Smallpox - Communicable Disease Control and Prevention, San Francisco Department of Public Health Smallpox What is Smallpox and How do People Get it? Smallpox disease is a serious, highly contagious, and often life-threatening infection marked by a rash of round pox (blisters) on the face, arms, and legs. It is caused by the Variola virus. The last case of smallpox in the United States was in 1949. The last case in the world was in Somalia in 1977. Worldwide vaccine campaigns have wiped out smallpox everywhere. Since the disease no longer occurs naturally anywhere in the world, smallpox vaccination for the general public was stopped because it was no longer necessary. Today, smallpox virus is kept in two approved laboratories in the USA and Russia. Historically, people got smallpox by touching or breathing in the smallpox virus. This is called being exposed to smallpox. Not everybody who is exposed to smallpox will get sick. But many will, and as the smallpox viruses multiply inside the body, they can cause serious illness. Smallpox is not spread by insects or animals.

There is no naturally-occurring smallpox. Terrorists could use smallpox virus to hurt people on purpose by releasing the virus in public places. If people start to get sick from smallpox, others can be exposed to the virus through: Breathing in the virus from a cough, sneeze, or saliva (spit) of someone with smallpox Touching skin that has smallpox skin blisters Touching contaminated body fluids or objects such as bedding or clothing Breathing in the virus in a room, bus, or train shared with someone who has smallpox Sharing a razor, tableware, or a toothbrush with someone who has smallpox What if there is a Smallpox Emergency in San Francisco? The San Francisco Department of Public Health (SFDPH) has a plan to respond quickly to a smallpox emergency. SFDPH will evaluate the smallpox situation and may recommend ways for people to keep themselves and their family safe. Recommendations may include smallpox vaccine for people who have been exposed and are at risk of illness, and steps to take to minimize the risk of being exposed to smallpox like staying at home or away from crowds of people.

SFDPH will also participate in efforts to provide needed medical support and treatment, and to reduce any ongoing sources of smallpox virus. How can I keep from Getting Smallpox? To lower your risk of getting sick if terrorists release smallpox virus on purpose: Stay informed. Listen to the news to learn how the emergency is affecting your community and what actions SFDPH recommends people take. If you were exposed to a suspicious substance or if you were in an area thought to containsmallpox virus, it may help to wash your skin and hair thoroughly with soap and water. It may also help to change and wash your clothing, or if you cannot wash your clothes immediately, to put them in a plastic bag to keep them separate from your other things. Stay away from, and keep your children away from, anyone who might have smallpox. Avoid being in enclosed areas with others who may be sick, such as buses and trains. Do not touch the skin area where someone had a smallpox vaccine placed. Wash your hands regularly and avoid touching your eyes, nose, and mouth. Is there a Medicine or Vaccine (shot) to Prevent Smallpox disease? There is no medicine to prevent smallpox.

However, the smallpox vaccine (shot) is helpful. Vaccine given within 4-7 days after someone is exposed to smallpox virus will prevent or lessen the disease in most people. Protection against smallpox lasts for about 5 to 10 years. It is not clear whether vaccinations received more than 30 years ago (for example in the early 1970's when smallpox vaccination was routine) would help. Although timely vaccine can prevent smallpox, it can also cause serious side effects in some people. If you have a weakened immune system (from cancer, AIDS, daily steroid use, heart disease, or other drug use that weakens your immune system), if you have eczema or another skin condition, if you are pregnant, or if you are allergic to certain antibiotics (polymixin b or neomycin), the smallpox vaccine can have serious side effects and may not be recommended. Can I Get a Smallpox Vaccine (shot) Now? No. The vaccine is not normally available to the general public. If there is a smallpox emergency, vaccine may be released to be given to exposed persons and people at highest risk for exposure including members of the public.

Can I Catch Smallpox from Someone? Yes. Smallpox is highly contagious (spread from person to person). A person with smallpox is most contagious when the smallpox rash is present, but may also be contagious before the rash appears, when the only sign is fever. What are the Signs of Smallpox disease? After exposure to the smallpox virus, it usually takes 7-17 days until illness begins. Smallpox generally begins with fever, headaches, body aches, and weakness on day 1. Then: Day 2-3: small, round pox (blisters) appear and spread on the face, arms, legs, and inside the mouth Day 7: the pox turn into bigger blisters and fill with pus Day 12: the blisters crust over; stomach pain and confusion can also occur Week 3-4: the blisters turn into scabs and fall off, leaving pitted scars on the skin Long-term effects of smallpox include scars, blindness, and deformed hands and feet. Call your doctor right away if you are having the signs listed above and think you may have been exposed to smallpox. You may need medical treatment.

