Paulo J. Reyes Beliefs:
Smallpox and The Need for Vaccinations
Should you vaccinate? Paulo J. Reyes truly believes so.
Here is his reasoning:
Although smallpox is considered a dead disease, its presence in certain laboratories is widely acknowledged. Thus, it is highly possible that it's available and could cause a current outbreak.
Also, the CDC considers smallpox a possible danger. They include it as one of the possible agents of a bioterrorist attack, and as such, they advise us to prepare for it. This is indicated in the CDC website under the subheading EMERGENCY PREPAREDNESS AND RESPONSE along with anthrax, plague, tularemia, etc.
Smallpox may present atypically and evade detection. If the disease occurs, it will present in a very unnatural way. That is, it will present as a result of a deliberate act to cause devastation.
The federal government should allow voluntary smallpox vaccinations to protect us from smallpox bioterrorist attack. At the very least, the Federal Government should allow the voluntary vaccinations of the first responders, which probably should include all hospital medical staff.
Ex-President Bush and the military have been vaccinated, shouldn't the American people?
Further, we should explore the development of a rapid assay to detect the presence of the virus (similar to the pregnancy test) so if the disease presents itself we will be able to detect it before it unravels into an epidemic or
pandemic.
It is naïve to believe that we will be able to identify it clinically if it presents, thus making a rapid assay unnecessary. If we can’t detect it early enough it will overwhelm the emergency medical systems, which would be the intent of the perpetrators.
Our community is immuno-naive to smallpox, that is, there is little to no immunity to the virus, thus the virus could spread rapidly. One is left with the conclusion that our first line of defense will not work (ring vaccinations). For this to work we would have to identify the smallpox outbreak early and isolate those exposed.
Containment would be made more difficult or impossible if the virus were aerosolized and the CDC seems to believe that the smallpox virus may be aerosolized.
To protect an individual from the virus, the individual must be vaccinated against the virus since there is no other therapy. The general public should be allowed on a voluntary basis to be vaccinated against smallpox.
Why then are we not vaccinating the American public? Reasons are given that make little sense. Should government make this decision for us or should there be more debate on this issue?
I welcome the opportunity to present these facts so that the public can be informed and protected. Years of extensive research shows we need to do more. Lets stand together while it’s a voluntary decision and not force upon by others.
Description of Smallpox-Small pox is a disease caused by the
variola virus. It had many natural presentations associated with the
various strains of the virus. The difference in the presentations,
however, were primarily in the severity of the disease they caused, as
well as the mortality rates associated. Two common presentations were
variola minor, also called alastrim and variola major. Variola minor’s
presentation was more benign, giving rise to less pox lesions, a less
severe disease in general, with a mortality rate of 1% or less. Variola
major gave rise to more severe disease with mortality rates as high as
40%. Their presentations were otherwise similar and can be broken down
into three phases: an incubation period, the prodrome, and the pox/rash
phase.
Smallpox Information-Quick Links....
History
Small pox is an infectious disease that has plagued man for
thousands of years, causing more deaths than perhaps any other illness. And in
the last century, alone, it has touted to have caused the death of some 500
million people—more than warfare had. It was, however, certified eradicated
by man in 1980, no longer able to cause natural epidemics after 1977. During
its reign as the scourge of mankind, it has probably had a significant impact
on the history of man. It is thought that Ramsey V died of this infection in
1155 B.C.
A small pox epidemic struck Athens 430 B.C., killing approximately one-third
of the population. This may have played a factor in the defeat by Sparta of
the Greeks in the Peloponnesian War. It also caused the death of Marcus
Aureilus in 165 A.D. Again, affecting the history of man. During the Elephant
Wars, 570 A.D., the Abyssinians were decimated by an outbreak of small pox
while they laid siege to Mecca. This preempted a successful conquest of Mecca,
again, playing a role in the history of man. In the 1500s, the Conquistadors
brought the infection to the Americas, and over the ensuing 300 years, played
a role in the decimation of the Native American population. However, the
advent of its demise came with the introduction of vaccinations by the British
doctor Edward Jenner with cow pox in the late 1700s. These vaccines, using
vaccinia, were used in the ’60s and ’70s by D.A. Henderson and the World
Health Organization to contain epidemics, and since there were no other hosts
for the virus to ultimately eradicate the virus. After 1980, the virus only
existed reportedly in two repositories—one in the former USSR (Moscow) and
in a repository in Atlanta, Georgia (at the CDC).
