Everything About Smallpox And The Associated Skin Lesions

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Smallpox was an extremely contagious and deadly disease. The last case was reported it 1977 and WHO certified the global eradication of the disease in 1980.

History Of Smallpox:

It is important to know the history of the disease to properly understand the effect and consequences of it. Smallpox now has been eradicated to a large extent but before it was eradicated it was a very serious infectious disease caused by the variola virus. Variolation, a process called after the virus variola that causes smallpox, was one of the early methods for controlling the disease. During variolation, people who had never had smallpox were exposed to material from smallpox sores (pustules)  by scratching it into their arm or inhaling it through their nose. People frequently acquired smallpox-like symptoms after variolation, such as fever and a rash. But  fewer people were killed after they had acquired smallpox naturally.

Image source: By Don Eddins

The basic symptoms of smallpox were fever, and a distinctive, progressive and quite aggressive skin rash. 3 out of every 10 affected died with this disease. Many small pox survivors still have the scars especially the ones on their faces. In some extreme cases smallpox left people blind. Thankfully the vaccination was discovered in time which played a major role in eradicating smallpox.

Symptoms Of Smallpox:

It takes around 10 to 14 days for the symptoms to show. During the first 7 to 10 days you feel completely normal, fine even healthy. But once the symptoms start showing up they cause:

  • Fever
  • Discomfort
  • Headache and overall body pain
  • Dizziness and severe fatigue
  • Neck and back pain
  • Possible nausea

Causes Of Smallpox:

It is caused by the variola virus.

  • Direct contact- like mentioned above it is very contagious if you come in contact with a person who is suffering from smallpox there are very high chances you might have also catch it. The virus is also airborne so it can be transmitted through air droplets that escape when a person coughs or sneezes.
  • Through contaminated items- small pox can also spread when you come in contact with contaminated clothing, bedding etc. Although the risk are less than direct contact.
  • Indirect contact- in some very rare cases the airborne virus can spread farther, possibly through the ventilation system.

Skin Lesions Associated With Smallpox:

Photo Credit: CDC/James Hicks

Eruptive stage- As the fever and other symptoms subside then comes the skin lesions. Flat, red spots start appearing first on your face and hands and forearm and later all over your torso. Skin lesions usually start developing uniformly throughout the time you are suffering with the disease. Within a few days all these skin lesions convert into blisters with clear fluid, which turns into pus. In 8 to 9 days scabs begin to form later falling off and leaving deep pitted scars.

Modified – type smallpox- it occurs in previously vaccinated people. This stage consists of severe headache, backache and fever which is similar to the original type. However when the skin lesions start showing up they are more aggressive and start evolving way quicker and crusting completes in 10 days as in the original type it takes 14 days.

Prevention And Vaccines:

Smallpox vaccines are available to protect patients from the disease. Because smallpox has been eradicated, the smallpox vaccine is no longer recommended for the general public. While some antiviral drugs may help treat smallpox, there is no smallpox treatment that has been shown successful in people who are sick with the disease.

The smallpox vaccine, commonly known as the vaccinia virus vaccine, can prevent smallpox. The vaccine is made from the vaccinia virus, which is a poxvirus that is similar to smallpox but less dangerous. In the United States, there are two licensed smallpox vaccines and one investigational vaccine that might be utilized in a smallpox emergency.
There are two vaccines available, which are:

  • The first one is ACAM2000. This vaccine  contains vaccinia virus, a poxvirus belonging to the genus Orthopoxvirus. This vaccine can cause rashes, fever, and head and body aches.  The vaccinia virus can cause serious consequences in some persons, especially those who are immunocompromised. The replication-competent smallpox vaccine is made up of a live, infectious vaccinia virus that can be transmitted from the vaccinated recipient to unvaccinated people who come into close contact with the inoculation site or its exudate. The risk of side effects is the same for household contacts as it is for the vaccine recipient. As a result, additional precautions must be taken at the vaccination site to prevent the virus from spreading.
  • There is a second vaccine JYNNEOSTM. It can be used to vaccinate people of 18 and older with certain immune weaknesses or diseases, such as HIV or atopic dermatitis. In people with HIV and atopic dermatitis, JYNNEOS was tested, and no serious side effects were found. If there is an outbreak people who got vaccinated in childhood are less likely to catch smallpox.


  1. 1.
    USA.gov. Smallpox . Centers for Disease Control and Prevention. https://www.cdc.gov/smallpox/clinicians/clinicaldisease.html

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