8/14/2019 Adeno & Pox 07s

1/31

8/14/2019 Adeno & Pox 07s

2/31

11/26/08 2

Adeno virus

Host specific virus

Respiratory

> 40 types

Acute febrile pharyngitis

Infants & young children

Pharyngo - conjunctival fever

Swimming pool conjunctivitis

School age children

Acute respiratory disease New military recruits

DNA, non enveloped

Infection of RT, Eye, bladder, intestine & heart

Appearance of space vehicle

8/14/2019 Adeno & Pox 07s

3/31

11/26/08 3

Infantile

Gastoenteritis

1-15% of all viraldiarrheal disease in

children

(Serotypes 40 - 41)

Hemorrhagic cystitis

Occurs primarily in boys-

self limited

(Serotypes11 - 21)

Left ventricular

dysfunction

Both children& adults

Ocular

Follicular conjunctivitis

Self limiting

Epidemic Kerato conjunctivitis

Shared towels, ophthalmic

soln. unsterile instruments

Leads to corneal opacity (shipyard eye)

8/14/2019 Adeno & Pox 07s

4/31

11/26/08 4

Lab diagnosis

Specimens Swabs from throat, eye,urine or feces

Culture Human embryonic kidney,HeLa, HEP-2

Identification CPE- Grape like clusters

Serology Rise in titre of Abs inpaired sera - ELISA

Treatment No drugs

Prevention Live attenuated vaccine

only military population

8/14/2019 Adeno & Pox 07s

5/31

11/26/08 5

Molluscum Contagiosum

Children & young adults

Causes pink or pearly whiteumbilicated wart like lesions on skin

DNA virus belong to pox viruses

Spreads by direct contact (STD)

Can not be cultured

Diagnosis by clinical picture & HPE

HPE: Molluscum bodies

Disappears within 1yr

To avoid spread - Surgical

removal / Cryotherapy/ Laser

Avoid touching, rubbing,

scratching, shaving over the area

Eosinophilic intracytoplasmic inclusions

8/14/2019 Adeno & Pox 07s

6/31

11/26/08 6

8/14/2019 Adeno & Pox 07s

7/3111/26/08 7

8/14/2019 Adeno & Pox 07s

8/3111/26/08 8Abandoned small pox hospital

8/14/2019 Adeno & Pox 07s

9/3111/26/08 9

In the early eighteenth

century, especially in

Britain, there was

renewed interest in

oriental medical practice,

and in particular the useof inoculation against

smallpox (variolation).

This arose in part from

the fact that, in 1718,

while resident at the

Embassy in Istanbul,

Lady Mary Wortley

Montagu was so

determined to prevent the

ravages of smallpox and

so impressed by the

Turkish method that she

ordered the Embassy

surgeon at Istanbul,

Charles Maitland, to

inoculate her 5-year-old

son in March 1718. Sheherself had suffered from

a bout of smallpox in

1715 that disfigured her

beautiful face, and her 20-

year-old brother had died

of the illness 18 months

earlier.

8/14/2019 Adeno & Pox 07s

10/3111/26/08 1

2 clinical varities

Highly fatal seen in Asia -

Non - fatal seen in Latin America -

Variola major (classical small pox)

Variola minor (Alastrim)

Vaccinia virus Artificial virus

Employed as a vector for developing recombinant vaccine

Brick shape, can be seen undermicroscope 300 nm

Small pox - Variola Virus

By inhalation- reach reticulo endothelialcells viremia seeding of mucosa &

skin

8/14/2019 Adeno & Pox 07s

11/3111/26/08 1

Pocks of small pox virus on CAMof developing chick embryo

Pocks of variola are small,shiny, white, non necrotic & nonhemorrhagic

Pocks of vaccinia are large,irregular, greyish, necrotic &hemorrhagic

8/14/2019 Adeno & Pox 07s

12/3111/26/08 1

Features Chicken poxSmall pox

Distribution of

RashCentrifugal Centripetal

Characteristics

of Rash

Evolution of

Rash

Palms & soles involved Seldom affected

Axilla free Axilla affected

Deep seated Superficial

Vesicles multilocular& umbilicated

Unilocular & dewdrop appearance

Only one stage of

rash at one time

Pleomorphic: rash in

successive crops

No area of inflammation

around vesicles

Area of inflammation

around vesicles

Slow macule, papule,

vesicle, pustule

Rapid

Scabs form after 10-14 days After 4 - 7 days

8/14/2019 Adeno & Pox 07s

13/3111/26/08 1

Successful eradication

Life long immunity after recovery

No long term carriers

No known animal reservoir

Case detection was simple with characteristic rashes

Subclinical infections did not transmit disease

Highly effective vaccine - heat stable & long term protection

International cooperation

8/14/2019 Adeno & Pox 07s

14/3111/26/08 1

Unanswered Questions

Are we absolutely certain that laboratory infection such as that whichoccurred in Birmingham, England will not occur?

