Final: Smallpox

Question 1

What was the virus responsible for smallpox?

Answer 1

Variola

Question 2

What are the “relatives” of the variola virus?

Answer 2

cowpox, vaccinia, camelpox, monkeypox, chickenpox

Question 3

What is the most likely mode of transmission?

Answer 3

Person to person
Inhalation of Droplets (less than 2 meters)
Direct contact
With infected body fluids (saliva, blood)
Scabs
Contaminated Objects (fomites)

Question 4

What is the length of contagion?

Answer 4

Most contagious rash onset
First 7-10 days
Contagious until last scab falls off

Question 5

What are the initial symptoms of smallpox?

Answer 5

Small red spots in mouth and on tongue

Question 6

Contrast the distribution of smallpox rash vs chicken pox rash:

Answer 6

Smallpox rash is centrifugal, most rash occurs on arms, legs, hands and feet. chicken pox rash is more centralized on the body.

Question 7

What period of time can smallpox be transmitted more easily?

Answer 7

Cool, dry winter months but can be transmitted in any climate

Question 8

What is the case fatality rate in Variola major ordinary?

Answer 8

30%

Question 9

What is the case-fatality rate in variola major malignant or “flat”?

Answer 9

97%

Question 10

What is the case fatality rate in variola major hemorrhagic?

Answer 10

near 100%

Question 11

What is the case fatality rate in variola major modified?

Answer 11

rarely fatal

Question 12

What is the case fatality rate of variola minor?

Answer 12

less than 1%

Question 13

What was the number and case fatality rate in 18th century Europe? Among children?

Answer 13

• 400,000 deaths per year, 20-60% case fatality

- 80-98% fatality in infants

Question 14

What were the most common complications among smallpox survivors?

Answer 14

Scars, limb deformities and blindness

Question 15

What was variolation?

Answer 15

obsolete method of immunizing patients against smallpox by infecting them with substance from the pustules of patients with a mild form

Question 16

What was the source of the method of variolation?

Answer 16

China, India

Question 17

Who introduced variolation in Great Britain (made it popular)?

Answer 17

Lady Mary Wortley Montague

Question 18

Who is considered the “father” of vaccination?

Answer 18

Edward Jenner

Question 19

What was used in modern vaccines?

Answer 19

vaccinia virus

Question 20

When was the last US vaccination?

Answer 20

1972

Question 21

What are some serious complications to smallpox vaccine?

Answer 21

1) Inadvertent inoculation
2) Generalized vaccinia
3) Erythema multiforme

Question 22

What are some life threatening complications to smallpox vaccine?

Answer 22

1) Progressive vaccinia
2) Post vaccinal encephalitis
3) Eczema vaccinatum

Question 23

Who should not get the smallpox vaccine?

Answer 23

People with:
1) Eczema or atopic dermatitis 
2) Skin conditions
3) Chickenpox, herpes, psoriasis, shingles
4) Weakened immune system
5) Transplant, chemotherapy, HIV, others
6) Pregnant women
7) Less than 18yr. old
8) Breastfeeding mothers
If exposed, get vaccine no matter what

Question 24

Where was the last case of Variola major?

Answer 24

Bangladesh 1975

Question 25

Where was the last case of Variola minor?

Answer 25

Somalia 1977

Question 26

What year did the WHO declare smallpox dead?

Answer 26

1980

Question 27

What were the reasons for the eradications success?

Answer 27

``` Stable Virus No animal reservoir No insect/animal vector Vaccinees easily identifiable Diseased easily identifiable Herd Immunity Strategy *Effective Vaccine available* ```

Question 28

What was the strategy to eliminate smallpox?

Answer 28

Mass vaccination campaigns in each country 80% of population target Vaccine of ensured potency Detect and contain cases and outbreaks

Question 29

Where are the smallpox stores?

Answer 29

1) CDC in Atlanta, Georgia | 2) Vector Laboratories in Koltsovo, Russia

Question 30

How many US military were vaccinated post 9/11?

Answer 30

578,286

Question 31

Where is the origin of monkeypox?

Answer 31

Central Africa

Question 32

What is the animal reservoir for monkeypox?

Answer 32

African squirrel

Question 33

How is monkeypox transmitted?

Answer 33

bites, aerosol, direct contact to animal

Question 34

Where was the outbreak distributed in the US?

Answer 34

6 Mid-Western states

Question 35

What was the response of the US to monkeypox?

Answer 35

1) Treat patients 2) vaccinate for smallpox 3) Control infection (with bleach) 4) Embargo of animals from Africa 5) Euthanasia of animals 6) Quarantine animals for 6 weeks

Question 36

What did Jenner use in his first vaccination?

Answer 36

cowpox

Question 37

What were Brilliant's keys to eradicating smallpox?

Answer 37

1) Surveillance 2) Early Detection 3) Early Response