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Smallpox is a highly contagious and fatal infectious disease, which has no specific treatment other than preventive vaccination. The word pox derived from Latin word for “spotted”, which indicates the small bumpy blisters that becomes apparent on the body and face of an infected person. It is a viral disease caused by Variola virus. Symptoms include high fever, rash and fatigue. This disease is eradicated by a collaborative and extensive global vaccination program carried by World Health Organization (WHO). The last known case of the disease was in Somalia in 1977. This disease was declared to be eradicated in the year 1979 (World Health Organization, 2002).
Since smallpox is eradicated from the world and no longer a naturally occurring disease, even a single laboratory identified case can be considered as an outbreak (Fenner, Henderson, Arita, Jezek, & Ladnyi, 1988). Following case definition is followed to identify smallpox.
Visual identification: Illness associated with acute fever (generally greater than 38.3° C/101° F) that is followed by rash; the rash take the form of firm, deep seated vesicles or pustules that develops at the same time without any other apparent cause.
Laboratory identification criteria: Identification of Polymerase Chain Reaction (PCR) DNA of Valoria virus in the clinical sample is an effective identification process of smallpox onset. Another approach that can be followed in laboratory is the isolation of Valoria virus from the clinical sample with PCR confirmed. However, the laboratories must be WHO smallpox reference laboratory or have appropriate WHO reference capabilities (Centres for Disease Control and Prevention (U.S.), 2002, p. 06).
The pervasiveness of smallpox is massive. Centres of Disease Control and Prevention (CDC) categorizes this disease as Category A agent. This category of agent is believed to be capable of introducing extreme threat to public health and have moderate to high degree of potential to disseminate epidemic outbreak. Precautionary health awareness and public health preparedness is essential to deal with Category A agent disease like smallpox.
This disease is highly pervasive or contagious. It can be transmitted from person to person through physical contact. Airborne contact and contact with virus contaminated materials are also to possible sources of transmission of the disease. Since the onset of smallpox in an epidemic form may have serious consequences, early prevention through vaccination is recommended.
Tracking of smallpox poses unique challenges to the health care professionals and officials since the disease is extinct from the world. There are two approaches of tracking smallpox-pre-event surveillance and post-event surveillance. In pre-event tracking, where the possibility of occurrence of smallpox is extremely low, the surveillance depends mainly on particular clinical case definition, which mainly aims at finding out a classic case of the disease. It simply indicates the fact that first case of smallpox is highly likely to be unnoticed in first few days of onset if the presentation is non-specific. The main aim of pre-event tracking is to identify first occurrence-if ever happens-without any false alarm.
A more extensive approach of tracking takes place in post-event surveillance. As the name implies, post-event surveillance is performed once the outbreak of the disease or appearance of the virus is ever traced. This approach includes contact identification, tracing, vaccination and epidemiologic investigation.
Since there is no known treatment of smallpox is discovered, vaccination is the only line of defence. Vaccine of smallpox is likely to effectively operate for the first four days of disease onset. Vaccination is the only intervention to the disease. The vaccine to smallpox does not contain its root virus, Variola but a similar virus namely Vaccinia. However, pre-vaccination is not recommended since it develops complications. A prompt response from the health care professional with the sight of individual affected by smallpox can be a handy intervention to prevent rapid growth of the disease.
Orem’s basic conditioning factors can be used in assessing and preventing smallpox. The self-care theory shows how an individual should act to maintain their own health (Moore & Pichler, 2000, p. 01). In this case with smallpox, an individual has the responsibility to avoid contacts with sick people to prevent themselves from getting the disease. Also, on realization that a person is sick with smallpox, he or she has the responsibility to seek medical help where they get vaccinated against the virus. According to Orem, the nurse should assess the patient to note their needs and then using the required nursing system provide the care needed by the patient. In this case, once a patient has been noted to have been exposed to the virus, vaccination should be given to help prevent the patient from becoming ill.
As a nurse at paediatric hospital, this experience with smallpox has great impact in reshaping my views regarding epidemiological health condition. Children are most susceptible to contagious diseases and are likely to be attacked by smallpox more easily. There are multitudes of infectious epidemic diseases in the world, which requires prevention and intervention at early stage of onset. Therefore, to deal with child and infant patient this knowledge based experience would greatly facilitate my outlook.
Centers for Disease Control and Prevention (U.S.). (2002). CDC Smallpox response plan and guidelines. Atlanta, GA: Dept. of Health and Human Services, Centers for Disease Control and Prevention.
Fenner, F., Henderson, D., Arita, I., Jezek, Z., & Ladnyi, I. (1988). In: Smallpox and Its Eradication. History of international public health, 6, 1371-1409.
Moore, J. B., & Pichler, V. H. (2000). Measurement of Orem's Basic Conditioning Factors: A Review of Published Research. Nursing Science Quarterly, 13(2), 137-42. doi:10.1177/08943180022107573
World Health Organization. (2002, February 1). Global Alert and Response (GAR). Retrieved July 3, 2014, from http://www.who.int/csr/disease/smallpox/faq/en/
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