Demon Pox

Demon Pox is a highly contagious disease that has been responsible for several devastating outbreaks across Eleron. Characterised by the itchy rash, exhaustion, hyperthermia and delirium, dehydration and dizziness that can accompany the hyperthermia, Demon Pox can be deadly to the vulnerable and those without safe cool shelters and steady water, though it is easily cured by magic.
Demon Pox is a fascinating disease, as hyperthermia is a state triggered by the body no longer being able to cool itself adequately due to the outside environment, the victim's response is far more in line with hyperthermia than a fever, and yet is caused by a disease. It was once believed Demon Pox was an arcane disease that altered the environment around an individual to cause hyperthermia, however, victims placed under an Antimagic Field show no signs of relief. Thusly, the disease was noted as being natural, though the exact nature of its cause is unknown.
The origin of the name Demon Pox is debated, but what is agreed upon is that the name likely comes from the intense heat victims suffer while carrying the disease. It is likely the disease was originally believed to be fiendish in origin, and maybe even seen as a curse. In The Valeran Archipelago it is also known as Siennian Pox and in Cebran it is known as Demon's Inner Fire.

Transmission & Vectors

An airborne disease, often transmitted through coughs and sneezes. It can take up to two weeks for symptoms to begin presenting, but the disease is infectious a few hours after contracting it. The disease presumably affects all humanoid species, though this cannot be confirmed as not every humanoid species have been recorded as suffering from the disease.

Symptoms

Early symptoms include exhaustion and mild itchiness, and rarely dry eyes. After a few days, this develops into major to extreme itchiness depending on the severity of the case. At this point the most dangerous part is self-inflicted harm from scratching, as victims seek to relieve their constantly crawling and itchy skin. This stage can last anywhere from a few days to several weeks before the hyperthermia begins to kick in.
The last and most dangerous stage of the illness is when the victim's body goes hyperthermic, and as the victim's body temperature increases so does their sweating and general thirst as they begin to feel uncomfortably hot. If kept in a cool environment and provided adequate water the disease can be waited out, provided the victim is not at risk of self-harm to relieve the itching, which is only worsened as the profuse sweating begins. Victims may begin to experience the symptoms typical of heat stress and dehydration including delirium, headaches, nausea and loss of coordination and concentration. 
The combination of delirium and exhaustion with the relentless itching can cause the most long-term damage, in some extreme examples victim's resorted to using blades to scratch their skin with, and the energy expenditure from scratching comes at great cost to the already-exhausted body.

Treatment

Treatment varies in complexity depending on the severity of the illness, as well as the resources available to the affected. It is possible to simply wait out the disease with adequate surveillance and water, and a cool environment, as in severe cases death may still occur if the body remains in an overheated state for too long. It typically is impossible to prevent some form of organ damage in a medium to extreme case with this method.
In older treatment styles, victims would be forcibly restrained to prevent them from continuously scratching themselves, however, this is largely a discontinued practice due to the mental stress it inflicts on the patient unless the situation is extremely dire. There has been success with soothing salves of peppermint to relieve itchy skin, and restorative magic can either offer relief of symptoms or fully cure them. If available, it is recommended patients seek complete magical curatives to stop the disease entirely. Enchanted amulets of health that protect against disease are effective, and sworn Paladins that are blessed with immunity to disease cannot contract Demon Pox.

Prognosis

Measuring the deadliness of Demon Pox is difficult, as it entirely depends on the situation and treatment available to the individual. In general, 4E statistics from Sien suggest the death rate is around 5-15%, and 0% if stopped before its final stage. In regional areas without restorative magic access, the percentage may reach up to 50%. Historically, the death rate of epidemics tends around the 35-40% range, as medical facilities and personnel become overwhelmed. The wide variation in statistics implies gaps within the written history and records of the disease.

Sequela

Survivors of Demon Pox find themselves more sensitive to heat afterwards and are more prone to heat stress and heat strokes. Patients who experienced severe cases of Demon Pox may have suffered internal damage to their organs and may require long-term care.