Can another orthopox virus be transferred to small pox virus?

Are there hitherto unknown animal reservoirs of small pox virus?

Will animal pox (Monkey) eventually replace the eradicated small pox

virus as a wide spread pathogen?

Lastly could biological warfare with small pox virus be waged infuture?

Gl b l H lth

8/14/2019 Adeno & Pox 07s

15/3111/26/08 1

Global Health

HistoriesJuly 2006

8/14/2019 Adeno & Pox 07s

16/3111/26/08 1

The end of smallpox but for WHO it is only

the end of the beginningvictory oversmallpox has implications that go far beyondthe individuals directly concernedIt

reasserts our ability to change the worldaround us for the better.

1980

Hal fdan Mahl er ,Director- General , W HO1973- 1988.

8/14/2019 Adeno & Pox 07s

17/3111/26/08 1

1988

For centuries, variola virus stalked the world with

impunity, causing unmeasured suffering, death andblindness. Today it is confined to glass vials keptunder high security in six laboratoriessmallpox is adisease which can be confined to history the first

disease ever eradicated by man.

Donald Ainslie Henderson,

Chief, Smallpox Eradication,

WHO 1966-1977.

8/14/2019 Adeno & Pox 07s

18/3111/26/08 1

April 1999

"While we fervently hope smallpox would

never be used as a weapon, we have aresponsibility to develop the drug andvaccine tools to deal with any future

contingency a research and developmentprocess that would necessarily requiresmallpox virus.

US President Bill Clinton

8/14/2019 Adeno & Pox 07s

19/3111/26/08 1

May 1999

During the World Health Assembly, the USA

successfully argues against calls for the destruction

of smallpox stocks held in the USA and Russia,recommending instead that stocks should bekept for therapeutic research

purposes

8/14/2019 Adeno & Pox 07s

20/3111/26/08 2

June 9, 1999

"If used as a biological weapon, smallpoxrepresents a serious threat to civilianpopulations because of its case-fatality rate of

30% or more... Although smallpox has long beenfeared as the most devastating of all infectiousdiseases its potential for devastation today is far

greater than at any previous time.

Henderson et al.

JAMA 1999;281:2127-2137

8/14/2019 Adeno & Pox 07s

21/3111/26/08 2

8/14/2019 Adeno & Pox 07s

22/31

11/26/08 2

8/14/2019 Adeno & Pox 07s

23/31

11/26/08 2

8/14/2019 Adeno & Pox 07s

24/31

11/26/08 2

8/14/2019 Adeno & Pox 07s

25/31

11/26/08 2

After September 11, 2001

2002: US government orders 200 million doses ofsmallpox vaccine, costing $428 million. The UKgovernment orders 20 million doses, costing 32Million

2003: UK government sets up Health ProtectionAgency to help prevent terrorist attacks and limittheir impact

2003: WHO, US, UK, European Commission and 6other countries stage "Global Mercury smallpoxalert exercise

8/14/2019 Adeno & Pox 07s

26/31

11/26/08 2

September 2003: Global Mercury

In this scenario, two travelers collapse at Vancouver airportwith a suspicious rash. They confess they are members of aterrorist group who have infected themselves with smallpoxand dispersed to 14 countries just as their infectivity ispeaking.

Quarantine officers issue an international alert. Franticcommunications ensue among the affected countries.Problems include cross-border coordination, languagedifficulties and equipment failures.

Afterwards, the exercise was described as a wellcoordinated, realistic and valuable test of internationalcommunications. "Participants believe that similar exercisesshould be scheduled regularly, possibly annually."

8/14/2019 Adeno & Pox 07s

27/31

11/26/08 2

Exercise Global Mercury

8/14/2019 Adeno & Pox 07s

28/31

11/26/08 2

2005

"We are not saying there might not befatalities, but we could prevent any

widespread disaster.

Gordon MacDonald,

Head of Emergency Strategic Planning,

UK Health Protection Agency

The Times August 24, 2005

8/14/2019 Adeno & Pox 07s

29/31

8/14/2019 Adeno & Pox 07s

30/31

11/26/08 3

2006: WHO GlobalOutbreak Network

8/14/2019 Adeno & Pox 07s

31/31