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The Smallpox Challenge by Ihor Magun, M.D., F.A.C.P. The last case of endemic smallpox was re ported in 1977 in Somalia. In 1980, the World Health Organization (WHO) declared smallpox eliminated from the world. Today, however, the disease poses a significant threat, and smallpox, the once-eradicated disease of the past, is now a daily headline in the news. Smallpox is a virus that produces a rash, which then progresses to blisters and pustules. These become firm and develop a central indentation. The disease is easily spread from person to person and death occurs in 20-30% of people infected. Survivors are left with horrific scars and disfigurement. No cur rent treatment is available. The current vaccination recommendations are the focus of much debate. It is, for example, not know whether prior vaccinations provide adequate immunity and protection. Answers to this and other questions are not known. In weighing risk to benefit ratio of vacci nation, researchers in the medical community must consider the threat and risk of contagion against the threat and risk of significant serious reactions to the vaccine itself. The vaccine is a weakened live smallpox vi rus. A needle is dipped into the vaccine solution then injected into the upper arm fifteen times. After three of four days, an itchy and sore red bump appears. By the end of the first week, a blister forms, fills with pus, and drains. During this time, the injection site should be covered with gauze and changed daily. The soiled gauze should be disposed in a sealed, plastic bag. In the second week, the blister dries and a scab is formed. By the third week, the scab falls off, leaving a small scar in the area of injection. Shedding of the virus from the site may occur until the scab develops. There is risk of transmission to others, but with proper local care of the injection site, good handwashing, and proper covered clothing, the risk is very small. In addition to the natural vaccine reactions, the vaccination can produce some daunting side ef fects. These include tenderness and redness at the in jection site, generalized skin rashes, fever, generalized weakness, and enlargement of lymph glands. Serious, but not life-threatening, reactions occur in about one thousand of every million people vaccinated, and the Center for Disease Control (CDC) reports one to two deaths per one million vaccines administered. Especially vulnerable are women who are pregnant or who intend to become pregnant within four weeks after vaccination, women who are breast feeding, people with immune deficiency (HIV/AIDS) or leukemia, transplant patients or individuals with generalized cancer. Others at risk are people who have ever been diagnosed with eczema or atopic dermatitis (even if it is mild or not a current medical problem), those with incompletely healed skin conditions (e.g., bums, shingles, herpes, acne, psoriasis), individuals with allergies to the vaccine, infants younger than one year, and individuals who use steroid eyedrops. Vaccination has already been offered and ad ministered to certain individuals in this country. Presi dent Bush was revaccinated at the end of December 2002. The decision to vaccinate the president was mo tivated by recent world events. Since smallpox has been eliminated as a natural hazard, any positive case would be likely to be the result of a bioterrorist act. Appropriate measures of containing an outbreak would then be initiated by authorities. A more extensive and up-to-date list of recommendations may be found on the CDC's website at www.cdc.gov/smalbox. 20 “НАШЕ ЖИТТЯ”, БЕРЕЗЕНЬ 2003 Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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