The ultimate eradication of the virus was scheduled for December of 1983.
However, a debate ensued, and at the conclusion of that debate, the virus
lived on in those two repositories where they were reportedly well protected.
However, now we’re told that the virus may be in the hands of North Korea,
Iraq and perhaps other adversaries. And we’re also faced with the reality,
post-9/11, that there are zealots or individuals with the ruthlessness and
willingness to use such a virus to harm the United States. Thus the need to
know about small pox.
Incubation Phase
The incubation period has a range of 4 to 17 days, on the average, of about
12 days. During this phase, there are no symptoms. The virus is replicating
within the host cell after the virus has been inhaled. During this phase, the
individual is not infectious, however, the virus is in stealth, undetectable.
The advantage of the longer incubation period is that it gives physicians a
longer period of time to find individuals who are exposed, quarantine them,
and vaccinate those who require vaccination. It is touted that if an
individual who has been exposed is vaccinated within 4 days of the exposure,
it may protect them against the infection or lessen the disease that will
develop as a result of the infection. Conversely, the shorter the incubation
period, the less time there is to do all this.
Prodrome
Prodrome is the phase when the patient becomes symptomatic. At this point,
there is no rash. However, the patient begins to develop fevers, which could
be as high as 104 or 105 degrees, body aches, headaches, nausea, vomiting, and
abdominal pain. This is associated with a decrease in appetite, sensitivity to
light, and, in many cases, dehydration. This phase coincides with the release
of the virus from the initially infected cells. It is not uncommon to
misdiagnose the patient during this phase with something other than small pox.
Since there is no classic rash to distinguish these patients from other
illness that gave rise to abdominal pain and fevers. The symptomatology is so
severe that in most cases, the patients are bedridden and are unable to get
about. With variola major, many patients succumb to the disease in this phase.
Individuals with concurrent illnesses or who are immune-deficient are more
likely to succumb to the disease than those otherwise healthy. The prodrome
lasts 2 to 5 days on the average.
Rash Phase
The rash phase begins after the prodrome. It is in this phase, or a day
before this, that the patient is most infectious. That is, he is able to
transmit the disease to other individuals. However, the patient can be
infectious perhaps to a lesser extent during the prodrome. This we know
because the virus can be isolated in the oral cavity during the prodrome. What
heralds the rash phase is the appearance of a rash which is characterized by
small red spots which eventually transforms into papules (small pimples) then
into a vesicle (small blister) and finally into a pustule which is akin to a
pus-filled blister. The rash initially presents over the face and upper
extremities, and subsequently over the lower extremities. To a lesser extent,
over the torso. However, as the disease develops, the rash covers the entire
body. At any one time, the rash is in the same stage of development with
little variation. That is, they are either spots (macules), pimples (papules),
blisters (vesicles) or pustules, all in the same stage. This distinguishes it
from chicken pox, which can be found on various parts of the body in different
stages, that is, some macules, some vesicles, some pustules. When the rash
initially presents as a red spot, it can be mistaken for the measles,
allergies, and other viruses. If the individual succumbs during this stage, he
may be misdiagnosed and the real diagnoses eluding the physician.
As the rash matures, it begins to scab, forming umbilicated lesions (that is,
a rash characterized by pimples that appear like a mouth of a volcano). In
severe cases, the rash covers the entire body. That is, each individual pus
lesion is side by side, covering most of the body. This is referred to as
confluent small pox. This is particularly painful since any movement results
in the cracking of the scabs. The hands and feet become covered which makes it
impossible to walk or to use one’s hands. At times, the scabs fall from the
hands and feet, leaving the hands and feet raw. This phase of the disease
lasts two to four weeks. It is not unusual though, at the beginning of this
phase of the disease, for the individual’s fever to dissipate, only to rise
again with complications from the infection.
Complications
Complications of the disease include pneumonitis, that is, the infection of
the lung; meningitis, that is, the infection of the lining of the brain;
encephalitis, infection of the brain, meningoencephalitis, the infection of
the lining around the brain as well as the brain; dehydration; secondary
bacterial infection of the pox rash; hemorrhaging and weakening of the immune
system, predisposing the individual to other types of infections. For those
who survive the small pox disease, chronic complications include scarring of
the cornea (which is the clear part of the eye), resulting in blindness and
disfiguring scarring of the skin. Many patients die of these complications,
and these complications are more common in two forms of small
pox—hemorrhagic small pox and malignant small pox which will be discussed
later.
