Retaining smallpox samples - To save or not to save.

(http://209.61.208.233/en/Section10/Section2596_15015.htm)

During the course of my research for this assignment I have read articles which portray both sides of the continuing smallpox debate. I have also investigated the history of smallpox, its devastating effect on people through the ages and how it affects the body.  The articles and web pages I used are listed below;

Anon. (2010). Smallpox demise linked to spread of HIV infection. London: BBC Riedel, S. (2005). Edward Jenner and the history of smallpox and vaccination. Bethesda: National Center for Biotechnology Information

Boseley, S. (2013). New wave of 'superbugs' poses dire threat, says chief medical officer. London: Guardian News and Media Limited.

Brady, B. (2013). £80m 'wasted' on smallpox terror threat. London: The Independent. Hammond, E. and Li Ching, L. (2011). Smallpox Virus Stocks at the 64th WHA:

Centers for Disease Control and Prevention. (2007). Side Effects of Smallpox Vaccination. Atlanta: Centers for Disease Control and Prevention

Flight, C. (2011). Smallpox: Eradicating the Scourge. London: BBC.

Hinson, T. (2013). Could smallpox really be turned into a biological weapon by terrorists? London: Associated Newspapers Limited

Implementing the Conclusions of the Major Review1. [s.l.] The Third World Network. McKay, B. (2011). Smallpox-Destruction Deadline Gets Delayed. New York: Dow Jones & Company, Inc.

McKie, R. and Stargardter, G. (2011). Smallpox virus: crunch time for the fate of a global killer. London: Guardian News and Media Limited.

Nordqvist, C. (2011). Should Smallpox Samples In The USA And Russia Be Destroyed?. Bexhill-on-Sea: MediLexicon International Ltd.

Nordqvist, C. (2011). Smallpox Samples To Stay For The Moment, World Health Organization Decides. Bexhill-on-Sea: MediLexicon International Ltd.

Sebelius, K. (2011). Why We Still Need Smallpox. [s.l.] The New York Times Company.

Spillius, A. (2011).   'We must keep smallpox stocks' US and Russia tells World Health Organisation. [s.l.] Telegraph Media Group Limited.

Swami, P. (2011). Fears of bioterrorism led superpowers to retain smallpox virus. [s.l.] Telegraph Media Group Limited.

I was particularly impressed with the article written for the New York Times by the US Secretary of Health and Human Services, Kathleen Sebelius. Her argument to retain the remaining stocks was well presented and, like my own view on this, focused around the research potential for future vaccines and antivirals. I am also in favour of keeping the remaining vials to continue medical research and expand our knowledge of this disease which, if some of the articles I have read are to be believed, could be misused by terrorists.

If, as Chief Medical Officer Dame Sally Davies (2013) states, “ we will find ourselves in a health system not dissimilar to the early 19^th Century at some point” as super bugs evolve and our resistance to antibiotics increases, then destroying these vital sources of research would prove costly.  Once the samples are destroyed, any research already undertaken would then become useless and considered out of date.

The reason I would chose to keep the samples of remaining smallpox would be to continue medical research and to ensure we are prepared for another possible outbreak of smallpox. As Sebelius (2011) stated “We’ve beaten smallpox once, but must be ready and prepared to beat it again, if necessary”.

Many of the cases for retaining the samples of smallpox I read centred on needing to be prepared for the threat of terrorists using smallpox as a bio weapon. To use smallpox effectively, the virus would need to be generated in a lab which, as Sillies (2011) says is improbable. “American officials fear that a lethal strain of smallpox could be obtained or synthesised and used in a weapon, although terrorists do not currently have the specialists or the large laboratories needed to synthesis the virus” and this is backed by Craig Venter, one of the 1^st geneticists to map the human genome who agrees that “At the moment it requires a pretty sophisticated scientific team”. Of course it is entirely possible that some countries may have retained their own samples of the virus after the eradication. The WHO asked all countries to either destroy or hand over their remaining stocks but this was an act of good faith and the request was never followed up with a compliance check.

