What Is Smallpox? Symptoms, Diagnosis, Treatment, And Prevention

What Is Smallpox - Symptoms, Diagnosis, Treatment And Prevention - ER of Dallas

Smallpox survivorship was high, but death rates were also high. The death rate from smallpox was about 30%. Furthermore, survivors of the disease frequently had extensive scarring and even lost their sight. Since a smallpox vaccination became available, smallpox no longer infects people. Since the smallpox vaccine was the first to be developed successfully, it marked a major turning point in the development of modern medicine.

This article examines the definition of smallpox and the people it affects. We also discuss whether smallpox could recur and examine its symptoms and treatment.

What Is Smallpox?

It was a dangerously contagious disease that harmed people until the late 20th century. Its origins are unknown, but experts believe it has been around for roughly 3,000 years based on the smallpox-like rashes found on certain ancient Egyptian mummies.

The smallpox virus was the cause of it. This virus belongs to the orthopoxviruses family, including monkeypox and cowpox. Historians assert that smallpox was first documented in writing in China in the fourth century.

What Is Smallpox - ER of Dallas

Over the ages, the variola virus was able to spread to other countries and regions due to human activity. By the sixth century, trade had allowed it to reach Korea and Japan, and as empires grew, it also made its way across North Africa, Spain, Portugal, the Middle East, and North Africa.

In the eleventh century, smallpox was introduced to northern Europe by the Crusades. Smallpox was then brought from Portugal to western Africa by colonialism and the slave trade, and it was subsequently carried over the Atlantic to the Caribbean, North America, and South America. Here, it wiped out Indigenous peoples’ populations.

The smallpox outbreak was a disease that rapidly dispersed over a wide geographic region. It was among the deadliest illnesses that people have ever encountered.

How Did Smallpox Spread?

From the moment symptoms appear until the scabs completely come off, the smallpox virus can spread.

It may proliferate even though:

  • Contact with a smallpox patient’s bodily fluids
  • Airborne transmission by saliva droplets released when a smallpox patient coughs or sneezes
  • Sharing clothes or bedding with a smallpox patient

Types of Smallpox

Four varieties of smallpox exist. Among them were:

Types of Smallpox - ER of Dallas
  1. Variola minor: A frequent smallpox subtype that is less deadly. Less than 5% of people sick died, according to an analysis of studies conducted in 2021.
  2. Malignant smallpox: An extremely uncommon and fatal form of smallpox in which the lesions do not turn into pustules or skin lumps filled with pus. Rather, they stayed plump and pliable for the duration of the sickness.
  3. Variola major: A more prevalent and fatal strain of the virus. According to the same analysis, 30% of cases resulted in death.
  4. Hemorrhagic smallpox: An uncommon and fatal form of smallpox in which blood seeps from organs into the skin and mucous membranes.

What Steps Did We Take To Eradicate Smallpox?

The following are a few things that might have helped eradicate smallpox:

  • People only contract smallpox. Neither insects nor animals can spread it. Fewer avenues for infection result from this.
  • It dispersed somewhat slowly. Until an infected individual became too ill to be around many other people, smallpox was usually not contagious. It is usually disseminated among household members.
  • Outbreaks were contained by ring vaccination. Health officials might use “ring vaccinations” to contain smallpox epidemics because the disease only spreads among intimate contacts. This entailed immunizing just individuals who had recently come into touch with an infected person.
  • It was simple to recognize. Every smallpox victim experienced symptoms, such as a recognizable rash. There were no carriers of smallpox who were asymptomatic.

Are There Still Cases of Smallpox?

The only contagious disease that people have successfully eradicated is smallpox. There are still some variola virus samples in a few secure laboratories, but these are the only ones that are known to be surviving. There isn’t a variola virus that affects people.

Smallpox was finally eradicated thanks to the development of the first effective vaccine in history. A British physician named Edward Jenner noticed near the end of the eighteenth century that milkmaids who had previously experienced cowpox did not contract smallpox. This led him to conclude that cowpox, which is caused by a less severe orthopox virus, might shield a person from the more serious illness.

Although he developed the first vaccination in 1796, it took a while for people to start using it. Many people did not trust that the vaccine was safe and were terrified of it. But as time went on, researchers made improvements to the vaccine, and public awareness of this preventative measure increased.

The WHO proclaimed smallpox eliminated in 1980, with the last naturally occurring case being in 1977.

