Smallpox: could a deadly disease--declared eradicated on Earth--come back to haunt humans as a bioweapon? (Life Science Infectious Viruses).



It's one of history's oldest and most fearsome killers.

Smallpox causes scorching fever, oozing blisters, terrible scarring--and

death, especially in children. Thought to have taken its first human

life 10,000 years ago in Africa or Asia, the earliest evidence of its

deadly mischief is found on the scarred faces of mummies in the Cairo

Museum.

It's also written all over the history books: Mass outbreaks

of the disease gutted the world's greatest empires, from the Romans

to the Aztecs, and spared neither peasants nor princes: King Louis XV of

France died of it; Abraham Lincoln survived, but probably carried

lasting battle scars.

Smallpox is also the only disease to be deliberately--and

successfully--wiped out by man. The drive to defeat it accelerated in

the 18th century, when a British doctor named Edward Jenner developed

the first smallpox vaccine, a substance to shield humans against the

disease.

Millions lined up for Jenner's lifesaving discovery in the

centuries that followed--and slowly the number of cases began to drop.

Smallpox hasn't been seen on U.S. soil since 1949, but in Africa

and Asia the disease continued to ravage poor and remote regions. So in

1967, the World Health Organization (WHO) launched a global vaccination

campaign to eradicate smallpox. The strategy worked--the world's

last natural case occurred on October 27, 1977, in a hospital cook in

Somalia.

Today, the virus (microscopic panicle) that causes smallpox

officially exists in just two places: a high-security U.S. government

laboratory in Atlanta and a similar lab in Russia. But in the aftermath

of 9/11, some experts fear that terrorists or nations such as Iraq may

have secretly acquired the virus for use as a biological weapon. To

prepare for any potential threat, the U.S. government in January

announced a far-reaching program to vaccinate 11 million health-care

workers and military personnel. But the plan has sparked raging

controversy. More than 80 U.S. hospitals are refusing to administer the

vaccine, which can trigger rare but severe side effects--including

death. "The cost in deaths from vaccine complications will outweigh

any benefits," argues Dr. Thomas Mack, a University of Southern

California smallpox expert.

Others disagree: "The threat of bioterrorism is real,"

stresses Dr. Anthony Fauci, director of the National Institute of

Allergy and Infectious Diseases. To show Americans they have nothing to

fear, President George W. Bush rolled up his sleeve to receive his own

shot last December. What exactly is this disease, and just how real is

the threat? Read on.

Q: What is smallpox, and what are its symptoms?

A: Smallpox is a contagious and often-fatal disease caused by the

variola virus, a particle so tiny that roughly 1,000 linked together

span the width of a human hair. Despite its size, variola is a potential

killing machine: Nearly one out of every three infected people die.

The disease assumes different forms. But a person infected by the

virus usually feels nothing for the first seven to 17 days. Then, signs

of malignant smallpox set in: high fever, chills, body aches, and

vomiting--most people are too sick to get out of bed. After two to four

days, a scarlet rash appears in the mouth and throat, then on the face

and forearms; soon it spreads to the entire body. As the rash spreads,

the fever usually breaks. The person may even start to feel better--but

actually the worst is yet to come.

The rash gives way to tiny bumps, which fill up with a thick milky

fluid. The fever returns and the bumps become painful pustules--dense

pus-filled blisters that look like BB pellets embedded in the skin,

mostly on the face, arms, and legs. By the second week, the pustules

start hardening into crusty brown scabs, which fall off after three to

four weeks, leaving permanent pitted scars.

"The exact cause of death in fatal smallpox is unknown to

science," notes Richard Preston in his book The Demon in the

Freezer. But he says physicians who have watched it know its horrors:

"As the end approaches, the smallpox victim can remain conscious,

in a kind of frozen awareness."

Q: How is the disease spread?

A: Smallpox passes from person to person primarily through air on

virus-laden water droplets that explode from a patient's mouth when

he or she coughs or sneezes. Occasionally someone can become infected by

contaminated bedding, clothes, or other objects. As far as scientists

know, neither insects nor animals transmit the disease. But a human

infected with the disease is contagious until the last smallpox scab

falls off.

Q: What is the smallpox vaccine?

A: The most common vaccine used today is made from the vaccinia

virus, a close relative of the smallpox virus. Like all vaccines, it

works by stimulating the body's disease-fighting immune system (see

diagram, p. 10).

"Vaccinia and smallpox are so much alike that our immune

systems have trouble telling them apart," Preston notes. As a

result, he says, "within days, a vaccinated person's

resistance to smallpox begins to rise."

The logic behind the smallpox vaccine has changed little in the

last two centuries, ever since Edward Jenner developed medicine's

first successful vaccine. Jenner's breakthrough occurred in 1796,

when he observed that dairy-maids exposed to cowpox, a disease of cows

that causes only mild blistering in humans, rarely contracted smallpox.