The countries opposed to the retention of retaining the samples could be seen as a rather telling indictment of what may lie ahead, Nordqvist (2011) wrote “The US-Russian position is supported by the European Union, Australia and Canada. The following countries, led by Iran are against: Yemen, Peru, Kuwait, Philippines, Thailand, Saudi Arabia, Zimbabwe, the United Arab Emirates, Qatar, Bolivia, China, Bangladesh, and Indonesia”

My argument would be based almost entirely around the research we can still use these remaining samples for, the development of a cure should we have another pandemic and a vaccine which would protect against any threat.

The first recorded evidence of smallpox is from ancient Egypt. The mummy of Pharaoh Ramesses V of Egypt, who died in 1157 BC, had a pustular rash which would appear to be smallpox (BBC, 2011). This disease continued to affect and remain problematic for the human race for thousands of years. Thanks to an extensive programme by the World Health Organization (WHO), smallpox was finally eradicated in 1979, a mere 34 years ago. This is relatively small amount of time but the advances in science have been enormous.

The vaccines which were used prior to smallpox’s eradication were very similar to the original developed by Edward Jenner in 1796. The side effects of the vaccine could range from the very mild; the arm receiving the vaccination may be sore and red where the vaccine was given, to the extreme and potentially fatal, postvaccinal encephalitis which is inflammation of the brain. The technology we have at our disposal today could mean the development of a vaccine which does not pose a threat of side effects.

Work is also being undertaken to develop antiviral drugs which, in the event of an outbreak of smallpox, could be used to halt the diseases progression and reduce the risk of death or permanent disfigurement seen on previous survivors of the virus.

By keeping hold of these stocks we are increasing our chances of being able to protect ourselves and future generations from a disease which was a scourge of the human race for thousands of years.

As a parting quote from Sebelius “Destruction of the last securely stored viruses is an irrevocable action that should occur only when the global community has eliminated the threat of smallpox once and for all. To do any less keeps future generations at risk from the re-emergence of one of the deadliest diseases humanity has ever known. Until this research is complete, we cannot afford to take that risk.”

References

1.             Anon. (2010). Smallpox demise linked to spread of HIV infection. London :BBC [Online]. Available from: http://news.bbc.co.uk/1/hi/health/8686750.stm [08-04-2013]

2.             Boseley, S. (2013). New wave of 'superbugs' poses dire threat, says chief medical officer. London: Guardian News and Media Limited. [Online]. Available from: http://www.guardian.co.uk/society/2013/mar/11/superbugs-antibiotics-bacterial-diseases-infections [13-03-2013]

3.             Brady, B. (2013). £80m 'wasted' on smallpox terror threat. London: The Independent. [Online]. Available from: http://www.independent.co.uk/news/science/80m-wasted-on-smallpox-terror-threat-8537559.html [13-03-2013]

4.             Centers for Disease Control and Prevention. (2007). Side Effects of Smallpox Vaccination. Atlanta: Centers for Disease Control and Prevention [Online]. Available from: http://www.bt.cdc.gov/agent/smallpox/vaccination/reactions-vacc-public.asp [08-04-2013]

5.             Flight, C. (2011). Smallpox: Eradicating the Scourge. London: BBC. [Online]. Available from: http://www.bbc.co.uk/history/british/empire_seapower/smallpox_01.shtml#top [03-04-2013]

6.             Hammond, E. and Li Ching, L. (2011). Smallpox Virus Stocks at the 64th WHA: Implementing the Conclusions of the Major Review. Geneva: Third World Network. [Online]. Available from http://twnside.org.sg/title2/briefing_papers/twn/Briefing_Smallpox_2011.pdf [26-03-2013]

7.             Hinson, T. (2013). Could smallpox really be turned into a biological weapon by terrorists? London: Associated Newspapers Limited [Online]. Available from: http://metro.co.uk/2013/04/08/could-smallpox-really-be-turned-into-a-biological-weapon-by-terrorists-3585028/ [08-04-2013]

8.             McKay, B. (2011). Smallpox-Destruction Deadline Gets Delayed. New York: Dow Jones & Company, Inc. [Online]. Available from: http://online.wsj.com/article/SB10001424052702304520804576343072510493118.html [01-03-2013]

9.             McKie, R. and Stargardter, G. (2011). Smallpox virus: crunch time for the fate of a global killer. London: Guardian News and Media Limited. [Online]. Available from: http://www.guardian.co.uk/society/2011/feb/13/smallpox-virus-vector-health-terror [13-03-2013]

