Smallpox: An Update for Nurses

Abstract

The global eradication of smallpox in the late 1970s was a major achievement of the 20th century and brought out the best in science and public health. Prior to eradication, smallpox was a devastating disease with an overall mortality rate of approximately 5% to 30% for the most common form of the disease depending on vaccination status and the clinical presentation. The more severe forms of smallpox (i.e., flat and hemorrhagic type) had case fatality rates of approximately 96% to 100%. Currently, there is heightened international concern regarding the potential use of the smallpox virus as an agent for bioterrorism. Therefore, it is imperative that health care workers become familiar with clinical aspects of this disease as part of the national efforts to ensure homeland security. This article reviews the history, disease progression, and adverse events of smallpox; immunization practices; and nursing considerations.

Bioterrorism: Pathogens as Weapons

“…Naturally occurring smallpox was eradicated in the late 1970s. 24 However, the virus is not extinct. Supplies of virus are maintained in the CDC and State Research Center of Virology and Biotechnology in Novosibirsk, Russia.…”

“…All of these viruses infect humans but only smallpox is readily transmitted via person-to-person contact. 24…”

“…There are 2 distinct types of the variola virus: major and minor (alastrim). 24,25 Historically variola major had a fatality rates of approximately 30% in unvaccinated populations. Variola minor had a fatality rate of less than 1%.…”

“…With smallpox all lesions are at the same stage of development but with chickenpox lesions are at various stages of development. 24…”

“…All of these viruses infect humans but only smallpox is readily transmitted via person-to-person contact. 24 Variola virus produces a systemic disease and a generalized rash. 24,25 The disease is transmittable from the time of the development of the earliest lesions to the resolution of all scabs.…”