TOPICS:1. SMALL POX

2. CHICKEN POX3.RUBELLA

4. MEASLES

Caused by Variola virus

Double stranded DNA Orthopox virus

Variola major or minor

Stable outside host(retains infectivity)

SMALLPOX (चेचक ,शीतला, बड़ी माता)

RESERVOIR Before global eradication, the only reservoir - humans. No natural reservoir for the virus currently exists. AGENT variola major or minor

TRANSMISSION Inhalation of droplet or aerosols originating from

the mouth of smallpox-infected humans Direct contact with skin lesions or infected body

fluids of smallpox-infected humans Direct contact with contaminated clothing or bed

linens

EPIDEMIOLOGY

In the 18th century, British troops in North America gave smallpox infected blankets to their enemies, who went on to suffer severe outbreaks of smallpox.

Russian scientists describe covert Russian operations during the 1970s and 1980s that focused on bioweapons research and development including creation of more virulent smallpox strains and development of missiles and bombs that could release smallpox

SMALLPOX AS A BIOLOGICAL WEAPON

LAST CASE IN INDIA- 24TH MAY,1975 ( SAIBAN BIBI, ASSAM) INDIA DECLARED FREE OF SMALLPOX- 5TH JULY 1975LAST CASE OF SMALLPOX in WORLD- OCT 26, 1977MAY 8, 1980, OFFICIAL DECLARATION BY WHO - SMALLPOX

ERADICATED!

The End of Smallpox

Last case of Variola minor, Somalia 1977

Last case of Variola major, Bangladesh 1975

CHICKENPOX(छोटी माता)

EPIDEMIOLOGY OCCURRENCE – both as endemic and epidemic RESERVOIR – human AGENT – varicella zoster

TRANSMISSION person to person respiratory tract secretions direct contact with lesions

TEMPORAL PATTERN In temperate areas-distinct seasonal fluctuation with the highest incidence occurring in winter and early spring. In the United States, incidence is highest between March and May lowest between September and November. Herpes zoster has no seasonal variation and occurs throughout the

year.

GLOBAL STATUSChickenpox led to about 105 deaths a year during

the pre-vaccine years of 1990 to 1994. Between 2002 and 2007, the annual average

number of chickenpox deaths was the lowest ever reported, with 14 deaths recorded in 2007 and just 13 the year before. 

In 2006, a second dose was added to the vaccination roster which really eliminates casualties

Chickenpox related deaths are now extremely rare. 

The CDC's new report from THE NATIONAL

CENTER FOR IMMUNIZATION AND RESPIRATORY DISEASES, which updates an earlier analysis from 1995 to 2001, shows deaths have dropped by as much as 88 percent over the first 12 years in all age groups and by 97 percent in young people( 20 and under), since the varicella vaccine was introduced.

INDIAN STATUS OF CHCKEN POXIn 2013- 28090 cases of chicken pox with 61

deathsCase fatality rate = 0.21%Kerala – highest (121168 cases)West bengal – max deaths

RUBELLA

•From Latin meaning “little red”•GERMAN MEASLES•Discovered in 18th century•thought to be variant Of measles•Togavirus •RNA virus

EPIDEMIOLOGYOCCURRENCE -Rubella occurs worldwideRESERVOIR -human There is no known animal reservoir Transmission - spread from person to person

via droplets shed from the respiratory secretions of infected persons. There is no evidence of insect transmission

Temporal pattern - peak in late winter and spring

MEASLES (खसरा)morbilli, rubeola or red measlesParamyxovirus (RNA) Rapidly inactivated by - heat, sunlight, acidic

pH, ether and trypsin Highly contagious viral illness First described in 7th century Near universal infection of childhood in

prevaccination era Common and often fatal in developing countries

EPIDEMIOLOGY

OCCURRENCE -Measles occurs throughout the world RESERVOIR -human There is no known animal reservoir, and an asymptomatic

carrier state has not been documented.

TRANSMISSION - respiratory Airborne via aerosolized droplet nuclei has been documented in

closed areas (e.g., office, examination room) for up to 2 hours after a person with measles occupied the area.

Temporal pattern -peak in late winter–spring

Communicability -4 days before to 4 days after rash onset

In 2012, the World Health Assembly endorsed the Global

Vaccine Action Plan* with the objective to eliminate measles in 4 World Health Organization (WHO) regions by 2015 & 2 regions by 2020.

WHO Region Target Date for Measles Elimination

Target Date for Rubella Elimination or Control

African Region 2020 -

Region of the Americas

2000 2010

South-East Asia Region

2020 2020

European Region 2015 2015

Eastern Mediterranean Region

2015 -

Western Pacific Region

2015 2015

MEASLES 1993-2011

Endemic transmission interrupted Record low annual total in 2004 (37 total

cases) Many cases among adults Most persons with measles were unvaccinated

or unknown vaccination status In 2011, CDC reported 16 outbreaks of

measles and 220 measles cases, most of which were imported cases in unvaccinated persons

GLOBAL STATUS OF MEASLES Estimates of measles-related deaths have

been considered a crucial indicator to evaluate the progress of any nation towards measles elimination

The global estimates for the year 2013 suggest that close to 0.14 million deaths were attributed to measles, accounting for nearly 16 deaths each hour 

(Infection Ecology and Epidemiology 2015)

MEASLES STATUS IN INDIA More than one third of all measles deaths

worldwide (around 56 000 in 2011) are among children in India.

With support from WHO, in November 2010, India launched a massive polio-style measles vaccination project in 14 high-burden states, in a three-phase campaign.

Health workers were trained to detect and report measles outbreaks, and they found an unexpectedly high number of infections.

INCREASING CHILD VACCINATION

The government responded by establishing a system to ensure that every child who receives a first dose of the vaccine routinely gets a second. They also initiated ‘catch-up’ campaigns in areas where first-dose coverage was less than 80%.

With two phases of the measles vaccination campaign completed, and the third phase ongoing, more than 102 million children in 344 districts have been vaccinated, achieving between 87% and 90% coverage.

While it is not yet possible to assess

national impact, as the campaign is in different phases in different states, in some states the impact has been dramatic.

Gujarat, for example, has gone from nearly 1000 cases in 2010 to none in 2012.

In Bihar, once the state with the lowest immunization coverage levels in the country, the proportion of children immunized against common childhood diseases tripled as polio eradication activities intensified (from 18.6% in 2005 to 66.8% in 2010), underscoring the synergistic links between polio and measles efforts.

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