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Smallpox was once the most deadly, most feared disease in the world. It is very serious, and very contagious. It is caused by two different viruses, either variola major or variola minor, and is believed to have been in existence among humans since about 10,000 BC. It kills about a third of its victims and leaves the rest scarred, blind, deaf, or crippled, because there is no specific treatment available for it. Fortunately, it was completely eradicated from the world’s population by the World Health Organization (WHO) in 1979. However, samples of the smallpox virus and supplies of the smallpox vaccine still remain available for study under extremely tight security. The most significant danger that smallpox presents to the world today is in bioterrorism; if the virus falls into the wrong hands, serious damage could be wrought to the world’s populations. Nobody in the world any longer has any immunity from smallpox, and the vaccination has been discontinued since the disease was apparently eradicated three decades ago.


Variola major is the most serious form of smallpox, and when outbreaks of smallpox happened regularly, it was also the most common. With variola major, you experience a more extensive rash and a much higher fever. Variola major has four different variations: ordinary, modified, flat, and hemorrhagic. Ordinary variola major is the most frequently occurring type, and accounts for over 90% of the past occurrences of smallpox. Modified variola major is a very mild expression of smallpox that occurs in response to a vaccine. Flat and hemorrhagic variola major are very rare, but are the most severe forms possible, and always fatal. Variola minor happens less frequently than variola major, but is also less severe, and is seldom fatal.
Image: Smallpox

Once you are infected with the virus, there is an incubation period that averages 12 to 14 days. During this period, you won’t have any symptoms, you will feel fine and not be contagious, but the virus is replicating in your cells at an incredibly rapid rate. By the time symptoms do start, it is too late to do anything to prevent the disease from running its course. Then the first symptoms will start, and may mimic the symptoms of other illnesses such as flu. You will run a fairly high fever, usually between 101 and 104 degrees Fahrenheit, and experience malaise, or a general feeling of being tired and rundown, with nausea and vomiting. The onset of smallpox symptoms is usually marked by a severe headache and aching all over your body. Even in this early stage of the disease, you will feel too sick to go on with your normal duties, and this stage can last two to four days.

Next, a rash will emerge. It will look like small red spots on the tongue and in the mouth. These mouth spots quickly develop into sores, break open, and leak large amounts of the virus into the mouth, throat, and digestive tract. During this rash phase, with sores opening in the mouth, you are at your most contagious. While the mouth sores are opening, the rash begins to spread, beginning on the face, and moving to the arms, legs, and then to the hands and feet. Within 24 hours, the rash will cover the entire body. By the next day, the rash will begin to raise, producing bumps all over the body. A day later, the bumps fill up with a thick pus, and appear with a dimple in the center; this raised bump with the depression in the middle is the most obvious visually distinguishing characteristic of smallpox. At this point, the fever, which may have dropped, spikes and remains elevated until the scabs form over the raised bumps. The bumps then fill with even more fluid, and are now called pustules—they are even larger and more sharply raised, and they feel as though there is a solid grain or core within the pustule. Sometimes the pustules get so big that they grow together and cover the entire surface of the skin. The phase of the disease with the bumps and pustules lasts about five days. After about five days the pustules begin to crust and scab, and by the end of the second week, the pustules have mostly scabbed over. You are still contagious, and will be until the scabs have completely fallen off.


Smallpox is caused by a virus, the variola virus, which has been part of the human population for thousands of years. The variola virus has been eradicated from the human race, but still exists in stockpiles in laboratories, for the purpose of research and for developing vaccines. Smallpox is spread through face-to-face or touch-to-touch contact between human beings, or through contact with infected bodily fluids, such as the pus that seeps from smallpox sores.

It can also be spread through contact with things an infected person has had contact with, such as sheets or clothing. It has even been recommended that after a smallpox infection, the wallpaper in the sick person’s room be stripped and burned so that any airborne virus that clung to it can be prevented from infecting someone else. People become contagious when their fevers start, but they are at their most dangerously contagious once the rash starts.


The most serious risk of smallpox in the 21st century is that someone will deliberately release it in order to cause an epidemic of disease. Most Western nations are taking steps to prepare for this possibility by creating stocks of vaccines and by training emergency responders in identifying and treating smallpox. In the terrible event that smallpox is released into the general population again, it can be prevented by rapidly administering vaccines to as many people as possible; in many cases, an outbreak of smallpox can be prevented if you get the vaccine within the first four days of exposure. If you do come down with smallpox, there is no known effective treatment, though some companies are conducting ongoing research on antiviral agents.

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