Is there Treatment for Smallpox disease? There is no proven treatment for smallpox once the rash appears, but research is underway to find an effective anti-viral medication. Those who are ill with smallpox may benefit from supportive care in a hospital setting. How can I Find Information during a Smallpox Emergency? Check the SFDPH website . Local media such as newspapers, TV stations and radio will carry emergency instructions. Emergency radio stations include: KCBS 740 AM and KGO 810 AM. What can I do Now if I am worried about Smallpox? Read about smallpox at and at the CDC page . Go to to learn about steps you can take now to prepare for all disasters. Keep a card in your wallet with a list of your health problems, the names and doses of medicines you take, and any medicines you are allergic to. Additional Information WHO | Frequently asked questions and answers on smallpox Frequently asked questions and answers on smallpox Online Q&A Updated 28 June 2016 What is smallpox? Smallpox is an ancient disease caused by the variola virus. Early symptoms include high fever and fatigue.

The virus then produces a characteristic rash, particularly on the face, arms and legs. The resulting spots become filled with clear fluid and later, pus, and then form a crust, which eventually dries up and falls off. Smallpox was fatal in up to 30% of cases. Smallpox has existed for at least 3,000 years and was one of the world’s most feared diseases until it was eradicated by a collaborative global vaccination programme led by the World Health Organization. The last known natural case was in Somalia in 1977. Since then, the only known cases were caused by a laboratory accident in 1978 in Birmingham, England, which killed one person and caused a limited outbreak. Smallpox was officially declared eradicated in 1979. Does it occur naturally? Smallpox no longer occurs naturally since it was totally eradicated by a lengthy and painstaking process, which identified all cases and their contacts and ensured that they were all vaccinated. Until then, smallpox killed many millions of people. How can I catch it and is it contagious?

The virus which causes smallpox is contagious and spreads through person-to- person contact and saliva droplets in an infected person’s breath. It has an incubation period of between 7 and 17 days after exposure and only becomes infectious once the fever develops. A distinctive rash appears two to three days later. The most infectious period is during the first week of illness, although a person with smallpox is still infectious until the last scabs fall off. How fast does smallpox spread? The speed of smallpox transmission is generally slower than for such diseases as measles or chickenpox. Patients spread smallpox primarily to household members and friends because by the time patients are contagious, they are usually sick and stay in bed; large outbreaks in schools were uncommon. Weren't the remaining stocks of the smallpox virus destroyed after smallpox was eradicated? When smallpox was officially certified as eradicated, in December 1979, an agreement was reached under which all remaining stocks of the virus would either be destroyed or passed to one of two secure laboratories – one in the United States and one in the Russian Federation.

That process was completed in the early 1980s and since then no other laboratory has officially had access to the virus which causes smallpox. Then why is smallpox being talked about now? Some governments believe there is a risk that the virus which causes smallpox exists in places other than these laboratories and could be deliberately released to cause harm. It is impossible to assess the risk that this might happen, but at their request, WHO is making efforts to help governments prepare for this possibility. Can it be treated? There is no cure for smallpox, but vaccination can be used very effectively to prevent infection from developing if given during a period of up to four days after a person has been exposed to the virus. This is the strategy that was used to eradicate the disease during the 20th century. New antiviral drugs, that have been developed for other diseases since smallpox was eradicated, may have a role. No studies of their usefulness, or safety, have been conducted on humans exposed to smallpox. Is a vaccine currently available? There is a vaccine against smallpox that was a key tool in the eradication of the disease.

This vaccine does not contain the variola virus which causes smallpox, but a closely related virus called vaccinia. When this vaccine is given to humans, it protects them against smallpox. However, it may have rare, but serious side effects, which in extreme cases can be fatal. Since smallpox was eradicated, the vaccine is not recommended in routine immunization. It is used to protect researchers who work on the variola virus that causes smallpox and other viruses in the same virus family (known as orthopox viruses). It could also be used to protect anyone else judged to have a high risk of exposure to smallpox. The vaccine cannot be used in people who are immune depressed or immune suppressed. After the eradication programme, a second generation of vaccines was developed that used the same smallpox vaccine strains as the vaccines used during the eradication campaign. A third generation of smallpox vaccines representing more attenuated vaccine strains, was specifically developed as safer vaccines for those high risk groups with immune disorders or dermatitis at the end of the eradication programme. However as these vaccines have not been used during the eradication campaign, the efficacy/effectiveness is not known.