10.          Nordqvist, C. (2011). Should Smallpox Samples In The USA And Russia Be Destroyed?. Bexhill-on-Sea: MediLexicon International Ltd. [Online]. Available from: http://www.medicalnewstoday.com/articles/225616.php [13-03-2013]

11.          Nordqvist, C. (2011). Smallpox Samples To Stay For The Moment, World Health Organization Decides. Bexhill-on-Sea: MediLexicon International Ltd. [Online]. Available from: http://www.medicalnewstoday.com/articles/226464.php [08-04-2013]

12.          Riedel, S. (2005). Edward Jenner and the history of smallpox and vaccination. Bethesda: National Center for Biotechnology Information [Online]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/ [08-04-2013]

13.          Sebelius, K. (2011). Why We Still Need Smallpox. [s.l.] The New York Times Company. [Online]. Available from: http://www.nytimes.com/2011/04/26/opinion/26iht-edsebelius26.html?_r=0 [13-03-2013]

14.          Spillius, A. (2011).   'We must keep smallpox stocks' US and Russia tells World Health Organisation. [s.l.] Telegraph Media Group Limited. [Online]. Available from: http://www.telegraph.co.uk/health/healthnews/8267370/We-must-keep-smallpox-stocks-US-and-Russia-tells-World-Health-Organisation.html [13-03-2013]

15.          Swami, P. (2011). Fears of bioterrorism led superpowers to retain smallpox virus. [s.l.] Telegraph Media Group Limited. [Online]. Available from: http://www.telegraph.co.uk/health/healthnews/8267845/Fears-of-bioterrorism-led-superpowers-to-retain-smallpox-virus.html [13-03-2013]

What is smallpox? - A brief overview

(http://science.nationalgeographic.com/science/health-and-human-body/human-diseases/smallpox-article/)

Smallpox is a contagious disease caused by the Variola virus. There are 2 type of Variola. Variola Major is the most severe and common form and has a fatality rate of around 30%. Variola Minor is a much less severe and less common presentation with a fatality rate of only about 1%.

Transmission

The disease was transmitted through prolonged and direct face to face contact however it can be spread by contact with infected bodily fluids and also by contact with contaminated objects such as bed linen and towels. According to BBC History (2011), blankets contaminated with smallpox were used as an early bio weapon by the British forces during the Pontiac rebellion of 1763. “Sir Jeffrey Amherst, the Commander-in-Chief of the British forces in North America, wrote to Colonel Henry Bouquet: 'Could it not be contrived to send smallpox among these disaffected tribes of Indians? We must use every stratagem in our power to reduce them.' The colonel replied: 'I will try to inoculate the [Native American tribe] with some blankets that may fall in their hands, and take care not to get the disease myself.' Smallpox decimated the Native Americans, who had never been exposed to the disease before and had no immunity.”

Symptoms

Someone suffering from smallpox is not contagious during the incubation period which can last 7 – 17 days but averages out at 13 – 14 days. They can go on to sometimes be contagious with onset of the initial or prodrome phase; this is when the 1^st signs of the disease become evident. These symptoms include fever, head and body aches, malaise and occasionally vomiting. The person becomes most contagious with the onset of the rash. The rash first presents as small red spots on the tongue or mouth. As these spots develop into sores, they break open and deposit large amounts of the virus into the body via the mouth and throat. This is when the victim is at their most contagious. A rash now begins to develop on the skin, spreading from the face and usually cover the entire body within 24 hours. This rash becomes raised bumps which fill with a thick opaque fluid. These pustules scab over and, by the end of the second week of the rash forming, begin to fall off. The person remains contagious until the very last scab falls off.

Eradication

During the 20^th Century smallpox killed more than 300 million people (Sebelius, 2011) making it one of the most feared diseases of its time. Between 1966 and 1980 the World Health Organization (WHO) embarked on a program to eradicate smallpox by a collaborative global vaccination programme. According to WHO (2013) “The last known natural case was in Somalia in 1977. Since then, the only known cases were caused by a laboratory accident in 1978 in Birmingham, England, which killed one person and caused a limited outbreak. Smallpox was officially declared eradicated in 1979.”

