The disease from which the Queen of England Maria II and the Emperor of Japan Hagishiyama, the heir of Peter the Great and the son of Suleiman the Magnificent, the King of Spain Louis the First and the Princess of the Indians Pocahontas died. A virus that wiped out the cities of the Middle Ages and entire villages of Africa in the 20th century. It's all about smallpox. What is known about this disease to a modern layman? Let's try to fill in the gaps about the disease with smallpox, which in its consequences is equal to the plague and anthrax.
Historical excursion
Today smallpox is the only viral infection that has been eradicated by epidemiologists in all continents. But it was not always so. The last reliable case of infection of this disease was recorded in 1977, and in 1980, the World Health Organization announced the eradication of this disease. The term “smallpox,” or Variola, appeared in the records of Bishop Avench Maria (570 AD), although judging by the description of the symptoms, it was natural smallpox that exterminated a third of the inhabitants of Athens in the 430s BC and was a pestilence, which mowed the soldiers of the troops of Marcus Aurelius during the Parthian Wars in the 165-180s of our era. Crusades of the XI-XIII centuries opened a procession of small or smallpox in Europe and Scandinavia. Spanish conquistadors brought smallpox to South America. There, 90% of the indigenous population died from it. Until recently, smallpox was an epidemiological disease, the mortality rate of which exceeded 40%.
Black pestilence
What is this disease and what are its symptoms? Smallpox is a dangerous contagious disease transmitted by airborne droplets. In the body, the pathogen multiplies in the lymphatic system, then affects the internal organs. The source of infection of human (natural) smallpox, the photo of the symptoms of which is not for the faint of heart, can only be a person, although smallpox affects cats, monkeys, ungulates and other mammals. Animal virus can cause disease in humans. However, it is incomparable in severity and consequences with natural human smallpox.
The incubation period of the disease is from 10 to 20 days, the patient is non-contagious. An infected person experiences headaches and pain in the lumbar region for 3-4 days. There is vomiting and fever, an increase in body temperature up to 40 degrees. On the 2nd day, a rash appears that spreads centrifugally (face, body, limbs). The rash begins with the macula (pink spots), they pass into the papules and vesicles in the form of multi-chamber vesicles, followed by the stage of pustules (purulent vesicles). First occurs on the chest, hips, then spreads to the whole body. On the 7th day, pustules are suppurating, damage to the nervous and circulatory systems begins. Then the pustules burst, and scars remain in their place. In severe cases, death occurs as a result of heart failure and toxic shock on the 3-4th day. Among those who have the disease, one in five is affected by blindness, but all who have been ill receive persistent lifelong immunity.
Variation is the first step in the fight against the disease
Methods of preventing smallpox came to Europe from Asia. Various inoculation options (administration of live pathogens, infected material) have been known for a long time. Dried crusts sniffed in China, swallowed them in Persia, put on shirts soaked in pus in India. Muslims of the Mediterranean mixed pus taken from a patient on the 12th day of illness with blood in a scratch on the recipient's forearm. It was the latter method that came to Europe as a variation. We owe it to Lady Mary Worthley Montague, the wife of the Ambassador of England to Turkey. It was she who in 1718 instilled in this way herself and her children. Although variolation yielded the expected result for the Montague family, the method was not safe enough. There were no guarantees from such a procedure, the course of the disease could be very severe and often led to death (up to 2% mortality). In addition, the method did not give guarantees of immunity and led to the development of epidemics.
Life-saving vaccine
The honor of creating a vaccine against smallpox belongs to the English physician Edward Jenner (1749-1823). He noticed that milkmaids who had been infected with smallpox did not get sick during the epidemic of human smallpox. It was he who developed the method of vaccinating people with smallpox, and then with material taken from people vaccinated with the cow virus. By the way, the word "vaccination" comes from the Latin word "vacca", which means cow. The first person to whom Jenner was vaccinated using material taken from the hands of a thrush with cowpox was an 8-year-old boy, James Phipps. He suffered a mild illness, did not get sick later, and a grateful doctor built him a house and planted roses in his garden with his own hands.
But before becoming a worldwide panacea, Jenner's technique for a long time overcame the resistance of medical conservatives. And only after convincing evidence of the safety and effectiveness of vaccination against smallpox, it was recognized by the international community. Edward Jenner was lucky to live up to his confession - until his death, he led the English society of resistance.