Epidemiology

The outbreaks and epidemics that have occurred tend to gain their foothold in large cities, cases in rural regions rarely reach outbreak level. In tightly packed quarters, the transmission of the disease is more likely, with an increase in incidences during spring months, believed to correlate with those suffering from pollen allergies spreading demon pox as a result of their sneezing. Undeniably, demon pox's severity increases in heatwaves and warm weather as this only exacerbates the risk of hyperthermia.

History

Confirmed reports of the disease known today as Demon Pox can be found as far back as mid-2E, with possible oral history and secondary sources indicating it could have been present throughout 1E as well. While an unpleasant condition, it did not receive wide renown until a series of outbreaks throughout the countryside of Eleron all coincided within the same 3 years, with an estimated 250 dead. The death counts were extremely high in the small pockets of civilization that they occurred in, and the disease was not well known enough, or well researched enough to be dealt with quickly.
While the occasional occurrence of the disease returned over the years, as cities grew and population density increased throughout The Lisun Empire the risk of disease transmission grew higher until, in 867 2E, a new outbreak in the city of Lilren would devastate the city. As the Lisunese were a civilization with a strong arcane background, magical cures using restorative magic (spells like Lesser Restoration and Greater Restoration) were quickly confirmed to work, however, the available mages capable of administering such care were overworked and unable to prevent the diseases spread, resorting to curing only the most severe of cases to save lives and preserve resources. As many victims had to simply wait for the disease to run its course, it was common for family members to strap the afflicted to their beds to prevent them from hurting themselves. The city was put into lockdown, ending passage into and out of the city for the duration of the outbreak, and for an extra month after the last case. This action was commended at the time, as a key factor in the disease's containment to Lilren.
The Siennian Epidemic of 612-14 3E is the most famous widespread event caused by Demon Pox. Believed to have begun when an infected ship stopped in the port of Sien, it quickly spread amongst the dock ward and dockhands, and by the time the city was aware of what had happened, newly infected ships had long left Sien for other ports of call, spreading the illness up and down the eastern coast. Coincidentally the summer of 612 3E had the hottest recorded summer of Sien's history at the time, which only worsened the exhaustion and heat stress experienced by infected individuals. The early onset of exhaustion as a symptom saw many people unable to work, and the few temples of the city were overworked trying to cater to those who could afford their care. With the dense and high population, Sien had begun to boast at the time, it was hard to escape the effects of the disease. Doctors would take in those who couldn't afford curative magic and treat them in exchange for being allowed to experiment with potential treatments. This includes things like bloodletting, sedating patients heavily for the duration of the disease and ice baths were often attempted by doctors. Throughout Sien and other nearby affected settlements, the passing years only made things harder as the disease remained present, draining the population and the strength of the remaining workers. Workplace accidents rose sharply as victims in the early stages of the disease would head into work, small riots would break out on temple grounds from people trying to force entry, desperate for a certain cure the drained clerics could not provide.
In this event, Demon Pox hit the lower classes the hardest, due to both a lack of available care and the dock ward being more tightly packed than estates. It was common after the epidemic to see Siennians sporting various scarring from their previous attempts to relieve the maddening itch. The sudden blow to population and industry put the kingdom as a whole back a few years in terms of progress, and it took several decades for a complete recovery. The estimated death toll is around 850-900 people.
While originally a disease only found on Eleron, after contact was made between Eleron and Khosta, an outbreak occurred in the North Khostan port of Karju, proving itself quite deadly in the hot, humid climate. The outbreak lasted 6 months, with 147 confirmed deaths. Aid from Eleron in the form of expertise on the disease and spare clerics helped prevent the outbreak from spreading, or continuing for longer. Since this event, Karju has boasted a trained group of medics that are experts in disease and health, to prevent similar events from happening again.

Origin

Natural

Cycle

Short-term