See Syphilis for the “great pox”, which does not have any family ties with variola (in spite of its nickname).

The variola or small pox is a Infectious illness of viral origin , very contagious and epidemic, due to a Pox-virus. It was completely éradiquée in 1977 (date of the last known case), thanks to a campaign of the the World Health Organization (WHO) combining campaigns of massive Vaccination, since 1958, with a “strategy of monitoring and damming up”, implemented as from 1967.

The virus

It belongs to the Pox-virus which cause amongst other things:

• the Molluscum contagiosum, small tumor of the benign skin;
• variola;
• vaccinates it, which allowed the creation of the first vaccines and which reaches several animal species: cow, monkey…

History

Known in the old China where it would have been introduced in the year 49 of our era, it is generally allowed that variola was introduced in Europe by the Arab invasions, following the epidemic of Mecque in 572. However several scientists also wanted to see variola behind the epidemic which struck the Roman Empire during the reign of Marc Aurèle, usually called Peste antonine. The plague was then spread in the whole world, causing, during the centuries, of appalling Pandémie S persons in charge of million deaths. It is in particular most virulent of the diseases which decimated the Amerindian populations at the time of the conquest of the New World, as of its arrival in 1518.

Mechanism

It is about an exclusively inter-human disease; there is no reserve of animal virus.

The main door is usually the respiratory tracts, even if other ways of contamination are possible. A first viral replication is made on the level epithelium bronchi, without causing any symptom. The virus is diffused then in the reticulo-endothelial system and involves the first signs of the disease. The first lesion is frequently at the level of the Pharynx, thus allowing the salting out of the viruses in the atmosphere. The skin is reached by transfer of the virus to this level by the Macrophage S.

The disease, if it does not kill the patient, is immunizing: any réinfection by the same virus is impossible during years (even decades).

Description

The period between the contamination and the appearance of the first signs (lasted of incubation) is classically from 10 to 14 days. The eruption is preceded by a Fièvre during a few days, with shivers, headaches, nauseas…

The eruption is characterized by the appearance of red spots on the skin, becoming Vésicule S, then Pustule S before forming a crust. The extent is variable and remains for it narrowly connected to the evolution of the disease (an eruption of bigger size is a criterion of gravity). The lesions are more frequent on the level of the face and the palms. The lesion is seldom hemorrhagic (bleeding), but is, in this case, extremely serious.

Variola was a frightening and dreaded plague. It killed a patient on five (in the adults, close to a patient on three). When it did not kill, it often left a hailed face, disfigured to life. It always remained out of reach effective cure.

The differential diagnosis must be made with chicken pox. The latter has also an incubation period from 14 to 16 days (extreme 10-21 days), preambles such as fever and cephalgias, of the eruptions on the scalp, the trunk and the face. The principal difference between variola and chicken pox: the lesions of chicken pox (in the order maculae, papules, blisters, crusts) do not evolve/move all in even time . There can thus be at the same time papules, blisters etc contrary to variola.

Fight against variola

The history of the fight against variola can be divided into three periods: initially the phase of the Variolisation, then that of the Vaccination, finally that of the worldwide campaign of eradication (1958-1977).

Variolisation

The first written mention of variola comes from a doctor of Alexandria, Aaron. As of the 11th century, the Chinese practiced the Variolisation: it was a question of inoculating a form which one hoped for not very virulent disease by putting in contact the person to be immunized with the suppurant contents of the substance of the blisters of a patient. It is the Prime Minister Wang daN who after the loss of one of his sons of variola had convened various experts of all China to develop a Prophylaxie. A monk taoist brought the technique of inoculation which was diffused gradually in all China.

The result remained however random and risky, death rate could reach 1 or 2%. The practice was gradually diffused along the Silk route. In 1701, Giacomo Pylarini carries out the first inoculation with Constantinople.