Sasha Ospenny and Anton Vaktsinov
In Russia, every seventh child was dying from smallpox at that time. Pillage in Russia began in 1768 with the variation of the royal family - Catherine the Second and her son Paul. The empress was later called a true hero, and historians compared her act to a victory over the Turks. The compiled material was taken by a visiting British physician G. Dimedal from Sasha Markov, a seven-year-old peasant boy. The doctor received the title of baron from the royal family, and Sasha received the surname Ospenny and the nobility.
Jenner’s student, Professor E.O. Mukhin, in 1801 made the first vaccine in Russia received from her inventor. In the presence of royalty, Anton Petrov, a pupil of the Moscow noble house, was vaccinated with smallpox pathogens. The procedure was successful, and the boy received the name of the Vaccines and a lifelong pension. A corresponding decree was issued, and by 1804 the vaccination was carried out in 19 Russian provinces, almost 65 thousand people were vaccinated.
Smallpox virus: microbiology
The virus that causes this disease belongs to the DNA-containing poxviruses of the family Poxviridae, genus Orthopoxvirus. In humans, the causative agents of smallpox are two species - Variola major (classic smallpox, mortality - more than 50%) and Variola minor (alastrium with a mortality rate of up to 3%). These are large viruses up to 220 by 300 nanometers in size. They were first seen in a light microscope in 1906 by the German biologist Enric Paschen (1850-1936).
The smallpox virus virion (photo above) has an oval shape, in the middle there is DNA with proteins (1) that can independently start the synthesis of information RNA in the host cell. The core is covered by a shell (2) and resembles the shape of a dumbbell, since it is pressed from both sides by the side bodies (3). Smallpox virus has two coatings - protein and lipid (4). Once in the human body, the virus infects all cells, without experiencing a preference for any particular. In this case, damage to the skin affects the deep layers of the dermis. In pustules and crusts, the causative agent of smallpox is virulent for a long time, stored in corpses. The virus is highly contagious (contagious), can persist for a long time in the environment, does not die when frozen.
Diagnosis and treatment
The clinic and symptoms of the disease caused by the causative agent of smallpox are very characteristic, and the diagnosis is established by external signs. Another thing is that there are no more doctors who saw firsthand the patient. Therefore, in the early days when general symptoms appear, but there is no rash, the diagnosis of smallpox is difficult. But in this period the patient is already contagious and can infect others by airborne droplets. That is why quarantine measures are so effective. Microbiology uses electron microscopy and polymerase chain reaction methods to determine smallpox. In this case, the contents of pustules, crusts, smears of mucus are examined. For the modern treatment of smallpox (in the case of a resurgence of the disease), anti-venous immunoglobulins and antiviral drugs, as well as broad-spectrum antibiotics, can be used. Outwardly, the use of antiseptic agents is possible. In parallel, detoxification therapy is needed.
Preventative measures
Preventive measures come down to vaccination. Unvaccinated people are all susceptible to the pathogen; a person has no natural immunity to this disease. Children under four years of age are particularly susceptible. Modern vaccines are grown on chicken embryos or on tissue culture. There are several of them in the world, all have passed WHO certification. Vaccination is carried out with infected bifurcation needles, which make up to 15 punctures on the forearm. After which the vaccination site is closed. Fever and myalgia are possible within a week after the procedure. The success of the operation is checked by the presence of papules on the 7th day. Immunity lasts 5 years, after which it begins to decline and becomes insignificant after 20 years. Today, vaccination is indicated only for people whose professional activity is associated with a high risk of infection (employees of the relevant laboratories).
Complications
They can occur in 1 vaccine per 10 thousand patients. They are primarily associated with skin diseases. Contraindications are pregnancy, autoimmune diseases, eye inflammation. Severe complications include encephalitis (1: 300,000), eczema, myocarditis, pericarditis, a rash of non-infectious origin. Nevertheless, vaccination will prevent or significantly reduce the severity of the course of the disease. It is recommended to all family members of the patient and contact people for whom quarantine is set for at least 17 days.