Should the smallpox vaccine be widely used to protect people? Vaccination with the vaccinia virus as a protection against smallpox is not recommended for widespread use. No government gives or recommends the vaccine routinely since it can cause serious complications, and even death. It should be given only to those persons who have a high risk of coming into contact with the virus which causes smallpox, or who have been exposed. What can be done to protect people from smallpox? Doctors, health workers and hospital personnel around the world have been trained to identify infectious diseases, verify their diagnosis and then respond accordingly. The same system would identify any possible outbreak of smallpox even if the virus is deliberately spread to cause harm. The public health system would then be mobilized to trace all known contacts of the infected person and vaccinate them to prevent more cases of smallpox from developing. If this is done rapidly and effectively, the number of cases could be kept to a minimum and the outbreak would be contained. This was the approach which successfully eradicated the disease. Key is to have a good disease detection system in place as well as a rapid response to infectious diseases, no matter what their cause.

Several governments have examined the potency and levels of their smallpox vaccine stocks, and to consider whether, and under what circumstances, to obtain additional supplies. I had the vaccination when I was a child. Am I still protected? Anyone who has been vaccinated against smallpox (in most countries, this means anyone aged 40 or over) will have some level of protection. The vaccination may not still be fully effective, but it is likely to protect you from the worst effects of the disease. However, if you were directly exposed to the virus which causes smallpox, a repeat vaccination would be recommended. What is WHO doing now? WHO coordinates various preparedness and response activities to protect global health from any possible outbreak of smallpox. WHO receives information from governments and other sources on unusual disease outbreaks. It provides technical guidance to help countries respond to these events. WHO has displayed practical information on smallpox diagnosis, surveillance, and outbreak response on its web site. It can help countries identify potential sources of vaccine, should such a need arise. Eradication of Small Pox By the 1900s, vaccination had reduced small pox to a minor threat in the United States and most of Europe.

The last case of small pox in the U.S. occured in Texas in 1949. In 1958, the Russian delegate to the World Health Assembly made a formal proposal to eradicate small pox. The resolution was passed a year later, and one by one, countries around the world succeeded in eliminating the disease. With surveillance and containment, the deadly disease was eventually eradicated. The last case of small pox was reported in Bangladesh in 1975, and the last case of variola minor occured in Somalia in 1977. The WHO waited for two more years, then declared on October 26, 1977 that small pox had become the first disease ever to be eradicated. What characteristics of small pox made its eradication possible? Short incubation period: The small pox virus has an incubation period of 10-14 days before symptoms appear. Because it is not infectious in the prodromal stage, containment and surveillance were possible. Vaccination alone would not have been sufficient to eradicate the disease.

No animal reservoir: Because small pox only infects humans, the WHO knew that once the virus had been eliminated from human populations, it had been completely eradicated. There is no danger of humans being infected again by some animal carrier. This is not the case for many other human viruses, which have animal/insect vectors and/or carriers. High morbidity and mortality: Small pox was described as "the most terrible of all the ministers of death" by the historian Macaulay. It had a high case fatality rate, and survivors were left with permanent scars. To achieve international cooperation in eradicating a disease, it must be widespread and severe enough to be of worldwide concern. Clinically apparent disease: Small pox is considered an unusual virus in that every infection causes apparent symptoms. This also helped make surveillance and containment possible. This would have been impossible if there were asymptomatic carriers of the virus spreading infection to others. Mode of transmission: Although small pox is considered highly contagious, it is most commonly spread by person-to-person contact, which makes the spread of disease relatively slow. An effective vaccine: Just one dose of the small pox vaccine produced life-long immunity in almost all recipients. Subsequent shots or boosters were rarely needed.

There were few potential side effects, and the risk of complications from vaccination was much smaller than the risk of infection without vaccination. Furthermore, the vaccine was stable and could be transported to remote regions of the world, including tropical areas, without refrigeration. Finally, the small pox vaccine could be delivered with a bifurcated needle, with a minimum amount of training. Vaccines which require injection with syringes would be far too expensive and difficult to administer in less developed areas of the world. (See The Small Pox Vaccine for information about the development of the vaccine.) Social and economic factors: One of the most crucial factors of any campaign is sufficient funding. Although finances were lacking in third world countries, the more developed nations in the world supplied the necessary funding. It was economically advantageous for the wealthier countries to do this, since the cost of vaccination was much less than the cost of drugs and treatment. And once the disease had been eradicated, vaccines would no longer be needed either. The campaign was not without its difficulties, however, as small pox was considered a normal part of life in some cultures, while others believed in small pox deities.

