The disease that killed Queen Mary II of England and Emperor Hagishiyama of Japan, heir to Peter the Great and son of Suleiman the Magnificent, King Louis I of Spain and Princess Pocahontas of the Indians. A virus that wiped out the cities of the Middle Ages and entire villages of Africa in the 20th century. It's all about natural smallpox. What is known about this disease to the modern man in the street? Let's try to fill in the gaps about the disease of smallpox, which in its consequences is on a par with plague and anthrax.
Historical digression
Today, smallpox is the only viral infection that has been eliminated on the territory of all continents by the efforts of epidemiologists. But it was not always so. The last reliable case of infection with this disease was recorded in 1977, and in 1980 the World He alth Organization announced the eradication of this disease. The term smallpox, or Variola, appeared in the records of Bishop Avencia Marius (AD 570), although, judging bydescription of the symptoms, it was smallpox that exterminated a third of the inhabitants of Athens in 430 BC and was a pestilence that mowed down the warriors of the troops of Marcus Aurelius during the Parthian wars in 165-180 AD. The crusades of the 11th-13th centuries opened the procession of smallpox or smallpox across 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 with a mortality rate of over 40%.
Black Sea
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 cats, monkeys, ungulates and other mammals suffer from smallpox. An 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 macules (pink spots), they turn into papules andvesicles 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, the pustules suppurate, damage to the nervous and circulatory systems begins. The pustules then burst and scars remain in their place. In severe cases, death occurs as a result of heart failure and toxic shock on the 3rd-4th day. Among those who have had the disease, one in five is affected by blindness, but all those who have been ill receive stable lifelong immunity.
Variolation is the first step to fight the disease
Methods of preventing smallpox came to Europe from Asia. Various variants of inoculation (introduction of live pathogens, infected material) have been known for a long time. In China, dried peels were sniffed, in Persia they were swallowed, in India they wore shirts soaked in pus. The 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 variolation. We owe its distribution to Lady Mary Wortley Montagu, the wife of the British ambassador to Turkey. It was she who in 1718 instilled herself and her children in this way. And although variolation gave the expected result for the Montagu 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 fatal (up to 2% mortality). In addition, the method did not guarantee immunity and led to the development of epidemics.
Saving Vaccine
The honor of creating an inoculation fromsmallpox belongs to the English physician Edward Jenner (1749-1823). He noticed that milkmaids who had been ill with cowpox did not get sick during an epidemic of human smallpox. It was he who developed the method of vaccinating people with vaccinia, and then with material taken from people vaccinated with vaccinia. By the way, the word "vaccination" comes from the Latin word "vacca", which means cow. The first person to whom Jenner gave such an inoculation using material taken from the hands of a thrush who had cowpox was an 8-year-old boy, James Phipps. He had a mild illness, did not get sick later, and the grateful doctor built a house for him and planted roses in his garden with his own hands.
But before becoming a worldwide panacea, Jenner's technique overcame the resistance of medical conservatives for a long time. And only after convincing evidence of the safety and effectiveness of vaccination against smallpox, it was recognized by the world community. Edward Jenner was lucky to live to see his recognition - until his death, he led the English smallpox society.
Sasha Ospenny and Anton Vaktsinov
In Russia at that time every seventh child died of smallpox. Smallpox vaccination in Russia began in 1768 with the variolation of the royal family - Catherine II and her son Pavel. The empress was subsequently called a true hero, and historians compared her deed with a victory over the Turks. Smallpox material was taken from Sasha by a visiting British doctor G. DimedalMarkov, 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 in Russia inoculation of the vaccine received from its inventor. In the presence of roy alty, Anton Petrov, a pupil of a Moscow noble house, was vaccinated with smallpox pathogens. The procedure was successful, and the boy received the name Vaccine and a lifetime pension. A corresponding decree was issued, and by 1804 smallpox vaccination was carried out in 19 Russian provinces, almost 65 thousand people were vaccinated.
Varinopox virus: microbiology
The virus that causes this disease belongs to the DNA-containing poxviruses of the Poxviridae family, genus Orthopoxvirus. In humans, the causative agents of smallpox are two types - Variola major (classic smallpox, lethality - more than 50%) and Variola minor (alastrim with a lethality of up to 3%). These are large viruses up to 220 by 300 nanometers in size. In a light microscope, they were first seen in 1906 by the German biologist Enrik Paschen (1850-1936).
The variola virus virion (see photo above) has an oval shape, in the middle is DNA with proteins (1) that can independently start the synthesis of messenger RNA in the host cell. The core is covered with a shell (2) and resembles a dumbbell in shape, since it is squeezed from both sides by the side bodies (3). The variola virus has two envelopes - protein and lipid (4). Entering the bodyIn humans, the virus infects all cells without a preference for any particular ones. In this case, the defeat of the skin affects the deep layers of the dermis. In pustules and crusts, the causative agent of smallpox is virulent for a long time, persists in corpses. The virus is highly contagious (contagious), can persist in the environment for a long period, 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 the patient with their own eyes. Therefore, in the early days, when general symptoms appear, but there is still no rash, the diagnosis of smallpox is difficult. But during this period, the patient is already contagious and can infect others by airborne droplets. That is why quarantine measures are so effective. To determine natural smallpox, microbiology uses electron microscopy and polymerase chain reaction methods. At the same time, the contents of pustules, crusts, smears of mucus are examined. For modern treatment of smallpox (in the event of a resurgence of the disease), smallpox immunoglobulins and antiviral drugs, as well as broad-spectrum antibiotics, can be used. External use of antiseptic agents is possible. In parallel, detoxification therapy is necessary.
