A D E N O & P O X V I R U S

1. A D E N O & P O X V I R U S

2. Adeno virus Host specific virus DNA, non enveloped > 40 types Appearance of space vehicle Infection of RT, Eye, bladder, intestine & heart Respiratory Pharyngo - conjunctival fever Swimming pool conjunctivitis Acute febrile pharyngitis School age children Infants & young children Acute respiratory disease New military recruits

3. Ocular Infantile Gastoenteritis 1-15% of all viral diarrheal disease in children (Serotypes 40 - 41) Follicular conjunctivitis Hemorrhagic cystitis Self limiting Occurs primarily in boys- self limited (Serotypes11 - 21) Epidemic Kerato conjunctivitis Shared towels, ophthalmic soln. unsterile instruments Left ventricular dysfunction Leads to corneal opacity (ship yard eye) Both children & adults

4. Lab diagnosis Specimens Swabs from throat, eye, urine or feces Human embryonic kidney, HeLa, HEP-2 Culture Identification CPE- Grape like clusters Rise in titre of Abs in paired sera - ELISA Serology No drugs Treatment Live attenuated vaccine – only military population Prevention

5. Molluscum Contagiosum DNA virus belong to pox viruses Causes pink or pearly white umbilicated wart like lesions on skin Children & young adults Spreads by direct contact (STD) Eosinophilic intra cytoplasmic inclusions 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

8. Abandoned small pox hospital

9. In the early eighteenth century, especially in Britain, there was renewed interest in oriental medical practice, and in particular the use of 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. She herself 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.

10. Small pox - Variola Virus 2 clinical varities Highly fatal seen in Asia - Variola major (classical small pox) Non - fatal seen in Latin America - Variola minor (Alastrim) Vaccinia virus Artificial virus Employed as a vector for developing recombinant vaccine Brick shape, can be seen under microscope – 300 nm By inhalation- reach reticulo endothelial cells – viremia – seeding of mucosa & skin

11. Pocks of small pox virus on CAM of developing chick embryo Pocks of vaccinia are large, irregular, greyish, necrotic & hemorrhagic Pocks of variola are small, shiny, white, non necrotic & non hemorrhagic

12. Small pox Chicken pox Features Distribution of Rash Centripetal Centrifugal Palms & soles involved Seldom affected Axilla free Axilla affected Characteristics of Rash Superficial Deep seated Vesicles multilocular & umbilicated Unilocular & dew drop 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 Evolution of Rash Slow – macule, papule, vesicle, pustule Rapid Scabs form after 10-14 days After 4 - 7 days

13. Successful eradication No known animal reservoir No long term carriers Life long immunity after recovery Case detection was simple with characteristic rashes Subclinical infections did not transmit disease Highly effective vaccine - heat stable & long term protection International cooperation

14. Unanswered Questions Are there hitherto unknown animal reservoirs of small pox virus? Can another orthopox virus be transferred to small pox virus? Are we absolutely certain that laboratory infection such as that which occurred in Birmingham, England will not occur? 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 in future?

15. Smallpox, Bioterrorismand WHOThomson PrenticeGlobal Health HistoriesJuly 2006

16. 1980 “The end of smallpox – but for WHO it is only the end of the beginning…victory over smallpox has implications that go far beyond the individuals directly concerned…It reasserts our ability to change the world around us for the better.“ Halfdan Mahler,Director-General, WHO 1973-1988.

17. 1988 “For centuries, variola virus stalked the world with impunity, causing unmeasured suffering, death and blindness. Today it is confined to glass vials kept under high security in six laboratories…smallpox is a disease which can be confined to history – the first disease ever eradicated by man.” Donald Ainslie Henderson, Chief, Smallpox Eradication, WHO 1966-1977.

18. April 1999 "While we fervently hope smallpox would never be used as a weapon, we have a responsibility to develop the drug and vaccine tools to deal with any future contingency – a research and development process that would necessarily require smallpox virus.” US President Bill Clinton

19. 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 be kept for therapeutic research purposes

20. June 9, 1999 "If used as a biological weapon, smallpox represents a serious threat to civilian populations because of its case-fatality rate of 30% or more... Although smallpox has long been feared as the most devastating of all infectious diseases its potential for devastation today is far greater than at any previous time.“ Henderson et al. JAMA 1999;281:2127-2137

25. After September 11, 2001 2002: US government orders 200 million doses of smallpox vaccine, costing $428 million. The UK government orders 20 million doses, costing £32 Million 2003: UK government sets up Health Protection Agency to help prevent terrorist attacks and limit their impact 2003: WHO, US, UK, European Commission and 6 other countries stage "Global Mercury “ smallpox alert exercise

26. September 2003: Global Mercury • In this scenario, two travelers collapse at Vancouver airport with a suspicious rash. They confess they are members of a terrorist group who have infected themselves with smallpox and dispersed to 14 countries just as their infectivity is peaking. • Quarantine officers issue an international alert. Frantic communications ensue among the affected countries. Problems include cross-border coordination, language difficulties and equipment failures. • Afterwards, the exercise was described as a well coordinated, realistic and valuable test of international communications. "Participants believe that similar exercises should be scheduled regularly, possibly annually."

27. Exercise Global Mercury

28. 2005 "We are not saying there might not be fatalities, but we could prevent any widespread disaster.” Gordon MacDonald, Head of Emergency Strategic Planning, UK Health Protection Agency The Times August 24, 2005

29. 2005 "We shouldn’t be complacent but it is important for the public to realise that while there would be deaths, as there would be in a conventional attack using explosives, there wouldn't be the kind of widespread catastrophe they might imagine.” Dr Nigel Lightfoot, Director of Emergency Response Capability, UK Health Protection Agency .

30. 2006: WHO Global Outbreak Network

31. Conclusions • The risk of a terrorist smallpox attack is currently low but is being taken very seriously • Many countries are staging prevention and control exercises • Multimillion doses of vaccine are being held in readiness • WHO is urging countries to develop and strengthen preparedness plans