Furthermore, other countries, such as Nigeria and Bangladesh, were engaged in civil wars and had other concerns besides eradicating small pox. To cultivate social support for eradication, the WHO offered financial rewards for reporting cases of small pox, and the reward was increased as the number of cases decreased. Can other viral diseases be eradicated as well? Currently, the two main candidates for eradication are measles and poliomyelitis. Both viruses, like small pox, lack an animal reservoir and have high morbidity and mortality rates. Effective vaccines have been developed for both diseases, although polio may require multiple doses. Surveillance and containment, however, may be impossible because individuals infected by either virus can spread infection to others before symptoms appear. Disease Eradication | History of Vaccines WHO photo by T.S. Satyan Smallpox eradication campaign When a disease stops circulating in a region, it’s considered eliminated in that region. Polio, for example, was eliminated in the United States by 1979 after widespread vaccination efforts. If a particular disease is eliminated worldwide, it’s considered eradicated.

To date, only one infectious disease that affects humans has been eradicated.* In 1980, after decades of efforts by the World Health Organization, the World Health Assembly endorsed a statement declaring smallpox eradicated. Coordinated efforts rid the world of a disease that had once killed up to 35% of its victims and left others scarred or blind. Smallpox eradication was accomplished with a combination of focused surveillance—quickly identifying new smallpox cases—and ring vaccination. “Ring vaccination” meant that anyone who could have been exposed to a smallpox patient was tracked down and vaccinated as quickly as possible, effectively corralling the disease and preventing its further spread. The last case of wild smallpox occurred in Somalia in 1977. Smallpox was a good candidate for eradication for several reasons. First, the disease is highly visible: smallpox patients develop a rash that is easily recognized. In addition, the time from exposure to the initial appearance of symptoms is fairly short, so that the disease usually can’t spread very far before it’s noticed.

Workers from the World Health Organization found smallpox patients in outlying areas by displaying pictures of people with the smallpox rash and asking if anyone nearby had a similar rash. Second, only humans can transmit and catch smallpox. Some diseases have an animal reservoir, meaning they can infect other species besides humans. Yellow fever, for example, infects humans, but can also infect monkeys. If a mosquito capable of spreading yellow fever bites an infected monkey, the mosquito can then give the disease to humans. So even if the entire population of the planet could somehow be vaccinated against yellow fever, its eradication could not be guaranteed. The disease could still be circulating among monkeys, and it could re-emerge if human immunity ever waned. (The discovery of an animal reservoir for yellow fever was in fact what derailed a yellow fever eradication effort in the early 1900s.) Smallpox, however, can infect only humans. In effect, aside from the human population, it has nowhere to hide. Equally important is the ability to protect individuals against infection. People who survived smallpox naturally developed lifelong immunity against future infection. For everyone else, vaccination was highly effective.

WHO trained vaccinators quickly, and they could immunize large groups of people in a short time. The eradication of smallpox raised hopes that the same could be accomplished for other diseases, with many named as possibilities: polio, mumps, and dracunculiasis (Guinea worm disease), among others. Malaria has also been considered, and its incidence has been reduced drastically in many countries. It presents a challenge to the traditional idea of eradication, however, in that having malaria does not result in lifelong immunity against it (as smallpox and many other diseases do). It is possible to fall ill with malaria many times, although individuals may develop partial immunity after multiple attacks. In addition, although promising steps have been made, no effective malaria vaccine yet exists. Other diseases present additional challenges. Polio, though it has been reduced or eliminated in many countries through widespread vaccination, still circulates in some areas because (among other reasons) many cases do not present easily recognizable symptoms. As a result, an infected person can remain unnoticed, yet still spread the virus to others.

