|
|
Nursing Continuing Education
Institute Smallpox Epidemic:
Could you deal with it?
| Course Number |
LWN421 |
| Objectives |
At the end of this course, you will
1) describe smallpox, 2) identify smallpox skin lesions, 3) describe
smallpox transmission, and 4) list smallpox protection measures. |
| Credit Hours and Fee |
3.0 CE Credit Hours with a fee of $24.00 |
| Instructor |
Rudolf Klimes, PhD (Indiana University), MPH
(Johns Hopkins University); Adjunct Professor, Folsom Lake College,
Folsom, CA |
Welcome
to this
3-contact-hour Continuing Education course with instant online processing and
certification 24/7. Study the course below, take the 12-question
multiple-choice
TEST, register and pay online. If
you score 75% or above, you may print your CE certificate on your printer as
soon as you finish.
If you have difficulty printing your certificate,
click here.
You may retake the test once.
Take the
Virus Pre-test now
1.
What is smallpox?
"That disease...was then the most terrible of all the ministers of death. The
havoc of the Plague had been far more rapid: but Plague had visited our shores
only once or twice within living memory; and the small pox was always present,
filling the churchyard with corpses, tormenting with constant fears all whom it
had not yet stricken, leaving on those whose lives it spared the hideous traces
of its power, turning the babe into a changeling at which the mother shuddered,
and making the eyes and cheeks of a betrothed maiden objects of horror to the
lover."
---Thomas Babington Macaulay,
History of England
1.1 The first documented case of smallpox is thought to be the Egyptian
Pharaoh Ramses V who lost his life to the disease in 1157 B.C. Soon after,
smallpox began to spread like wildfire throughout the world. By 700 A.D.,
smallpox had spread to Japan in the East, and Europe and Northern Africa in the
West. In 189 A.D., it killed as many as 2,000 people a day in the Roman Empire.
It then spread to the New World due to slave trade and the Spanish conquistadors
in South America.
1.2 In 1796, Edward Jenner, an English country doctor, discovered a way to
prevent smallpox which did not pose such a grave threat to lives like the
smallpox inoculation did. Jenner had noticed that milkmaids who had caught the
mild cowpox virus did not develop the more virulent smallpox. He felt that
inoculation with cowpox would prevent a person from getting the dreaded
smallpox.
1.3 Viruses are much smaller than bacteria and human cells. The virions of
poxviruses are remarkably larger than other viruses, which can be detected
through light microscopy. It is the most complex of human infective viruses. The
variola virions are oval/brick shaped particles of about 200-400nm long with
20nm spikes, and 30nm membrane. Their external surface is ridged in parallel
rows, and sometimes arranged helically.
1.4 Variola virus causes smallpox.
Variola minor cases are discrete, ordinary types, with extensive
rashes and smaller lesions. The rash heals quicker and with less toxemia than
variola major. Variola major has a 20-30% case-fatality rate, while variola
minor has less that a 1% case-fatality rate. Mortality tended to be highest in
the very young and in the elderly. Where the smallpox was endemic in large
population groups, it was usually a disease of childhood. One attack of smallpox
gave most an almost complete immunity to reinfection. Vaccination with a potent
preparation of vaccinia virus gave complete protection against smallpox for
about 5 years.
1.5 Smallpox was the first and to date only disease ever eradicated by man.
However, stocks of the variola virus are still kept at the CDC in Atlanta and in
an institute in Moscow. They are kept frozen in liquid nitrogen and are locked
away under constant surveillance. These stocks are the last known remnants of
one of the deadliest killers in history.
THE WHO OFFICIALLY DECLARED SMALLPOX TO BE ERADICATED FROM MANKIND ON MAY 8,
1980
Smallpox is rated among the most dangerous of all potential biological
weapons, with far-reaching ramifications.
2. How
does smallpox manifest itself?
The most noticeable symptoms include: high fever, nausea, aches, and puss
filled swelled rashes. After the incubation period, the onset is acute, with
fever, malaise, headache and backache. This initial phase lasts for about 4-5
days. On the 3rd/4th day, the characteristic rash appears, first on the face,
forearms and hands. Within a day or so thereafter, the rash spreads to the trunk
and lower limbs. Pustules dry up 8-9 days after the initial onset, and crust by
the 14th -16th day. The rash is most abundant on the face, the upper arms rather
than the lower arms, the lower legs, rather than the thighs, and sparse on the
trunk, especially the stomach.
