History of Smallpox Research

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Smallpox goes way back to the date of the Egyptian Empire around the 3rd century BCE, however its origin is unknown. The first discoveries of smallpox were on three mummies, who had smallpox-like rashes found all over their bodies. “Ramses V, for example, who ruled for roughly four years in the 12th century B.C., looks to have had the raised bumps on his face and body for which smallpox is named.” (Greenspan). The ancient Egyptians left behind clues describing what smallpox could be. Another ancient group of people named the “Hitties” held the Egyptians responsible for transmitting the disease over to them in the course war between the two empires. Some critics conclude that the “Plague of Athens” triggered by the spread of the virus and also the “Antonine Plague.” Several years later, it would end up wiping out millions and even killing Marcus Aurelius, leading to the diminishment of the Roman Empire. According to the Centers for Disease Control and Prevention:

 6th Century – Increased trade with China and Korea introduced smallpox to Japan.

 7th Century – Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.

 11th Century – Crusades further spread smallpox in Europe.

 15th Century – Portuguese occupation introduces smallpox into part of western Africa.

 16th Century – European colonization and the African slave trade import smallpox into

the Caribbean and Central and South America.

Smallpox appeared around 10,000 BC and was probably spread from northeastern Africa to India by the means of ancient Egyptian merchants. Smallpox originates from the Latin word “spotted” and referencing to bumps on the surface of the epidermis of the human face. According the Centers for Disease Control and Prevention, 3 out of 10 people who are diagnosed with this disease end up dying. According to the Center for Disease Control and Prevention, there are two clinical forms of smallpox. .One variant is “Variola major” while the other is nicknamed “Variola minor”. The typical virus is “Variola major”, an extensive rash and soaring fever.

There are four types of variola major smallpox: ordinary (the most frequent type, accounting for 90% or more of cases); modified (mild and occurring in previously vaccinated persons); flat; and hemorrhagic (both rare and very severe). Historically, variola major has an overall fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal. (CDC)

Variola minor is less common and is way less severe, with death rates less than 1%. Smallpox has been around for quite a long time but it is now eradicated thanks to the help of worldwide vaccination programs. The last signs of smallpox in the United States was in 1949 and worldwide was in 1977, in Somalia. Treatment for smallpox was discontinued because it was no longer a threat to humanity.

 The most common way to catch smallpox is to have direct and prolonged contact with the carrier and the victim. It can also be spread through bedding or clothing, as well as with direct contact with infected bodily fluids. There are no records of animals or insects carrying the disease, but humans are the only natural hosts of variola according to the CDC. There are 7 stages of smallpox: Incubation Period, Initial Symptoms, Early Rash, Pustular Rash, Pustules and Scabs, Resolving Scabs, and Scabs resolved. First off is the Incubation Period where the people feel no symptoms or pain and is non-contagious (may last 7 to 17 days). Next is the Initial Symptoms where patients develop symptoms such as fever, malaise, head and body aches, and sometimes vomiting. The temperature of the patient is very high ranging from 101 to 104 degrees Fahrenheit, causing the patient to be too sick to carry on which normal activities (may last 2 to 4 days). This is also known as the Prodrome Phase which can sometimes be contagious. Following suit is the Early Rash; during this phase, the patient will begin to develop a rash on their tongue and mouth, leading to the spread of a virus into the mouth and throat, making the patient contagious. Rashes begin to form all over the body from head to toe usually within 24 hours and it causes to fever to go down a bit, making the patient feel a little better (lasts about 4 days). According to studies from the Center for Disease Control and Prevention:

By the third day of the rash, the rash becomes raised bumps. By the fourth day, the bumps fill with a thick, opaque fluid and often have a depression in the center that looks like a belly button. (This is a major distinguishing characteristic of smallpox.) Fever often will rise again at this time and remain high until scabs form over the bumps. (CDC)