Symptoms of Smallpox Infection

Smallpox symptoms progress over time and include

Symptoms of Smallpox Infection - ER of Dallas
  • Elevated temperature.
  • Sores, followed by rash-related hard pustules.
  • Severe headache.
  • Back pain.
  • Rash that originates in your mouth, moves to your face and eventually spreads throughout your entire body.
  • Stomach ache.
  • Extreme weakness and exhaustion.

The first symptoms to manifest are fever, headache, and exhaustion. They last for two to four days, although when the rash appears, the fever may stay the same or return. After that, the rash develops in phases that last a few days each.

Smallpox Rash: What Does It Look Like?

Your mouth and face are where the smallpox rash first appears, and it soon spreads over most of your body. It begins as a rash and progresses to hard lumps that eventually develop scabs. When someone has ordinary smallpox, which is the most frequent kind, the rash progresses through multiple stages:

First rash. A rash appears on your tongue, as well as the interiors of your mouth and throat, following the onset of symptoms. Your mouth’s red spots turn into sores that eventually burst.

Rash spreading. Your face, arms, legs, back, and chest are next affected by the rash. It covers your entire body, including the palms of your hands and the soles of your feet, in about a day.

Pus (thick fluid) collects in skin bumps. Every bump might have a dent in the center of it. The bumps fill with fluid for approximately two days.

Scratches and pustule rash. Pustules—firm, spherical lumps—develop from bumps. The pustules develop crusty scabs during the following ten days.

Scabs decide. The scabs peel off over a week or so, leaving scars behind.

How Is Smallpox Diagnosed

Rashes can be a symptom of several disorders. However, it is extremely improbable that a rash is caused by smallpox.

How is Smallpox Diagnosed - ER of Dallas

The following are the main smallpox diagnostic criteria:

  • A fever with a minimum temperature of 101 degrees Fahrenheit (38.3 degrees Celsius), occurring one to four days before the appearance of a rash, and at least one additional symptom such as excessive weakness, headache, backache, chills, vomiting, or intense abdominal pain
  • Traditional smallpox lesions as previously mentioned
  • Lesions on a single body part that are at the same stage of development (for example, having only pustules on the arms as opposed to blisters and pustules mixed)

It’s very likely that someone has smallpox if they fit the aforementioned description. The following are minor diagnostic criteria (lower likelihood):

  • A rash where the face and extremities have the highest concentration of lesions
  • Lesions that start out as mouth, facial, or forearm lesions
  • Severe sickness
  • Rash that gradually transforms into many forms
  • Ailments on the hands’ palms or the feet’s soles
  • Laboratory testing can confirm a smallpox diagnosis and rule out other possible diseases, like chicken pox.

Treatment of Smallpox

Treatment for smallpox in the past involved isolating the patient until all of the scabs fell off in order to relieve symptoms and stop the illness from spreading. However, researchers have created antiviral drugs to treat smallpox in recent years.

The medication tecovirimat (TPOXX) was licensed by the U.S. Food and Drug Administration (FDA) in 2018 for the treatment of smallpox. The medication functions by preventing the action of a protein known as p37, which in turn stops virus particles from escaping an infected cell and infecting other cells.

According to research, tecovirimat can treat illnesses akin to smallpox in animals and is effective against the variola virus in lab conditions (in cell cultures). Additionally, studies demonstrate the safety of tecovirimat, with headache, nausea, and abdominal pain being the most common side effects.

However, because the medication was created after smallpox was eradicated, human testing has not been conducted on it, raising questions about how well it would function in the extremely improbable case of an outbreak.

Further research has demonstrated that the antiviral medications brincidofovir, an experimental medication also used to treat adenovirus and cytomegalovirus retinitis in patients with AIDS, and cidofovir (Vistide), which is occasionally used to treat cytomegalovirus retinitis in eye infections in AIDS patients, are both effective against smallpox in laboratory settings and can treat diseases related to smallpox in animals.

Patients who have smallpox have not been tested for cidofovir or brincidofovir. Researchers are still looking at the toxicity and efficacy of the medications.

