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Smallpox was a highly contagious disease that was once worldwide. The incubation period is about 12 days following exposure. At first there is high fever, fatigue, and head and backaches. Severe abdominal pain and delirium are sometimes present. A characteristic rash comes out after a three-day period. The rash comes out mainly on the face arms and legs. It starts out as flat red lesions that become vesicular (fluid-filled) and later pustular (pus-filled). They begin to crust over early in the second week of the disease. While similar to chickenpox, an important difference is that the rash evolves at the same rate. That means each individual pox change from stage to stage at the same time all over the body. The pustules are characteristically round, tense and deeply embedded in the skin. When the scab falls off, the skin is left pigment free and usually there is a scar. The majority of patients with smallpox recover, but death occurs in up to 30% of cases.

Saliva droplets from an infected person can spread smallpox to others. The patient is most infectious during the first 7 to 10 days of rash. He is not contagious prior to having a rash. Contaminated clothing or bed linen could also spread the virus. This disease could also spread if introduced to the environment in aerosol form as a biological weapon.

Edward Jenner first discovered the prevention of smallpox in 1796. He demonstrated that an infection caused by cowpox protected against smallpox. Subsequently, a vaccine was developed and the World Health Organization began a program in 1967 to eradicate smallpox. This was successfully accomplished in 1980. Treatment of smallpox is mainly supportive therapy plus antibiotics for secondary bacterial infections. Vaccination within 4 days of first exposure may be protective against getting smallpox or at least reduce its severity.

There are obvious reasons why we are concerned about smallpox being used as a biological weapon. What should we do now? An effective control program should include early detection of infected individuals, keeping track of possible contacts and a focused selective vaccination program. Early detection is important and if you suspect this illness please see your doctor. The Center for Disease Control and Prevention currently has an emergency supply of smallpox vaccine.