War of annihilation
In the middle of the 20th century, the countries of Europe, the USA, Canada and the Soviet Union were able to introduce mandatory vaccination of the population. The World Health Organization in 1959 declared a total war against smallpox on the planet. The idea of worldwide vaccination was proposed by Russian academician and virologist Viktor Mikhailovich Zhdanov (1914-1987), who was deputy minister of health of the USSR and director of the Dmitry Iosifovich Ivanovsky Institute of Virology. Millions of dollars have been spent on this campaign over 20 years. By 1971, smallpox had disappeared in South America and Asia. The last case was reported in Somalia (1977), where the infection occurred naturally. In 1978, a case of infection was recorded in the laboratory. In 1980, WHO announced the complete destruction of human smallpox on Earth. Today, its pathogens are stored in the American Center for Disease Control and Prevention in the laboratory of Emory University (Atlanta) and in the laboratory of the Vector State Virology and Biotechnology Center "Vector" (Koltsovo).
The threat remains
After 1980, most countries refused compulsory vaccination of the population. Our contemporaries - this is the second generation that lives unvaccinated. However, although only humans are carriers of the pathogen, there is no guarantee that the primate smallpox virus does not mutate. The second threat to the return of the disease is the lack of guarantees that WHO has complete data on preserved strains of the virus. After all, it was not in vain that after the 2001 scandal in the United States, when envelopes with anthrax spores were sent out, all American servicemen were vaccinated against smallpox. Let's hope that vaccine stocks in epidemiological laboratories still remain unclaimed.
Biohazard source
Data on the use of smallpox as a biological weapon is known. So, during the Franco-Indian War (1756-1763), Great Britain used smallpox as a biological weapon against France and the Indians. There is evidence of research on the development of smallpox-based weapons during World War II (1939-1945). There is a version that the US was considering a scenario for the use of such weapons during the Vietnam War on the Ho Chi Minh trail. During the Cold War, studies were conducted in the Soviet Union to unify the smallpox and Ebola viruses. However, these studies did not gain wide scope due to the inefficiency of such weapons due to the availability of anti-arterial vaccines. But even today materials appear in the media that inspire certain uneasy moods.
Smallpox and AIDS
U.S. immunologists from the University of California have published data from their studies stating that withdrawal of smallpox vaccination could lead to an increase in human immunodeficiency virus infections. According to them, in the tissues of people vaccinated against smallpox, the causative agent of immunodeficiency multiplies five times slower. This does not mean that a smallpox vaccine protects you from another deadly pathogen. Scientists give the key role in this protective mechanism to the receptor proteins of cell membranes (CCR5 and CD4), which the virus uses to enter the cell. As scientists emphasize, these studies have so far been carried out only on tissue cultures, and not on the entire body. But even the low probability of reducing the risk of infection deserves attention and study. With further confirmation of the effectiveness of vaccination against smallpox to reduce the risk of infection with the human immunodeficiency virus (albeit not 100%), it is quite possible and not so difficult to return to the previous methods.
On the need for vaccination
According to epidemiologists and infectious disease specialists, all infections are manageable, and they are controlled by vaccination. Refusing preventive vaccinations, we risk making the infection uncontrollable. This is exactly what happened with diphtheria, when in the 90s the inhabitants of the post-Soviet space refused to vaccinate en masse. The 1994-1996 diphtheria epidemic clearly demonstrated the failure of such failures. Doctors from Europe went to the CIS countries to see what diphtheria looks like.
Today, smallpox is not the only disease conquered by humanity. In developed countries, on the verge of extinction, deadly human companions - whooping cough, mumps, rubella. Until very recently, the polio vaccine contained three serotypes (different types of virus). Today it already contains two serotypes - the third strain of the pathogen strain has been eliminated. To be vaccinated or not is up to everyone to decide. But do not underestimate the achievements of medicine and neglect the basic methods of protection.
Grateful humanity
The name of Edward Jenner entered the history of the struggle of mankind with pandemics. In many countries, monuments were erected to him; universities and laboratories were named after him. He became an honorary member of many scientific societies and academies, and some Indian tribes even sent him honorary belts. In 1853, a monument was unveiled to him in London (at first it was located on Trafalgar Square, later it was moved to Kensington Gardens), at the opening of which Prince Albert said:
No doctor has saved the lives of such a significant number of people like this person.
The great sculptor Monteverdi created another monument that perpetuated the moment of vaccination of smallpox to a child. The sculpture is installed in Boulogne (France). And if Jenner is deservedly considered the author of the discovery, then the child James is his co-author, although he did not suspect what role he would play in the fate of all mankind.