The technique is imported in occident at the beginning of the 18th century, by Lady Mary Wortley Montagu the woman of the ambassador of Great Britain in Turkey which learns it from Doctor Emmanuel Timoni (Ca 1670-1718), doctor of the embassy from Great Britain to Istanbul. Graduate of the university of Padoue, member of Royal Society of London since 1703, Doctor Timoni publishes in 1713 in Philosophical transactions of Royal Society his treaty on the inoculation. Its work is again published the following year in Leipzig. Starting from this date, the publications on this subject multiply, Pylarino in 1715, Leduc and Maitland in 1722… It is introduced in France by the doctor Theodore Tronchin in 1756. In 1760, Daniel Bernoulli showed that, in spite of the risks, the generalization of this practice would make it possible to gain a little more than three years of life expectancy to the birth. It however caused the hostility of many doctors.

In India, variola is described in the ayurvedic books . The curative treatment ayurvedic passed by the inoculation of a " material varioleux" one year old old man, resulting from the pustules of people having contracted variola the previous year. The effectiveness of this method was attested by British doctor J.Z. Holwell in a report/ratio with the College off Physicians with London in 1767.

Vaccination of Jenner

Itself very favorable to the variolisation, the British doctor Edward Jenner heard of a popular belief according to which to catch the variola of the cows would preserve human form. The May 14th 1796, it inoculated then with a child of the pus taken on the hand of farm infected by the Vaccine (via the contact with worse of the infested cow), or variola of the cows (“ cow pox ” in English). Three months later, it inoculated variola with the child, who resisted it, appearing thus immunized against the virus. This practice was spread then gradually in all Europe. Nevertheless, variola remained endemic during all the 19th century and gradually from Europe only after the First World War disappeared.

For the anecdote, vaccination at that time consisted in taking pus directly pustules and infecting the men with (not to forget that Louis Pasteur and the asepsis came only later). And rather than to transport an infested cow, it was simpler to move with a man recently “vaccinated” and who presented the pustules. And thus the integrality of a convent was one day vaccinated against variola, although it was consequently infected occasion by the Syphilis.

Total eradication of variola

The Soviet Union entirely proposes into 1958 éradiquer the variola, which then made 2 million victims per annum on Earth. The project is taken again the same year by the the World Health Organization (WHO). The initial strategy, suggested by the USSR, estimated that a rate of vaccination of 80% would suffice for éradiquer the virus

WHO then changes strategy into 1967, implementing the “strategy of monitoring and Endiguement”.

In December 1979, a scientific commission declared variola éradiquée in the whole world, conclusion taken again by WHO in 1980. Vaccination was removed following this success.

In France

The Third Republic makes vaccination antivariolar obligatory in 1902. The last epidemic of variola goes back to November 1954 with Vannes. The sergeant Roger Debuigny returned visit to his family in Morbihan, bringing with him of the silk of Saigon which would have been contaminated. There was 16 died out of 73 cases.

After 1980

Officially, two stocks are preserved at ends of research to the Center for Disease Control (CDC) with Atlanta (the USA) and to the Institut of State of virology and biotechnology to Koltsovo (Russia). These two laboratories were initially create at ends of bacteriological Guerre at the time of the Cold war. Recently, and in particular following the attacks with the carbuncle in the United States in 2001, certain institutions proposed the possible use of variola as a bacteriological weapon.

In 1999, a committee of WHO announces that the reserves of vaccines available are limited too much and that it is necessary to start again the production of vaccines. A survey of the WHO of 1998 evaluated the number of amounts available on a world level to 90 million.

Consequently, the United States, France and other countries started again the production of vaccine against variola, in particular after the Attentats of September 11th, 2001 and them attacks with the carbuncle. In France, a “governmental play of collective vaccination against variola” lays down, on the assumption of a reappearance of the virus, a device of vaccination of the whole of the population of 14 days within units of basic vaccination (UVB) distributed on the territory.

Monkeypox

The Monkeypox or orthopoxvirus simien or virus of the variola of the monkey . (circulates in a enzootic way in the ombrophilous forests of central and Western Africa) can transmit itself to the man, causing a syndrome whose clinical demonstrations are similar to those of variola (pustuleuse eruption, fever, symptoms respiratory with a fatal outcome in certain cases). CIM-10: B04.

References

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