According to Sebelius (2011) “At that time, the WHO called on all nations to destroy their collections of smallpox virus or transfer them to the WHO-sanctioned collections at one of two labs in Russia or the United States”

Our assignment

It is these remaining stocks that our assignment concerns. We are asked to address the following question and complete a paper in support of our stance in relation to it.

One of the longest and most contentious international policy debates has swirled around the question of whether to destroy the last known stocks of the smallpox (Variola) virus, which are preserved at two World Health Organization (WHO)-authorized repositories in Russia and the United States. Although smallpox was eradicated from nature more than three decades ago, concerns surfaced in the early 1990’s that a few countries might have retained undeclared samples of the virus for biological warfare purposes.  Because a smallpox outbreak would be a global health emergency of major proportions, in 1999 the WHO approved a research program at the two authorized repositories to develop improved medical defences against the disease.

References

Centers for Disease Control and Prevention. (2007). Smallpox Disease Overview. Atlanta: Centers for Disease Control and Prevention [Online]. Available from: http://emergency.cdc.gov/agent/smallpox/overview/disease-facts.asp [27-03-2013]

Flight, C. (2011) Silent Weapon: Smallpox and Biological Warfare. London: BBC. [Online]. Available from: http://www.bbc.co.uk/history/worldwars/coldwar/pox_weapon_01.shtml [27-03-2013]

Sebelius, K. (2011) Why We Still Need Smallpox. [s.l.] The New York Times Company. [Online] Available from: http://www.nytimes.com/2011/04/26/opinion/26iht-edsebelius26.html?_r=0 [13-03-2013]

World Health Organization (2010) The Smallpox Eradication Programme - SEP (1966-1980). Geneva: WHO. [Online]. Available from: http://www.who.int/features/2010/smallpox/en/ [27-03-2013]

World Health Organization (2013) Smallpox. Geneva: WHO. [Online]. Available from: http://www.who.int/csr/disease/smallpox/en/ [27-03-2013]

Should The Smallpox Samples Be Saved - The Next Assignment

Our latest assignment focuses on the remaining samples of the smallpox virus.

In this assignment brief, we are asked to conduct research and produce a paper in support of whether we believe the smallpox samples should be retained or destroyed. We will then be presenting our findings and arguing our case in an open discussion.



http://textbookofbacteriology.net/themicrobialworld/Smallpox.html















Do you have an opinion on this topic? Please leave any comments below.

Syphilis

Obviously I am obsessed with 'crusty crotch' diseases. As part of our blogging assignment, we were supposed to add a fact sheet on a disease we have previously studied. Better late than never eh?

I have resisted the urge to post unsettling pictures of infected body parts!!

Infectious Disease Fact Sheet
Name of Disease	Syphilis
Name of causative agent	Treponema Pallidum
Type of microbe	Bacterium
Gram-reaction	Negative
Cell shape & arrangement	Spiral shape
Epidemiology:
Geographic Prevalence	World wide
Reservoirs	Humans
Main transmission mode	Sexual/Blood contact with an infected person                                 Trans placenta in cases of congenital syphilis
Pathology:
Major tissues/organs affected	Dependent on the stage of the disease
Major signs/symptoms	Primary - Small painless spot on the area of infection      Secondary - rash on the palms of hands/soles of feet/back/genitals                                                                                                   Latent - No symptoms present                                                     Tertiary - Extensive damage to internal organs or soft tissue. Gummas (large ulcerated spots with are reluctant to heal)
Sequalae	Scaring to areas affected, death
Latency	Dependent on the stage of the disease
Treatment:
Main treatment methods	Antibiotics
Typical length of treatment	Dependent on the stage of the disease.
Prophylactic measures	Abstain from sexual contact, monogamy, condoms (though not effective if the sore is not covered by the condom)

Infectious Diseases

http://www.human.de/en/productNew/Rapid_Screening_Tests/Reagents_and_Consumables/Infectious_Diseases.php

I am a mature student studying Access to Nursing and Midwifery at Doncaster College. As part of our English core studies, we have been asked to design and produce a blog which will be used as a store house for our notes on infectious diseases. These notes will contribute to our essays and form part of our marks for the course overall.