Prevention for Smallpox

  • People who have smallpox should not go to daycare, preschool, school, or work until all scabs have fallen off and they have received clearance from the Chief Quarantine Officer of the Dallas Emergency Room to return.
  • There is a vaccine on the market. In Australia, smallpox vaccination is not covered by the National Immunization Program and is not generally advised. Unless it is contraindicated, vaccination is advised for laboratory personnel who regularly handle vaccinia poxviruses.
  • South Australia’s health department, along with health departments around the world, is preparing for the potential that smallpox could be purposefully deployed as a bioweapon.
  • Smallpox cases should be promptly isolated until they are no longer contagious.
Prevention for Smallpox - ER of Dallas

Do We Still Vaccinate For Smallpox

Doctors no longer administer smallpox vaccinations on a regular basis. specific demographics, such as specific military personnel and researchers, continue to receive smallpox vaccinations. Vaccines against smallpox are kept in reserve by the US government in case there is another outbreak.

Why Is There a Scar From The Smallpox Vaccine?

In contrast to most contemporary vaccinations, the smallpox vaccine uses vaccinia, a live, unmodified smallpox virus. Rather than administering an injection, a medical professional pricks your shoulder and dips a two-pronged needle into the virus. At the vaccination site, you contract vaccinia. A blister that forms as a result of the infection eventually leaves a scar.

Vaccine recipients of this type of smallpox vaccine are required to closely observe the instructions for maintaining the immunization site. If they don’t, they could spread the vaccinia virus to another person. This vaccination comes in two varieties: APSV and ACAM2000.

Side Effects of the Smallpox Vaccine

The smallpox vaccination does not require an injection, or “shot,” in contrast to the majority of other immunizations.

Rather, a bifurcated (two-pronged) needle dipped in the vaccination solution is used to inject it. A physician punctures the skin (typically the upper arm) several times in a matter of seconds with a needle.

Within three to four days after a successful vaccination, a red, itchy lesion forms at the injection site. In the first week, this lesion becomes a big blister that fills with pus and starts to drain. In the second week, it starts to dry and scab over; in the third week, it falls off, leaving a little scar.

The vaccinia virus can easily spread throughout this process to other parts of the body or even to other people by touch. A dangerous infection that could endanger vision can result by touching the vaccine sore and subsequently the eye. It’s also possible for the vaccine sore to turn into a dangerous allergic or toxic rash.

Rarely, recipients of the vaccination experience additional serious or potentially fatal side effects, such as:

  • Heart pain and heart attack Heart lining inflammation, or both
  • Eczema vaccinatum is a severe rash that develops in individuals who already have skin disorders, such as eczema or atopic dermatitis, and who contract the vaccinia virus via another immunization.
  • In patients with compromised immune systems, progressive vaccinia, or an accumulation of inflammatory tissue at the vaccination site, can occur.
  • Inflammation of the brain


At What Age Was The Smallpox Vaccine Given?

At one point, all children in the United States received a different smallpox vaccine at the age of one year. In the United States, the smallpox risk had significantly decreased by the 1960s.

How Long Does The Smallpox Vaccine Last?

According to certain research, the smallpox vaccination can offer protection for several years. Every three years, the Centers for Disease Control and Prevention (CDC) advises obtaining a booster shot for people who require the smallpox immunization for their line of work.

When Did The Smallpox Vaccine Stop?

The public can no longer obtain the smallpox vaccination. The United States discontinued its routine smallpox immunization program in 1972. The World Health Organization (WHO) declared the eradication of smallpox in 1980. As a result, there is no need to safeguard the general people from the illness.

When Was The Smallpox Vaccine Created?

Jenner used material from a human smallpox sore two months later, in July 1796, to inoculate Phipps in order to gauge his level of resistance. Phipps, who was the first to receive a smallpox vaccination, continued to enjoy excellent health. Edward Jenner with smallpox and vaccination patients; colored etching after J.


A serious viral disease caused by the variola virus was smallpox. Its approximate age, according to historians, was 3,000 years. It was highly lethal; three out of ten victims died from it.

Smallpox symptoms included fever, vomiting, headaches, body aches, and a rash that developed into pustules and scabs. Though there was no cure, people might avoid illness thanks to the creation of the first vaccination.

The last known instance of smallpox occurring spontaneously occurred in Somalia in 1977. In 1980, the World Health Organization pronounced the disease to be completely eradicated following years of mass vaccination campaigns. In case people ever require medication that targets the variola virus, scientists are still working on developing such a treatment.

Take action right now to protect your community’s and your own health by contacting Emergency Room Dallas for professional advice. Let’s eradicate smallpox and give our global society’s resilience and well-being first priority.

Dr. Abbas
Dr. Abbas Raza Mian, MD, is an experienced health care provider primarily located in Dallas, TX. He has specializes in Internal Medicine, Other Specialty, and Hospital Medicine. Dr. Mian is affiliated with a regional medical center.

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