Title: Smallpox- The Deadly Scourge
题目：天花-致命的灾难
Author 作者: Jon Mark Hirshon
翻译：葛赟 校正：肖锋

·      Smallpox (Variola ) 天花：
Only eradicated human infectious disease. 
唯一已根除的人类传染性疾病
Prior to the advent of vaccination, it killed an estimated 400,000 Europeans annually and was a major cause of blindness.
在疫苗出现之前，每年约40万欧洲人因此病而丧生，是当时主要的失明原因之一。
·      Major potential as a bioterrorism agent:  
主要的潜在的生物恐怖制剂
Now only supposed to exist in two laboratories in the world (at the CDC in Atlanta, Georgia and in the Vector Institute in Koltsovo, Russia).
现在全世界仅存在于两大实验室中（在乔治亚州亚特兰大的疾控中心－CDC，和俄罗斯叶卡捷琳堡的传染病研究所）。
 
·      Recently, previously unknown vials of active virus from the 1950s were found in a NIH laboratory in Maryland.
最近，在马里兰NIH实验室发现20世纪50年代的一些当时未知的活病毒的小瓶。
·      Clinical Presentation临床表现:
Incubation is usually 10-12 days (range 7-17 days)
潜伏期通常为10-12天（7-17天范围内）。

Signs and symptoms include症状和体征为:
Febrile (38.8-40.0C) prodome lasting 1-4 days, headache, myalgia (esp. back/spinal pain), pharyngitis, chills, abdominal pain
持续发热（38.8-40℃）1-4天，头痛，肌痛（背部和脊柱痛），咽炎，寒战，腹痛。
Rash: classically round and well circumscribed.  May be confluent or umbilicated. The rash evolves slowly: macules to papules to pustules to scabs.
皮疹：典型圆形和边缘清楚的皮疹，可能会融合或脐形凹陷的。皮疹进展缓慢，斑疹，到丘疹，到脓疱，最后结痂。
·      It is important to differentiate smallpox from chicken pox (Varicella):  鉴别天花和水痘非常重要。
Smallpox: Significant prodrome. Centrifugal rash (trunk to extremities). Can involve soles and palms. Lesions are in the same stage of development on any one part of the body.
天花：明显的前驱症状，离心性的皮疹（躯干到四肢），包括足底和掌心。皮损在身体的任意一个部位都处于同一个发展阶段。
Chickenpox: Minimal prodrome. Centripetal rash (extremities to trunk). Seldom on soles and palms. Asynchronus evolution of rash.
水痘：很少有前驱症状。同心性皮疹（四肢到躯干）。很少出现在足底和掌心。皮疹可异步进展。
Bottom Line 要点:
Smallpox is a global public health emergency and requires immediate reporting.  If the clinical presentation is unclear, discuss with local infectious disease experts or public health officials.
天花是全球公共安全紧急事件，要求立即报告。如果临床表现不明显，与当地传染病专家和公共安全官员进行讨论。
References 参考文献：
http://www.washingtonpost.com/national/health-science/fda-found-more-than-smallpox-vials-in-storage-room/2014/07/16/850d4b12-0d22-11e4-8341-b8072b1e7348_story.html
http://emedicine.medscape.com/article/237229-overview
http://www.who.int/csr/disease/smallpox/en/