The phase after that is the Pustular Rash; the bumps transform into pustules that are usually round and firm to the touch. Many people described it as if there was something hard under the skin (lasts about 5 days). The next phase is the Pustules and Scabs; According to the CDC “The pustules begin to form a crust and then scab (lasts about 5 days). By the end of the second week after the rash appears, most of the sores have scabbed over” (CDC). The second to last stage is the Resolving Scabs; the scabs become to fall off of the skin, leaving future scars (lasts about 6 days). The majority of the scabs will fall off three weeks after the rash has appeared (the person is contagious until all of the scabs have fallen off). The final phase is the Scabs resolved; this is when all of the scabs have fallen off, confirming that the person is no longer contagious.

 A man by the name of Edward Jenner is the person who came up with the vaccine that would later cure and eradicate smallpox. Edward Jenner was born on May 17, 1749, in Berkeley, Gloucestershire. He developed a strong urge to pursue science and nature throughout his early life and beyond. Jenner became an apprentice to a country surgeon and apothecary at only the young age of 13. Later on he became the apprentice of Dr, George Harwicke, where he learned new knowledge of surgical and medical practice. After the completion of his apprenticeship, he became a student of John Hunter and began to work with him for 2 years. His experiences with Hunter intrigued his curiosity on natural science. He had heard of tales that dairymaids were immune to the effects of smallpox due to their exposure of cowpox in the past. Inspired from these tales, Jenner created a theory that cowpox could protect against smallpox and also be transmitted from one host to the next as a means of protection against the disease. According to a scientist from the Baylor University Medical Center Proceedings:

In May 1796, Edward Jenner found a young dairymaid, Sarah Nelms, who had fresh cowpox lesions on her hands and arms. On May 14, 1796, using matter from Nelms’ lesions, he inoculated an 8-year-old boy, James Phipps. Subsequently, the boy developed mild fever and discomfort in the axillae. Nine days after the procedure he felt cold and had lost his appetite, but on the next day he was much better. In July 1796, Jenner inoculated the boy again, this time with matter from a fresh smallpox lesion. No disease developed, and Jenner concluded that protection was complete. (Riedel)

The word vaccination is derived from the latin word vacca which means cow and cowpox is vaccinia. Jenner published a couple of books to support his arguments on cowpox protecting against smallpox. Jenner traveled to London in search of volunteers for his experiment, but he ended up finding none. However, vaccination began to gain popularity from other surgeons that tested out his theory. The use of vaccination gained popularity in England by the 1800s and it almost reached popularity of other European countries. Jenner passed down the vaccination throughout many different scientists and ended up handing it down to Thomas Jefferson. Jefferson appointed him vaccine agent in the National Vaccine Institute which was an organization designed to put forth a national vaccination program in the United States. Jenner cared not for his awards and personal life because he was so focused on the research of vaccination. He won awards from parliament such as 30,000 euros, but he also suffered from attacks and ridicules. Jenner founded the “Temple of Vaccinia,” a one-room hut in his garden where he vaccinated the poor free of charge. He was an important person that contributed to the protection against the deadly disease known as smallpox. Without Jenner, we might not have been able find out how to defend against smallpox, leaving us vulnerable to the disease that killed millions of people in the past.

 According to Simonsen and Snowden smallpox is:

Smallpox is a member of the viral family poxvirus, genus orthopoxvirus, and species variola virus. Poxviruses are the largest of the human viral pathogens and have a brick-shaped appearance on electron microscopy.  Variola virus measures approximately 300 nm to 350 nm long. The poxviruses possess a linear, double-stranded DNA genome, and are unique in that their genetic makeup encodes all the proteins necessary for replication allowing them to replicate in the host cell cytoplasm. (Simonsen and Snowden)