On a hunch, Jenner inserted pus from the blistered hands of a dairymaid

into the arm of a healthy 8-year-old boy. When the boy was later exposed

to smallpox, Jenner found it had no effect. He called his treatment

"vaccination," from the Latin word vacca for cow. Vaccinia,

the virus used to make the vaccine today, is also made with the help of

cows, and scientists say it's all but indistinguishable from the

virus Jenner used in his landmark experiment.

Q: Why is the vaccine so controversial?

A: Simple, says Thomas Mack: "This is the single most

dangerous live-virus vaccine we have." Vaccines for flu and other

viral diseases are typically made from weakened or killed

disease-causing particles. Since the smallpox vaccine employs vaccinia

at full-strength, the virus can be unpredictable--and hits some people

hard. Routine side effects include a fever and sore, swollen muscles;

about one in every 1,000 people requires medical treatment for severe

rashes and other side effects.

But 15 of every 1 million people will suffer permanent blindness or

other potentially life-threatening reactions, says the U.S. Centers for

Disease Control and Prevention: "Based on past experience, it is

estimated that between 1 and 2 people out of every 1 million people

vaccinated may die."

Since side effects are more common in people who are pregnant, have

skin infections like eczema, or weakened immune systems, opponents to

the vaccination plan argue it's even more dangerous today that it

was in previous generations. More than 60 million Americans are

estimated to have compromised immune systems from cancer, an organ

transplant, or HIV, for example,

Despite the risks, some doctors are determined to get vaccinated.

"I sort of feel a sense of duty to get it done," Dr. Joel

Geiderman, co-chairman of the Department of Emergency Services at

Cedars-Sinai Medical Center in Los Angeles, said recently. "Duty to

my patients, to the public, even to my country. I want to be able to

help my patients if they need me."

Q: Does smallpox really pose a threat as a lethal weapon?

A: Most experts believe the chances are slim. "The possibility

scares me," virologist Don Francis, who worked the front lines in

the global effort to eradicate smallpox, admitted in USA Today.

"It's a dangerous disease, and we have little immunity."

One way terrorists could turn smallpox into a weapon is by putting

the virus in a sprayer and misting the air. "It's not that

difficult," notes D.A. Henderson of Johns Hopkins Center for

Civilian Biodefense Studies in Baltimore. The toughest part, he says, is

getting hold of the smallpox itself. "It's harder to get than

anthrax." Another possibility: a "living bomb" scenario,

in which a terrorist infects himself with smallpox, then fans out

through U.S. airports or other crowded areas to spread the disease.

Still, many scientists believe an outbreak can be contained if

caught fast enough. "The idea is to build a fire-break of immune

people," says Jonathan Tucker, author of Scourge: The Once and

Future Threat of Smallpox.

An infected person would be quarantined as authorities vaccinated

anyone who had come in contact with him, says Tucker. The strategy,

known as ring vaccination, is the same one WHO officials used to quash

the disease in the 1970s. By denying the virus a new host, it soon burns

itself out.

One problem is that despite centuries of experience, scientists

don't know how easily smallpox can spread. Some think it's as

infectious as viruses such as chickenpox or measles, which can race

through human populations like wildfire. Other experts think terrorists

trying to use smallpox as a weapon would ultimately be undermined by the

disease itself--since its classic scarlet rash and disfiguring pustules

make smallpox very difficult to hide.

"It's not anthrax in an envelope," says virologist

Francis. "It's a person with a rash who's very

sick." And that just might give authorities the warning they need

to avert a smallpox disaster.

HOW THE SMALLPOX VACCINE WORKS

Vaccines are altered forms of disease-causing bacteria or viruses,

which imitate a natural disease to stimulate the immune system. Smallpox

is caused by the variola virus, and the vaccine is made from its

relative vaccinia.

1 Diluted live vaccinia virus is injected into the bloodstream,

replicating itself and stimulating the immune system without causing the

disease.

2 The immune system sends out white blood What is UpViral? cells called macrophages,

which identify the virus as an invader and begin to gobble up viral

particles.

3 Some macrophages collect information about the virus and transmit

it to the bone marrow, where all white blood cells are produced.

4 Bone marrow produces two kinds of white blood cells called

lymphocytes: B cells and T cells. B cells mature into plasma cells,

which produce antibodies tuned specifically to destroy the vaccinia

virus. T cells travel to the lymph nodes, where they mature.

5 When the body manufactures T and B cells specifically designed to

combat vaccinia, the cells UpViral Bonus become concentrated in the lymph nodes. If

the actual smallpox virus enters the body, these lymphocytes will

destroy virus particles before they can reproduce.

It's Your Choice

After reading the article, choose the correct answer to these

questions:

1 Which of the following statements about smallpox is not true?

A Nearly one third of all people infected by the variola virus die.

B Smallpox pustules give way to scabs, which fall off to leave

permanent scars.

C An infected person is contagious for two weeks.

D The disease is especially dangerous for children.

2 The smallpox vaccine

A derives from the dead vaccinia virus.

B is given using a conventional needle.

