[tsofian]

Originally Posted by cosmicfish

First, and correct me if I am wrong on any of these, smallpox is not quickly spread through air or casual contact, but rather through the kind of skin-to-skin contact not normally found in a professional setting like PB. I don't see how it would spread through PB fast enough to prevent containment, or for the last person to be medicated before the first person died from the medication. Contagions like this could take months to spread through PB once introduced.

Second, I thought the more malignant forms that have close to 100% fatality were not distinct versions of the disease but rather variations in how people present, in which case untreated fatalities would still be less than 50%. Again, at the rate the disease would spread, they would probably stop any contaminated meds and take whatever survivors they could get.

I still have an issue with the contaminated stock just "happening" to wind up at PB. It just seems like a stretch that the Project would stock it, that the contamination would slip through their quality control, and that it would wind up at PB.

And why aren't we talking about UA? Is there a reason that TMP would not use their deliberately designed trump card on this? Especially once contaminated vaccine started killing people.

I am confused why Krell would necessarily think this was PB. Unless someone let something slip, could this not be a regional base, or a group, or something else? How does he know so much about the Project that he can definitively characterize PB through such limited contact?

I am not trying to be negative here, this was always one of the weak spots of the module and I am not sure that there is a good solution out there.

Here is the CDC basics page for Smallpox
http://www.bt.cdc.gov/agent/smallpox/disease/

and here is wikipedia https://en.wikipedia.org/wiki/Smallpox

Here is the Wikipedia information on Prognosis
The overall case-fatality rate for ordinary-type smallpox is about 30 percent, but varies by pock distribution: ordinary type-confluent is fatal about 50–75 percent of the time, ordinary-type semi-confluent about 25–50 percent of the time, in cases where the rash is discrete the case-fatality rate is less than 10 percent. The overall fatality rate for children younger than 1 year of age is 40–50 percent. Hemorrhagic and flat types have the highest fatality rates. The fatality rate for flat-type is 90 percent or greater and nearly 100 percent is observed in cases of hemorrhagic smallpox. The case-fatality rate for variola minor is 1 percent or less.[23] There is no evidence of chronic or recurrent infection with variola virus.[23]

In fatal cases of ordinary smallpox, death usually occurs between the tenth and sixteenth days of the illness. The cause of death from smallpox is not clear, but the infection is now known to involve multiple organs. Circulating immune complexes, overwhelming viremia, or an uncontrolled immune response may be contributing factors.[20] In early hemorrhagic smallpox, death occurs suddenly about six days after the fever develops. Cause of death in hemorrhagic cases involved heart failure, sometimes accompanied by pulmonary edema. In late hemorrhagic cases, high and sustained viremia, severe platelet loss and poor immune response were often cited as causes of death.[24] In flat smallpox modes of death are similar to those in burns, with loss of fluid, protein and electrolytes beyond the capacity of the body to replace or acquire, and fulminating sepsis.[45]

Here is Wikipedia information on the 1972 outbreak in what was then Yugoslavia

In early 1972, a 38-year-old Kosovo Albanian Muslim clergyman named Ibrahim Hoti, from Damnjane near Đakovica, Kosovo, Serbia, undertook the pilgrimage to Mecca. He also visited holy sites in Iraq, where there were known cases of smallpox. He returned home on February 15. The following morning he felt achy and tired, but attributed this to the long bus journey. Hoti soon realised that he had some kind of infection, but, after feeling feverish for a couple of days and developing a rash, he recovered - probably because he had been vaccinated two months earlier.

On March 3, Latif Musa, a thirty-year-old schoolteacher, who had just arrived in Đakovica to enroll at the local higher institute of education, fell ill. He had no known direct contacts with the clergyman, so he might have been infected by one of the clergyman's friends or relatives who visited him during his illness, or by passing the clergyman in the street.

Here is a good article on the airborne nature of the German outbreak in 1970
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2427800/

I will quote from its abstract
In a recent outbreak in Meschede, Federal Republic of Germany, detailed epidemiological studies have clearly indicated that 17 of the cases were infected by virus particles disseminated by air over a considerable distance within a single hospital building. Several features believed to be of importance in this unusual pattern of transmission were common to a similar outbreak in the Federal Republic of Germany in 1961 in which airborne transmission also occurred. These features include a source case with extensive rash and cough, low relative humidity in the hospital and air currents which caused rapid dissemination of the virus. While airborne transmission of this sort is rarely observed in smallpox outbreak, it is important to recognize that it may occur under certain circumstances.