Measles is problematic in a similar way: although the disease results in a highly visible rash, a significant period of time elapses between exposure to the virus and the development of the rash. Patients become contagious before the rash appears, and can spread the virus before anyone realizes they have the disease. Guinea worm disease is likely on the verge of eradication. Only 25 cases were reported in 2016, from just 3 countries (Chad [16 cases], Ethiopia [3 cases], and South Sudan [6 cases]). [1] Though the case count increased by 3 cases from 2015, for the first time Mali reported no cases of Guinea worm disease. The Carter Center International Task Force for Disease Eradication has declared six additional diseases as potentially eradicable: lymphatic filariasis (Elephantiasis), polio, measles, mumps, rubella, and pork tapeworm. [2] *Rinderpest, a disease that affected livestock, has also been eradicated , largely due to vaccination.

Sources BBC - History - British History in depth: Smallpox: Eradicating the Scourge Print this page The scourge of the world An estimated 300 million people died from smallpox in the 20th century alone. This virulent disease, which kills a third of those it infects, is known to have co-existed with human beings for thousands of years. As the world's population grew, and travel increased, so the virus that Edward Jenner called the "speckled monster" grasped every opportunity to colonise the world. The first stages of preparing vaccine © The earliest physical evidence of smallpox is the pustular rash on the mummified body of Pharaoh Ramesses V of Egypt, who died in 1157 BC. Traders carried the disease from Egypt to India during the 1st millennium BC. From there it swept into China in the 1st century AD and reached Japan in the 6th century. Returning crusaders provided a way for smallpox to spread through Europe in the 11th and 12th centuries. Smallpox was particularly successful in virgin populations.

The Spanish inadvertently owe much of their success in conquering the Aztecs and Incas in Mexico in the 16th century to smallpox. Unlike the Spanish, the native Indians had no immunity to the disease, having never encountered it before. It wiped out huge numbers of them. A century later the North American Indians suffered a similar devastation. In the 18th century smallpox decimated the aborigines when it reached Australia, the last corner of the world to have escaped its ravages. he Spanish inadvertently owe much of their success in conquering the Aztecs and Incas in Mexico in the 16th century to smallpox. People struggled to find ways to battle with smallpox. Variolation was a process developed in the 10th century in China and India. It involves taking pus from the pocks of someone suffering from smallpox and inoculating healthy people with it. Usually a mild case of smallpox developed, giving lifelong immunity afterwards.

There was a risk of death from this, but in a world where smallpox was rife the odds made it worthwhile; about 0.5-2 percent of people died after variolation, compared with 20-30 per cent after natural smallpox. A major disadvantage of the practice was that variolated people could pass on severe smallpox to others. Top Edward Jenner's breakthrough Lady Mary Wortley Montagu (1689-1762) is credited with introducing variolation to Britain in 1721. Severely pockmarked herself after surviving the illness, she learnt about variolation in Constantinople, where her husband was the British Ambassador. She had her children inoculated and persuaded the Princess of Wales to do the same. Image of a statue of Edward Jenner vaccinating a baby © The real breakthrough in fighting the virus came in 1796, when Edward Jenner carried out his famous experiment. He inserted pus extracted from a cowpox pustule on the hand of a milkmaid, into an incision on the arm of an eight-year-old boy, James Phipps.

Jenner was testing his theory, drawn from the folklore of the countryside, that milkmaids who suffered the mild disease of cowpox never contracted smallpox. Jenner proved conclusively that contracting cowpox provided immunity against smallpox as well. He was quick to realise the enormous potential of vaccination. In 1801 he wrote 'It now becomes too manifest to admit of controversy, that the annihilation of the Small Pox, the most dreadful scourge of the human species, must be the final result of this practice.' Edward Jenner © It was to be well over a hundred years before Jenner's vision finally began to be realised. In 1959 the World Health Assembly passed a resolution to undertake the global eradication of smallpox. The goal of eradication made sense to the developed countries in Europe and North America. Although vaccination had largely wiped out the disease from these areas, they all continued to suffer outbreaks of smallpox caused by imports from developing countries where the disease was endemic. There were a number of outbreaks that demonstrated how a few smallpox cases could spark mass panic and large-scale disruption.

In 1947 a Mexican businessman, unaware he was incubating smallpox, travelled by bus to New York. Worried that a smallpox epidemic would spiral out of control in the densely populated city, the health authorities decided to act pre-emptively and mass vaccinate New Yorkers. Over six million people were vaccinated within a month at hundreds of vaccination stations in hospitals, firehouses, and police stations. In all, 12 people caught smallpox and two of them, including the Mexican, died. Ironically six people also died from adverse reactions to the vaccine. Top Draconian measures in Yugoslavia Dusanka Stupar © In Wales in 1962 a traveller from Pakistan seeded a smallpox outbreak in the Rhondda. Twenty-five people contracted smallpox, and six of them died, including a nine-month-old baby. As the epidemic grew, so did the public clamour for vaccination, and 900,000 people were eventually vaccinated in South Wales. One of the last major European outbreaks was in Yugoslavia in 1972.