C causes no side effects in people with compromised immune systems.

D is virtually the same vaccine today given by Edward Jenner 200

years ago.

3 Aerosolizing smallpox means

A transmitting the virus by coughing.

B spraying the virus in the air.

C containing the virus through vaccination.

D combating the virus with antibodies.

ANSWERS

1. c 2. d 3. b



BEYOND SMALLPOX: OTHER BIOWEAPONS



Unfortunately, smallpox is only one of several potential biological

agents that can be exploited as a bioweapon. Here are four others:



PLAGUE HOW IT'S SPREAD HOW IT ATTACKS



Caused by the highly Fleas that have fed Plague attacks

contagious bacteria on infected rodents lymph nodes, which

Yersinia pestis, spread plague to fight infections. One

commonly found in rats. humans. Also to six days after

spreads via air exposure, fever and

through coughing. chills set in, then

Can be aerosolized, coughing up blood.

or sprayed in air.



BOTULISM



Caused by a toxin The bacteria can Botulism poisons

from Clostridium grow in canned the nervous system,

botulinum bacteria, foods. As a germ causing symptoms

which thrive without weapon, the toxin such as blurred

oxygen in soil could be used to vision and extreme

or canned food. poison food, but is weakness.

not contagious.



EBOLA



Four virus families Spread by rodents, Fever and aches

cause hemorrhagic ticks, mosquitoes, begin four to 16

(profuse bleeding) person-to-person days after infection.

diseases: Marburg, contact. Highly Virus interferes with

Ebola, and others. contagious. Can blood clotting.

be aerosolized. Severity: mild to

deadly.



TULAREMIA



Caused by Francisella Highly infectious, Within three to

tularensis, a bacteria the disease easily 14 days of exposure,

in rodents and ticks. passes through swollen glands,

body tissues into fever, and

bloodstream. Can pneumonia set in.

be aerosolized.



PLAGUE HOW IT'S TREATED



Caused by the highly Caught early,

contagious bacteria plague is treatable

Yersinia pestis, with antibiotics like

commonly found in rats. streptomycin.

Untreated, plague

can kill in days.



BOTULISM



Caused by a toxin If found early,

from Clostridium botulism can be

botulinum bacteria, treated with

which thrive without antitoxin drugs

oxygen in soil that neutralize

or canned food. poisoning.



EBOLA



Four virus families No vaccines exist.

cause hemorrhagic The infected person

(profuse bleeding) must be isolated to

diseases: Marburg, prevent virus from

Ebola, and others. spreading.



TULAREMIA



Caused by Francisella Antibiotics work,

tularensis, a bacteria but even without

in rodents and ticks. them, up to 95

percent of infected

people recover.

DEBATE IT: A voluntary public vaccination program may begin next

year. Should every American be vaccinated? Should there be exceptions?

Would you want to be vaccinated?

Did You Know?

* The word variola was coined around 580 A.D. to describe smallpox

from the Latin "mark on the skin," the pus-filled blisters

that are the hallmark of the disease.

* In 980, the Arab scientist Rhazes wrote that while smallpox was

transmitted from person to person, survivors never developed it

again--the first scientific theory of acquired immunity.

* In January, the U.S. Environmental Protection Agency (EPA)

upgraded 3,000 air-quality monitoring devices around the country--which

normally measure air pollution--to additionally detect smallpox,

anthrax, and other pathogens within 24 hours of their release.

Cross-Curricular Connection

History: Research a well-known historical figure who contracted

smallpox and write a brief report about his or her experience with the

disease.

Critical Thinking:

Smallpox was officially declared eradicated in 1980. Why do you

think two laboratories--one in the U.S. and one in Russia--kept samples

of the virus that causes the disease?

Resources

Scourge: The Once and Future Threat of Smallpox, Jonathan B.

Tucker, Grove Press, 2002

"Smallpox: Your Questions Answered," Time Online Edition,

December 13, 2002

www.time.com/time/nation/article/0,8599,399780,00.html

"Smallpox: The Triumph over the Most Terrible of the Ministers

of Death," Annals of Internal Medicine, October 15, 1997

www.acponline.org/journals/annals/15oct97/smallpox.htm

CHECK FOR UNDERSTANDING

Directions: Circle the correct answer(s) to complete the sentence.

1. Smallpox was declared (a global threat, eradicated, under

control) after 1977, when a natural case appeared in (the U.S., Russia,

Somalia).

2. Vaccines work by stimulating the body's (immune, digestive,

respiratory) system.

3. Smallpox is (contagious, fatal). Inspiration for Dr. Edward

Jenner's breakthrough vaccination came from (chicken pox, cowpox).

4. Most experts believe the threat of smallpox as a bioweapon is

(slim, high, very high.)

ANSWERS

1. eradicated, Somalia 2. immune 3. slim 4. contagious, fatal;

cowpox

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Corporate Branding Benefits

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An Overview Of Entrepreneurship

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How To Promote Clickbank Products Without A Website-basic Techniques



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