Smallpox: Overview
Smallpox is a serious and often deadly viral infection. It is a contagious disease that spreads from person to person and can cause permanent scarring or even disfigurement.
Smallpox affected humans for thousands of years but began to disappear worldwide after 1980 thanks to successful smallpox vaccination campaigns. The last naturally occurring case was reported in 1977.
Although smallpox no longer spreads naturally, preserved virus samples remain in research laboratories. Scientific advances have made it possible to recreate the virus in laboratories, raising concerns that it could one day be used as a biological weapon.
Prevention and Treatment
Vaccines can prevent smallpox infection, but routine vaccination is no longer recommended since most people are unlikely to be exposed to the virus. However, newly developed antiviral medications may help treat smallpox if it were to reappear.
Symptoms of Smallpox
The first symptoms typically appear 12 to 14 days after exposure to the virus, although the incubation period can range from 7 to 19 days before symptoms begin.
After this incubation phase, flu-like symptoms suddenly appear, including:
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Fever
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Muscle aches
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Headache
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Severe fatigue
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Intense back pain
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Vomiting (sometimes)
A few days later, flat red spots appear on the body — often starting inside the mouth and on the tongue, then spreading to the face, arms, legs, and finally the trunk, hands, and feet.
Within a day or two, these spots turn into small fluid-filled blisters, which later fill with pus. These lesions, called pustules, eventually form scabs after about 8 to 9 days, leaving behind deep, pitted scars.
Smallpox can spread from person to person starting when the rash appears until all scabs have fallen off.
Causes and Transmission
Smallpox is caused by the variola virus and can spread in several ways:
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Direct person-to-person contact: Through talking, coughing, or sneezing near an infected person. Touching the skin lesions can also spread the virus.
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Indirect contact: In rare cases, airborne virus particles can infect people in nearby rooms or different floors of the same building.
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Contaminated objects: Touching infected clothing or bedding can transmit the virus, though this is less common.
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Bioterrorism threat: While unlikely, governments have prepared for the possibility of smallpox being used as a bioterrorist weapon because of its potential to spread rapidly.
Complications
Most people with smallpox recover, but some rare and severe forms are almost always fatal, especially among pregnant women and children.
Those who survive often have severe scarring, particularly on the face, arms, and legs. In some cases, smallpox can also cause blindness due to corneal infection.
Prevention
In case of a smallpox outbreak, patients are isolated to prevent spreading the virus. Anyone exposed to an infected person should receive the smallpox vaccine as soon as possible. The vaccine can either prevent infection or reduce disease severity if given within one week of exposure.
Available Vaccines:
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ACAM2000 Vaccine – Uses a live virus similar to smallpox but less harmful. However, it can cause severe side effects, such as heart or brain infections. Therefore, it is not routinely given unless a smallpox outbreak occurs.
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Jynneos Vaccine – Contains a highly weakened virus and is considered safer than ACAM2000. It is suitable for people with weakened immune systems or skin disorders.
Both vaccines can also protect against related viral infections like monkeypox and cowpox.
Vaccinated Individuals in Childhood
If you received the smallpox vaccine during childhood, you may still have partial immunity to the virus. Full or partial immunity can last for up to 10 years, and up to 20 years with booster doses.
In the event of a new outbreak, those previously vaccinated would still be advised to receive a new smallpox vaccine for enhanced protection.
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