Smallpox was not diagnosed until the epidemic was well under way, and Tito's Communist government took draconian measures to bring the outbreak under control. Despite this, there were still 175 cases and 35 deaths. A Muslim pilgrim had returned from Mecca to his village in Kosovo via Iraq, where there were cases of smallpox, and spread the disease to friends and relatives. A man called Ljatif Muzza in nearby Djakovica also became infected. Muzza fell ill and because of the seriousness of his condition was treated in a series of hospitals, ending up in Belgrade on 10th March. Nurse Dusanka Stupar was on duty that night with her colleague Dusica Spasic. Muzza had been misdiagnosed as suffering from a bad reaction to penicillin. In fact he had contracted the most virulent and highly contagious form of smallpox - hemorrhagic - in which the patient bleeds to death before developing pustules. He died later that night. It was a place of waiting for life or death... for the next 15 days we will live together and wait to see whose turn it is next...

The morning after Muzza's death Dusanka came down with measles and was forced to take a few weeks off work. During her absence the first smallpox cases appeared in Belgrade. Incredibly Muzza infected 38 people, eight of whom died. The first Dusanka knew about the epidemic was when health officials turned up at her home on 23rd March to take her in to quarantine. A few days later she discovered that her friend, Dusica, had already died of the disease. Enforced mass quarantine was instigated to stop the virus in its tracks. Dusanka recorded her experience of it in a diary. She was kept in a hotel guarded by armed police. It was 'a place of waiting for life or death... from today for the next 15 days we will live together and wait to see whose turn it is next.' Dusanka smuggled the diary out in her underwear; it was forbidden to take possessions out of quarantine for fear of infection. Top Containment Dr Suvakovic, who had seen smallpox in India, was part of a special team sent to Kosovo from Belgrade to deal with the epidemic.

He was shocked when he reached the smallpox hospital in Dakovica. Having never encountered smallpox before, the terrified doctors had abandoned their patients. Dr Birtasevic, an army medical doctor, remembers the strict measures taken to prevent the epidemic spreading outside Kosovo. Dr Suvakovic © The province was isolated, and no one allowed in or out without having been vaccinated. Public events, meetings and weddings were forbidden. He and his team vaccinated throughout the region. 'The working day was from when the sun came up to when it went down. It was very exhausting; there were no breaks, no Sundays or public holidays.' In the end almost the entire Yugoslavian population of 18 million people was vaccinated. ...almost the entire Yugoslavian population of 18 million people was vaccinated. It was fear of these kinds of epidemics that encouraged developed countries to fund the smallpox eradication campaign. Seven years after it had been proposed the campaign began in earnest in 1966 with the appointment of DA Henderson. Although mass vaccination calmed fears, it was not always the most medically efficient way to combat the disease. Henderson and his team developed a strategy of containment and surveillance.

Every time there was an outbreak, a WHO team would arrive, vaccinate and isolate those who were ill and trace and vaccinate all their contacts. Effectively they ring-fenced the disease until it had no way of moving on to its next victim. The eradication teams also actively hunted down the disease, travelling with a 'recognition card' showing a baby with smallpox, to explain to people what the illness looked like. Rewards were offered to encourage reporting of cases. The last natural case of smallpox was in Somalia in October 1977. Ali Maow Maalin, a 23-year-old hospital cook in Merca, had never been successfully vaccinated. After his diagnosis, an intensive tracing and vaccination campaign led to 54,777 people being vaccinated in the next two weeks. The disease was cornered, with no vulnerable hosts nearby to spread to. DA Henderson and his team rejoiced at the thought there would never be another case of this horrendous disease again. There were no official announcements, however, until a two-year period of intense surveillance was completed, making sure the disease was finally gone. Top A new threat? It was just as well.