The way smallpox transfers from one organism to another is through airborne respiratory droplet secretions or direct contact with lesions or contaminated follies. The virus (smallpox) migrates to regional lymph nodes where it begins replication. The virus changes based on how many days the patient has had the disease for. From 3 to 4 days of infection, an initial viremia occurs and from 8 to 12 days after infection, a secondary viremia occurs which coincides with the fever and other symptoms related to the disease. Although smallpox is really deadly, it does not spread as fast as other diseases such as measles or chickenpox. There is no current cure out there for smallpox, however the vaccination the Jenner developed can help prevent smallpox before it develops into its harmful stages. There are currently no further studies on smallpox or vaccinations related to it because it was eradicated in 1980 according to the World Health Organization. There was a campaign to eradicate smallpox led by the World Health Assembly in 1966. During this time, smallpox was common in over 30 countries, spreading rapidly throughout many counties across the world. There were mass vaccination programs that were successful in many countries, but a new approach called surveillance and containment became more popular. Surveillance involved house-to-house searches in order to locate people that reported smallpox cases. Containment involved ring vaccination and isolation of cases of victims that suffered from this disease. Hospitals had played a major role in the transmission of a large number of smallpox outbreaks. Due to all of the measures taken to eradicate this disease once and for all, smallpox was eradicated on May 8, 1980, which was declared by the 33rd World Health Assembly. A small fun fact is that smallpox is the world’s first eradicated disease. According to the CDS, there is still a possibility that the variola virus could be used as a biological attack that uses smallpox as a weapon to inflict harm on people, livestock, or crops. In a state of a smallpox emergency, one could visit their local public health department to get information on how to get a vaccine free of charge. In the event that you are infected with the disease, you would need to stay at home alone, away from others for at least 18 days so the disease would not transmit onto them. The patient is required to check their temperature twice a day and give their results to their local health department so they could help them if they show signs of symptoms of smallpox. The smallpox vaccine is safe for most people, but there are some mild side effects to some people that are unlike such as: sores on the vaccination site, lymph nodes on the armpits may become large and sore, slight fever, and lack of energy. However there are serious side effects for every 2 out of 1,000 people vaccinated, the person might experience “a toxic or allergic reaction that can take various forms…spreading the vaccinia virus by touching the vaccination site and then touching another part of the body or another person. It usually occurs on the genitals or face, including the eyes, where it can damage sight” (CDC). The rarest side effects of them all are life-threatening reactions between 14 and 52 people out of 1 million, which include: inflammation of the brain, buildup of inflamed tissue around the vaccination site, and a serious rash. The people that usually suffer from these side effects generally have a weaker immune system than most people or certain skin conditions. There are some cases with inflammation of the line of the heart and angina, but that is really rare. The vaccine is no longer effective if the patient has already developed the smallpox rash. Smallpox vaccine is currently not available to the public since smallpox is no longer a threat after its eradication, but if an outbreak of smallpox were to appear, there is enough smallpox vaccine to vaccinate every person in the United States. Here’s a timeline on cases that were related to smallpox according to CNN:

1950s Worldwide, 15 million cases of smallpox are reported each year.

1977 The last naturally occurring case of smallpox in the world occurs in Somalia.

1979 Smallpox meets the criteria for eradication by having no natural cases for two years.

1980 – The World Health Organization announces the official eradication of smallpox. (CDC)

It is estimated that about 300 million people died from smallpox in the 20th century alone. The virus killed about a third of those that it infected and took any opportunity it had to try to colonise the world. The Aztecs and Incas in Mexico fell ill to smallpox which wiped out huge numbers of them because they had no type of immunity towards the disease, making it easy for the Spanish to conquer them. Later on in the future, centuries later, the Native Americans would suffer from smallpox as well, wiping out between 400,000 to 500,000 Native Americans. An estimated 90% of Native Americans died from smallpox, which was brought by Europeans traveling from the Old World to the New World, bringing along new types of germs with them. It is believed by some people that smallpox was brought to America in 1520, when a Spanish ship sailing from Cuba, carried an African American slave that was carrying the disease. As soon as they arrived to Mexico, it was too late; the disease began to spread, beginning its deadly voyage across the continent. Smallpox destroyed the Inca Empire, killing Emperor Huayna Capac and weakened the successor to the throne, Atahuallpa.