Diagnosis
The diagnosis of small pox is not difficult if the classic skin lesion
(that is, the pox lesion) is present. Most physicians would probably be able
to make the diagnosis when they are presented such a rash. However, many
patients will present in the prodrome with an atypical rash, or with the
initial rash which may appear more macular, that is more like a red-spotted
rash. The diagnosis of these cases is much more difficult, and unless there is
a high suspicion for the disease, the diagnosis may be missed. Common mis-diagnoses
(when the patient presents with less than a classic rash) include: chicken
pox, hand, foot and mouth disease, folliculitis, impetigo, staphylococcal and
streptococcal, skin infections, allergies, and other blood disorders. There
are specific studies that can be performed to make the definitive diagnosis.
However, unless one has the suspicion of the disease being present, these
studies are not ordered. Also, the threshold for ordering these studies is
quite high since no physician wants to unduly alarm his patients or a
community about the presence of small pox. There is an adage in medicine, and
that adage is when you hear hooves you think of horses, not zebras. In an era
where small pox has not been seen in several decades, small pox is the zebra
not the horse. Also, certain studies such as variola viral cultures or
electromicroscopy to identify the variola virus or small pox serologies, that
is, the study to identify antibodies to the variola virus require approval by
a public health official. This could be an infectious diseases consultant, but
he may not want to approve such a study unless there are classic lesions of
the disease. So, it may be a Catch-22 set of circumstances which will
ultimately give rise to a delay in the diagnosis of the disease or the
recognition of an epidemic brewing.
Treatment
There is no specific treatment for small pox, however, there is treatment
for many of the complications from small pox, including dehydration and the
treatment of secondary bacterial infections with antibiotics. There are no
specific antiviral agents for small pox. However, there is some research using
agents such as cidofovir. However, these have not been released for use in the
treatment of small pox by the FDA. There are, however, several antiviral
agents used for patients suffering from AIDS, herpes simplex, herpes zostor
(also known as shingles), and the influenza virus.
These agents either abort the infection or lessen it. However, these agents
are not approved for the treatment of small pox, nor do we know whether they
would be effective. However, if there were an epidemic of small pox, my
feeling is the physicians, out of desperation, would attempt to use some of
these agents in consultation, having no other form of therapy for small pox.
In essence, the only effective therapy would be prevention and that would be
vaccinating the individual before he acquires the infection.
Mortality
The mortality rate of small pox varies. An epidemic of variola minor gives
rise to mortality rates in the 1% range. However, in variola major, depending
on the epidemic (the strain), the mortality rate may range from 10% to 40%.
Mortality rates being higher for hemorrhagic small pox and malignant small
pox. This will be discussed later. The true mortality rate of small pox is not
well known. This is because mortality rates quoted of epidemics occurring in
the last century were epidemics occurring in populations where vaccinations
were used, that is to say, some individual who acquired the infection had some
immunity depending on when the vaccine was given to them in relation to the
infection. Thus, they faired better than those individuals with no immunity.
This is because immunity to small pox lessens years after the vaccine is
given.
So, unless the individual has been recently vaccinated, the immunity to
small pox may be at a level where an infection can take hold, however, not to
the degree that it would cause the death of the individual.
No one knows what the actual mortality would be in a population where there
is little or no immunity to the variola virus. We do, however, know that in
certain individual groups, the mortality rate is higher, such as in the
pediatric population, less than one year of age. Their mortality rate is
higher than the general population. Also, pregnant females are more likely to
get hemorrhagic small pox perhaps as high as 50% which has a higher mortality
rate, ranging as high as 100%. And also, patients with concurrent illnesses
(such as diabetes, heart disease, etc.) or more specifically immune
deficiencies, will succumb to the disease more readily. We know nutrition
plays a role in how an individual will weather the small pox infection as it
plays a role in many other diseases. Then, of course, the mortality rate would
probably be negatively affected if the emergency medical services in a
community were inundated by an overwhelming number of small pox cases. It is
safe to say, the more immunity there is in the population, the less the
mortality.
Dr. Reyes is available for media interviews, radio interviews, etc. by contacting
Publisher Diana Ennen at Diana@pauloreyes.com or 954.971.4025
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