A Vaccine Preventable Illness

Smallpox, what is it?

Smallpox is a contagious infectious disease that can be spread easily, and can result in death. Smallpox is caused by the variola virus, which has been around for thousands of years. Researchers that examined the remains of an Egyptian Pharoah (Ramses V, who died in 1157 BCE) noticed scarring that is similar to the scars formed from smallpox. Vaccination is the only treatment that we currently have for this disease.

Signs & Symptoms

The signs and symptoms of smallpox vary over a long period of time. The following breaks down the progression of the disease and the duration.

Incubation period (7 to 17 days)

This is where a person is exposed to the disease, but is asymptomatic. During this time people are not contagious.

Initial Symptoms (2 to 4 days)

This stage includes symptoms like a general flu (fatigue, headache / body aches, vomiting) with a very high fever (101-104). During this stage people can on occasion be contagious.

Early Rash (~ 4 days)

This is when the rash first emerges producing small red spots on the inside of the mouth. These spots form sores that break open and spread the virus into the mouth and throat. The rash spreads all over the body, and towards the end of this phase the spots are fluid filled, raised off the skin, and have a depression in the center. This is the most highly contagious stage of the disease.

Pustular Rash (~ 5 days)

The red bumps are now fluid filled pustules all over the skin. This stage is still very contagious.

Pustules and Scabs (~ 5 days)

The pustules begin to crust over and form scabs. This stage is also contagious.

Resolving Scabs (~ 6 days)

The scabs begin to fall off, revealing scars on the skin. These scars usually become pitted. This stage is still contagious.

Scabs Resolved

After all the scabs have fallen off the person is considered no longer contagious.


Centers for Disease Control. (2007, Febuary 6). Centers for Disease Control. Retrieved from Smallpox Disease Overview:

Transmission of Smallpox

Transmission of smallpox can be done by direct contact with infected bodily fluids, fomites, and very rarely by air. The infected person has the potential to be contagious from the start of the incubation period all the way until the last scab falls off. Humans are the one and only natural carries for the Variola virus.

Severity and Complications of Smallpox

It is known as one of the most deadly diseases for human beings, but through a worldwide vaccination program it has been eradicated.There are two forms of the disease; the most common is Variola Major and the less common is Variola Minor. “Variola major has historically had about a 30% rate of mortality, while variola minor has a 1% mortality rate.” (Centers for Disease Control, 2007)

“The last case of smallpox in the United States was in 1949. The last case of a naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention.” (Centers for Disease Control, 2007)

Complications of smallpox are severe pitted scars on the skin where the pox marks form, and in the event that a pox appears on your eye, blindness can result.


Centers for Disease Control. (2007, Febuary 6). Centers for Disease Control. Retrieved from Smallpox Disease Overview:

Looking toward the future

Since this disease was eradicated worldwide, we generally do not have to worry about contracting this from the general public. However, live cultures of the virus remain stored at research centers like the CDC in Atlanta, GA. Post the September 11th terrorist attacks in the United States, some people are concerned about the threat of bio-terrorism.

For more information about Smallpox, please visit the following sites:

Personal Perspective

Considering this disease was eradicated worldwide, I am completely fine with taking this vaccination off the schedule and it makes this disease of low importance to public health. We should keep some vaccination on hand at places like the CDC, in the event of a bio-terrorism strike or a spontaneously occurring case. If this disease did reemerge, I could see adding this vaccination back on the routine vaccine schedule. Even though I am highly skeptical of the true safety of vaccines, I would probably have this vaccination if the disease reemerged, and for this one particular disease I would be ok with the government mandating vaccination. Even if you survive the disease, you will have extensive scaring, and possible blindness.