Variola Vaccines

The development of vaccines has stimulated a decline in the incidence of many infectious diseases and their associated high mortality rates. Diseases that once threatened large populations are now controlled through the implementation of effective vaccination programs. Variola or smallpox, one of these diseases, was once a major health concern with a high mortality rate. Through a global vaccination effort, the disease is now considered irradiated, however, in the aftermath of the terrorist attacks of September 11th, there are new concerns about the possible use of the Variola virus as a bioterrorism weapon. This paper will review the history of smallpox, etiology of the disease and nursing considerations should a new outbreak occur. Smallpox was first noted over 5,000 years ago and is believed to have evolved from an African rodent poxvirus (Hussain, 2015, p1). Pockmarks found on the mummified remains of Ramses is considered evidence of an Egyptian smallpox outbreak in 1157 B.C. (Hussain, 2015, p1) and a disease resembling smallpox was reported in China around 1122 B.C (Egelkirk, 2015, p 7). It is believed that, “International traders spread smallpox throughout the Old World during the 4th-15th centuries CE, while European explorers and conquerors brought the disease to the Western Hemisphere in the early 16th century” (Hussain, 2015, p1). By the 18th century, the disease was at pandemic proportion and caused over 400,000 deaths annually in Europe alone. (Riedel, S. 2005, p21). Those who didn’t die were often left with disfiguring scars and more than 30% suffered from blindness as a result of the virus. Perhaps the most notable event in the history of smallpox was the introductions of vaccinations which led to the eventual eradication of the disease. It has been noted that “the use of vaccines to prevent disease may date as far back as the 11th century, when the Chinese used a powder prepared from dried smallpox scabs to immunize people, either by introducing the powder into a person’s skin or by having him/her inhale the powder.” (Egelkirk, 2015, p295). This technique drew the attention of British physician, Edward Jenner, who himself was vaccinated using this method. Jenner noted that milkmaids in England who had been exposed to the less deadly cow pox appeared immune to smallpox. He hypothesized cow pox would protect against smallpox and could be used as a “deliberate mechanism of protection.” (Riedel, S. 2005, p24). In fact, Jenner actually labeled the procedure vaccination, which is a derived from the Latin term for cowpox, vaccina (Riedel, S. 2005, p24). As vaccination procedures matured so did the efforts to reduce the incidence of the disease. By the second half of the 20th century, a global vaccination effort was in effect and smallpox was declared completely eradicated by 1980. Smallpox is caused by exposure to one of two strains of the Variola species which is a member of the genus Orthopoxvirus, in the Poxviridae family. There are several forms of transmission for the disease and include: person to person through inhaled droplets, contact with secretions from an infected person’s pustules, from fomites and potentially through deliberate expose from a bioterrorism attack. The incubation period for smallpox is typically 7 to 17 days. Patients infected with the virus present with early symptoms of high fever, headache, malaise, aches and …show more content…
Smallpox is listed as a Category A agent on the CDC’s list of bioterrorism agent. The physician and nurse who diagnose a patient with the signs and symptoms is the first line of defense in the event of a bioterrorism attack or outbreak (Berkowitz, 2002, p3). They must recognize signs of the disease and differentiate them from other diseases such as chicken pox and collect proper specimens for culture. Patients suspected of having smallpox should be immediately be isolated in a room with proper air handling equipment: negative pressure and HEPA filtration (Williams, 2015, p255). Airborne precaution should be implemented which include the use of an N95 mask, gowns and gloves. Additional steps to prevent the spread of the disease includes autoclaving waste and laundry as well as proper decontamination of contaminated surfaces. Nursing must be trained in local policy for treating patients and disasters such as a bioterrorism attack. Nurses must also be trained on reporting requirements for disease such as