated to them as personal vehicles and drove Henderson reports on the 100% vaccination of their areas. And thousands of cases of smallpox were attributed to the poor quality of vaccines, primarily Soviet. Like, it's hot here, the Russian drug is decomposing. Only the bosses were distinguished by such meanness. Among the rank and file there were always enthusiastic doctors who were able to go all night on call to a mountain village with a torch in hand, removing earthen leeches from their feet. Employees of the global program walked side by side with them.

Soviet doctors, who understood the false statistics, began to visit every hearth. They came up with the idea of \u200b\u200bmobilizing all the health workers of the district for a week for this - the authorities allowed, and Indira Gandhi directly called on the population to help the WHO staff. Canadian student volunteer Beverly Spring decided to start sending volunteers to the market, who asked if there was smallpox in these places. The information received was always accurate. Then the vaccinators were put forward, and after inoculation, a watchman, usually from relatives, was assigned to the patient's house, who recorded all who came. In 1975, smallpox was no longer endemic in India, and Henderson sent Kandau an old jeep tire. But he did not eat it, because by that time he had retired.

The jeeps and people freed in Asia were thrown on the last bastion of smallpox - in Ethiopia. There, doctors did not keep fake statistics, because health care did not exist at all. The Muslim part of the country turned out to be more enlightened and loyal to vaccination - scattered foci of the disease were quickly eliminated there. The situation was worse in the Orthodox regions, where the clergy were engaged in variolation, saw in it a source of income, and therefore opposed the elimination of smallpox. Two local vaccinators were even killed in the line of duty. But when Emperor Haile Selassie was overthrown and then suffocated with a pillow, the new government needed international recognition and began to help WHO. It could not only close the border with Somalia. In the Ogaden Desert, Somali guerrillas captured a Brazilian smallpox specialist and released him only after the personal intervention of the UN Secretary General. Smallpox traces were in Somalia. Despite the war that this quasi-state waged with Ethiopia, the staff of the Global Program calculated all the sick among the nomads. They were taken to the hospital in the city of Mark. On the way, we met a friendly guy named Ali Mayau Mullin, who not only knew the way, but even got into a jeep and showed how to get there, because he worked as a cook in that very hospital. In a few minutes in the car, Ali picked up smallpox and went down in history, because he was the last person to be infected on Earth. When he recovered, WHO waited a while and announced a thousand dollar bonus to anyone who found a smallpox patient. This money never got to anyone.

Above left: Global Program staff polls the population for smallpox patients by displaying an identification card with a photo of a sick child.

Bottom left: sanitary control point at Moscow Vnukovo airport; the cordon was organized in 1960 to prevent the importation of smallpox from Asia and Africa.

Right: the last person on Earth to contract endemic smallpox - cook Aline Mayau Mullin (born 1954). Somalia, city of Mark, November 1977 ...