 From all of these incidents, it shows that smallpox was the most dangerous European virus. Surprisingly, children have more immunity to the disease than adults and elders. In 1959, the World Health Organization initiating an operation the eliminate smallpox from the world. They encountered many problems such as lack of funds, personel, and support and commitment from other countries, and they had a shortage of vaccine donations from supporters. This plan failed and smallpox was still widespread in 1966, causing outbreaks in many countries such as South America, Africa, and Asia. This failure brought forth the Intensified Eradication Program, which began in 1967 with a promise of renewed efforts. This time the laboratories were able to produce a bigger supply of high quality freeze-dried vaccine. This program ended up being more successful than the last plan, “…including the development of the bifurcated needle, establishment of a surveillance system to detect and investigate cases, and mass vaccination campaigns, to name a few” (CDC). Smallpox was already eradicated in North America and Europe during this time so the only continents left with smallpox were South America, Asia, and Africa. This program contributed greatly to the eradication of smallpox, ridding the world of smallpox in South America by 1971, followed by Asia in 1975, and Africa by 1977. The endmost cases of smallpox involved Rahima Banu, Ali Maow Maalin, and Janet Parker. Rahima Banu was a three-year old girl from Bangladesh, who was the last person that was infected by the variola major. She was the last person afflicted with the disease in Asia. She was isolated at home, surrounded by guards 24 hours a day until the disease disappeared completely, with no more traces of variola major. Within a 1.5 mile radius, a house-to-house campaign was started where every, house, school, and public area was visited by healers within 5 miles were visited by members of the Smallpox Eradication Program to make sure that there would be no possibility of a spread of the disease. Many people that reported cases of smallpox were rewarded by the program itself. Ali Maow Maalin was the final victim that was infected by variola minor, the less harmful to the body version of smallpox. He was a chef at a hospital that was located in Merca, Somalia. On October 12, 1977 Maalin transferred a pair of patients that were showing signs of small pox from the hospital to the local smallpox office. Unfortunately he was unlucky enough to develop a fever in October 22, which were signs of the accumulation of smallpox. At first he was wrongly accused of carrying the malaria virus, but he was finally diagnosed with smallpox in the end by a smallpox eradication staff on October 30. He was confined in his room all alone until he made a complete recuperation. Although she had made a full recovery from the disease, she died of malaria on July 22, 2013 while working in the polio eradication campaign. The last person to die of smallpox was Janet Parker. She was a medical photographer at the Birmingham University Medical School in England and also worked near a laboratory that was studying and treating smallpox. She had unexpectedly developed the illness, which was followed by a rash. However for some reason, it took 9 days until she was finally diagnosed with the deadly disease. Despite further treatment with vaccine she ended up passing away on September 11, 1978. The person that was taking care of her was her mother, who ended up getting diagnosed with smallpox on September 7, despite having taken the vaccine on August 24. Surprisingly Her mother did not end up dying from the smallpox disease, unlike her daughter, Janet Parker.

Works Cited

  • “History of Smallpox | Smallpox | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/smallpox/history/history.html.
  • Riedel, Stefan. “Edward Jenner and the History of Smallpox and Vaccination.” Proceedings (Baylor University. Medical Center), Baylor Health Care System, Jan. 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/.
  • National Archives and Records Administration, National Archives and Records Administration, georgewbush-whitehouse.archives.gov/news/releases/2002/12/20021213-2.html.
  • “Frequently Asked Questions and Answers on Smallpox.” World Health Organization, World Health Organization, 22 July 2016, www.who.int/csr/disease/smallpox/faq/en/.
  • Strassburg, M A. “The Global Eradication of Smallpox.” American Journal of Infection Control, U.S. National Library of Medicine, May 1982, www.ncbi.nlm.nih.gov/pubmed/7044193.
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