From both the German 1970 and the Yugoslav 1972 outbreaks it is appearent that airborne transmission is entirely possible.

You say you don't see how it could spread through Prime Base in less then month and question why containment actions did not control it.

Smallpox is contained and controlled through vaccination. It is otherwise untreatable, except for supportive care. Since I am running "classic" TMP the events occured in a 1980s technology Prime Base. This means that the only way to detect smallpox is by culturing off an infected person, or off partical traps in the air system of the base. In either of these cases the Morrow bioweapons group would conclude that Smallpox was in the base and that it was possible the disease was spreading.

There are two good things about smallpox vaccinations-One is that a second vaccination after three to five years offers increased protection (From Wikipedia)

The antibodies induced by vaccinia vaccine are cross-protective for other orthopoxviruses, such as monkeypox, cowpox, and variola (smallpox) viruses. Neutralizing antibodies are detectable 10 days after first-time vaccination, and seven days after revaccination. Historically, the vaccine has been effective in preventing smallpox infection in 95 percent of those vaccinated.[41] Smallpox vaccination provides a high level of immunity for three to five years and decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts even longer. Studies of smallpox cases in Europe in the 1950s and 1960s demonstrated that the fatality rate among persons vaccinated less than 10 years before exposure was 1.3 percent; it was 7 percent among those vaccinated 11 to 20 years prior, and 11 percent among those vaccinated 20 or more years prior to infection. By contrast, 52 percent of unvaccinated persons died.[42]

The other is that there is a window after exposure when Vaccination can offer protection from the disease (also off Wikipedia)

Smallpox vaccination within three days of exposure will prevent or significantly lessen the severity of smallpox symptoms in the vast majority of people. Vaccination four to seven days after exposure can offer some protection from disease or may modify the severity of disease.[41]

So a couple of Prime Base members return from the colony after having been exposed to Smallpox. They had been previously vaccinated but that protection was no longer at full strength or the massive amount of virus to which they were exposed simply overpowered their immune system. They become symptomatic with a fever and then a rash. The rash might well appear before the cultures taken when the fever developed had been finished and the disease identified. Either way the medical staff would not have taken any chances. Fighting smallpox was a well understood process. You vaccinate EVERYONE who might have been exposed. In this case that would be everyone in Prime Base. The vaccine has some limited side effects, so the risk of giving it to everyone is really far less then not.

The Project doesn't use the UA, because the have a specific vaccine for Smallpox. The UA might have been used for the Smallpox patients and it might or might not have worked (in this case it didn't). Also depending upon the type the lethality of smallpox can be nearly 100% (and in this case both patients died).

I think there i no stretch that the project would stock smallpox vaccine. Even in the 1980s there was a lot of chatter about Soviet bioweapons research. Smallpox was always one of the organisms of interest, right up there with anthrax (which cannot be contracted from an infected person).

There is some stretch that Prime base got the tainted lot, but I can live with that. It is a case of luck first favoring the Project-Krell's plan was to kill everyone in the Project during the first round of vaccinations but then coming around and punching the project in the nads. This isn't any less likely then a Confederate soldier dropping the plans for their invasion of the North, having those plans taken to the Union high command and then being ignored as purposeful misinformation. There are a lot of other points in history when events turned an a minor event, or a highly unlikely one

I doubt that the Project would run its own QA on medicines it was buying. They would be buying large amounts and most agencies just trust supplier QA results. There isn't really any reason not to. However if the contaminant was organomercury the test might only detect it as thimerosal, a mercury containing perservative commonly used in vaccines. Unless the assay was highly specific the amount might well go unnoticed.

Here is an article on how toxic the mercury is. A somewhat larger dose would act more quickly then the months it took in this case
http://stemed.unm.edu/PDFs/cd/CLASSR...ge_Science.pdf

It might also be possible that other compounds could be toxic is such small doses but also have a latency period as well.