More smallpox
images,
Vaccine reaction images
S mallpox was sometimes confused with chickenpox, but several features
of these diseases were significantly different:
- The initial symptoms of smallpox were much more severe than those
of chickenpox (i.e., high fever, severe muscle aches, etc.).
- Smallpox rash was most common on exposed portions of the body:
face, forearms, wrists, palms, lower legs, feet, and soles. (Chickenpox is
most common on covered areas of the body.)
- Smallpox rash lesions tended to be at the same stage of development,
and there was only one eruption of pox lesions. (With chickenpox, it is common
to have more than one eruption of pox lesions and the lesions may be in
different stages of maturation.)
- Smallpox lesions tended to be deeper in the skin than chickenpox lesions,
hard to the touch, and the vesicles were tough to break.
Signs and Symptoms: Clinical manifestations begin
acutely with malaise, fever, rigors, vomiting, headache, and backache. 2-3 days
later lesions appear which quickly progress from macules to papules, and
eventually to pustular vesicles. They are more abundant on the extremities and
face, and develop synchronously.
Diagnosis: Electron and light microscopy are not
capable of discriminating variola from vaccinia, monkeypox or cowpox. The new
PCR diagnostic techniques may be more accurate in discriminating between variola
and other Orthopoxviruses.
Treatment: At present there is no effective
chemotherapy, and treatment of a clinical case remains supportive.
Prophylaxis: Immediate vaccination or revaccination
should be undertaken for all personnel exposed. Vaccinia immune globulin (VIG)
is of value in post-exposure prophylaxis of smallpox when given within the first
week following exposure.
Isolation and Decontamination: Droplet and Airborne
Precautions for a minimum of 16-17 days following exposure for all
contacts. Patients should be considered infectious until all scabs separate.
Source
3. How
is smallpox transmitted?
3.1 A person infected with smallpox and overtly sick usually transmits the
virus face-to-face in a closed dwelling. There is no infectious subclinical
state.
3.2 There are two main routes of entry. One way is through air droplets. This
includes sneezing, coughing, etc., that may cause the virus to be expelled by
one person in vapor residue from respiration and secretion to live in the air
until entering and infecting another organism.
3.3 The other main source of entry is through direct contact. This involves
kissing, sexual intercourse, or any exchange of blood and bodily fluids that
have the potential to spread the disease from one organism to another.
4.
How can you protect yourself against smallpox?
4.1 Inoculation is a technique whereby a substance is introduced to a
patient in order to create immunity to a specific illness. In the case of
smallpox immunity, a patient is introduced to attenuated smallpox or cowpox, and
a trivial infection occurs. If the procedure has been successful, subsequent
exposure to the virus does not infect the patient. Variolation is inoculation
with smallpox (variola) and vaccination is inoculation with cowpox (vaccina).
4.2 Vaccination is not recommended now, and the vaccine is not available to
health providers or the public. In the absence of a confirmed case of smallpox
anywhere in the world, there is no need to be vaccinated against smallpox. There
also can be severe side effects to the smallpox vaccine, which is another reason
we do not recommend vaccination. In the event of an outbreak, the CDC has clear
guidelines to swiftly provide vaccine to people exposed to this disease. The
vaccine is securely stored for use in the case of an outbreak. In addition,
Secretary of Health and Human Services Tommy Thompson recently announced plans
to accelerate production of a new smallpox vaccine. Source
www.cdc.gov
4.3 Patients should be considered infectious until scabs separate, which
usually takes about three weeks from the time of infection. Isolation with
droplet and airborne precautions should be exercised for patients and all
contacts for a minimum of 16-17 days following exposure. Isolation in the home
or other non-hospital facilities should be considered where possible since the
risk for transmission is high and few hospitals will have enough negative
pressure rooms for proper isolation. Immediate vaccination, if available, should
be given to all medical personnel. Outside of the hospital setting, patients and
household contacts should wear a N95 or better mask. Care-givers should wear
disposable gowns and gloves, as well. Bed linens, clothing, and other exposed
articles must be sterilized or incinerated.
5.
Where can I find out more about smallpox?
The Bioterrorism Emergency Number is (770)
488-7100. The CDC Hotline is 888-236-2675.
Smallpox Library:
CDC-Smallpox,
General Article
TEST
Study this web-site for
3 hours for an
approved (RN-CEP 11430, MFT- PCE 39) 3-hours Continuing Education Certificate (0.3
CEUs).
Click
here for the self-correcting test & online payment, and 2) receive your
certificate immediately online. All is online, nothing by post-mail.
|
|