Preventive measures
Preventive measures come down to vaccination. Unvaccinated people are all susceptible to the pathogen, natural immunity inno one has this disease. Children under the age of four are especially susceptible. Modern vaccines are grown in chicken embryos or in tissue culture. There are several of them in the world, all of them have been certified by WHO. Vaccination is carried out with infected bifurcation needles, which make up to 15 punctures on the forearm. After that, the vaccination site is closed. During the week after the procedure, fever and myalgia are possible. The success of the operation is checked by the presence of a papule on the 7th day. Immunity persists for 5 years, after which it begins to decline and becomes negligible after 20 years. Today, vaccination is indicated only for people whose professional activities are associated with a high risk of infection (employees of the relevant laboratories).
Complications
They can occur in 1 vaccinated per 10 thousand patients. Associated primarily with skin diseases. Contraindications are pregnancy, autoimmune diseases, inflammation of the eyes. Severe complications include encephalitis (1:300,000), eczema, myocarditis, pericarditis, rash of non-infectious origin. Still, vaccination will prevent or significantly reduce the severity of the disease. It is recommended to all family members of the patient and contact people who are quarantined for at least 17 days.
War of annihilation
In the middle of the 20th century, European countries, the USA, Canada and the Soviet Union were able to introduce mandatory vaccination of the population. In 1959, the World He alth Organization declared total war on naturalsmallpox on the planet. The idea of worldwide vaccination was proposed by the Russian academician and virologist Viktor Mikhailovich Zhdanov (1914-1987), who was the Deputy Minister of He alth of the USSR and director of the Dmitry Iosifovich Ivanovsky Institute of Virology. Over the course of 20 years, millions of dollars have been spent on this campaign. By 1971, smallpox had disappeared from South America and Asia. The last case of the disease was reported in Somalia (1977), where the infection occurred naturally. In 1978, a case of infection in a laboratory was reported. In 1980, WHO announced the complete eradication of human smallpox on Earth. Today, its pathogens are stored in the American Center for Disease Control and Prevention at the laboratory of Emory University (Atlanta) and in the laboratory of the Russian State Scientific Center for Virology and Biotechnology "Vector" (Koltsovo).
Threat remains
After 1980, most countries abandoned the mandatory vaccination of the population. Our contemporaries are already the second generation that lives unvaccinated. However, despite the fact that only humans are carriers of the pathogen, there is no guarantee that the primate smallpox virus does not mutate. The second threat of the return of the disease is the lack of guarantees that WHO has complete data on the 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 stocks of the vaccine in epidemiological laboratories will still remain unclaimed.
Biohazard
Data on the use of smallpox as a biological weapon is known. Thus, during the French and Indian War (1756-1763), Great Britain used smallpox as a biological weapon against France and the Indians. There is evidence of research into smallpox-based weapons during World War II (1939-1945). There is a version that the United States considered the scenario of using such weapons during the Vietnam War on the Ho Chi Minh trail. During the Cold War, research was conducted in the Soviet Union to combine smallpox and Ebola viruses. However, these studies have not received wide scope due to the ineffectiveness of such weapons due to the availability of smallpox vaccines. But even today, materials appear in the media that inspire certain disturbing moods.
Smallpox and AIDS
American immunologists from the University of California published data from their research, which suggests that the abolition of vaccination against smallpox 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 the smallpox vaccine will protect you from another deadly pathogen. Scientists assign a key role in this protective mechanism to cell membrane receptor proteins (CCR5 and CD4), which the virus uses to penetrate the cell. As scientists emphasize, these studies have so far been carried out only on tissue cultures, and not on the whole organism. But even a small chance of reducing the risk of infection deservesattention and study. With further confirmation of the effectiveness of smallpox vaccination in reducing the risk of infection with the human immunodeficiency virus (albeit not by 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 managed by vaccination. By 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 massively refused to be vaccinated. The diphtheria epidemic of 1994-1996 clearly demonstrated the failure of such refusals. Doctors from Europe traveled to CIS countries to see what diphtheria looks like.
Today, smallpox is not the only disease conquered by mankind. In developed countries, deadly human companions - whooping cough, mumps, rubella - are on the verge of extinction. Until very recently, the polio vaccine contained three serotypes (different types of virus). Today it already contains two serotypes - the third variety of the pathogen strain has been eliminated. To be vaccinated or not is up to each individual to decide. But do not underestimate the achievements of medicine and neglect elementary methods of protection.
Grateful mankind
The name of Edward Jenner entered the history of mankind's fight against pandemics. In many countries, monuments have been erected to him, universities are named after him andlaboratories. He became an honorary member of many scientific societies and academies, and some Indian tribes even sent him honorary belts. In 1853, a monument to him was unveiled in London (at first it was located in Trafalgar Square, later it was moved to Kensington Gardens), at the opening of which Prince Albert said:
No doctor has saved the lives of as many people as this man.
The great sculptor Monteverdi created another monument that commemorates the moment of smallpox inoculation in a child. The sculpture was 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.