Smallpox made one last attempt to stage a comeback. In September 1978 Janet Parker, a medical photographer at the University of Birmingham, was accidentally infected with smallpox and later died. Her illness was initially diagnosed as a drug rash, but soon afterwards pustules appeared on her body. Mrs Parker's mother also developed smallpox, but survived. The ensuing investigation never established exactly how the smallpox virus had escaped from the university's laboratory. Public education about smallpox; rewards were offered to encourage reporting of cases © This accident was a sharp reminder that humans remained vulnerable to the disease, especially as routine vaccination had ended in many countries in the 1970s. Following their jubilant announcement in 1980 that smallpox had finally been eradicated from the world, the World Health Organization lobbied for the numbers of laboratories holding samples of the virus to be reduced. In 1984 it was agreed that smallpox be kept in only two WHO approved laboratories, in Russia and America. Twenty-two years after eradication, the world has little herd immunity and we have never been so vulnerable to smallpox.

Today these stocks still exist at the State Research Center of Virology and Biotechnology (Vector) in Koltsovo, Russia, and at the Centers for Disease Control and Prevention (CDC), Atlanta, in the United States. The World Health Assembly has passed resolutions to destroy the stocks, but each time the date of destruction has been postponed to allow ongoing research. In May 1999 it was decided to postpone destruction until 2002. The Americans announced in November 2001 that they have now decided not to destroy their stocks. In 2002, twenty-two years after eradication, the people of the world have little herd immunity to smallpox, and we have never been so vulnerable to it. In the late 1990s the public discovered that we still have reason to fear this virus. While the rest of the planet had celebrated the elimination of this horrendous disease, the Russians had embarked on an ambitious smallpox programme of their own; to turn it into an effective weapon. Smallpox - Symptoms, Diagnosis, Treatment of Smallpox - NY Times Health Information Back to Top Causes Smallpox was once found throughout the world, causing illness and death wherever it occurred.

It mainly affected children and young adults. Family members often infected each other. Smallpox spreads easily from one person to another from saliva droplets. It may also be spread from bed sheets and clothing. It is most contagious during the first week of the infection. It may continue to be contagious until the scabs from the rash fall off. Researchers believe that the smallpox infection might be able to stay alive (under the right conditions) for as long as 24 hours. In unfavorable conditions, the virus may only remain alive for 6 hours. People were once vaccinated against this disease. However, the United States stopped giving the smallpox vaccine in 1972. In 1980, the World Health Organization (WHO) recommended that all countries stop vaccinating for smallpox. There are two forms of smallpox: Variola major is a serious illness that can be life threatening in people who have not been vaccinated Variola minor is a milder infection that rarely causes death A massive program by the World Health Organization (WHO) wiped out all known smallpox viruses from the world in the 1970s, except for a few samples saved for government research.

Researchers continue to debate whether or not to kill the last remaining samples of the virus, or to preserve it in case there may be some future reason to study it. You are more likely to develop smallpox if you: Are a laboratory worker who handles the virus (rare) Are in a location where the virus was released as a biological weapon It is unknown how long past vaccinations stay effective. People who received the vaccine many years ago may no longer be fully protected against the virus. THE RISK OF TERRORISM There is a concern that the smallpox virus could be intentionally spread through a terrorism attack. The virus could be deliberately spread in spray (aerosal) form. Symptoms usually occur about 12 - 14 days after you have been infected with the virus. They may include: Backache Raised pink rash -- turns into sores that become crusty on day 8 or 9 Severe headache Back to Top Treatment If athe smallpox vaccine is given within 1-4 days after a person is exposed to the disease, it may prevent illness or make the illness less severe. Once symptoms have started, treatment is limited. There is no drug specifically for treating smallpox.

Sometimes antibiotics are given for infections that may occur in people who have smallpox. Taking antibodies against a disease similar to smallpox (vaccinia immune globulin) may help shorten the duration of the disease. People who have been diagnosed with smallpox and everyone they have come into close contact with need to be isolated immediately. They need to receive the vaccine and be monitored. Emergency measures would need to be taken immediately to protect the general population. Health officials would follow the recommended guidelines from the CDC and other federal and local health agencies. Back to Top When to Contact a Medical Professional If you think you may have been exposed to smallpox, contact your health care provider immediately. Because smallpox has been wiped out this would be very unlikely, unless you have worked with the virus in a laboratory or there has been an act of bioterrorism. Back to Top Prevention Many people were vaccinated against smallpox in the past. The vaccine is no longer given to the general public because the virus has been wiped out. The possible complications and costs of the vaccine outweigh the benefits of taking it. If the vaccine needs to be given to control an outbreak, it can have a small risk of complications. Some complications are mild, such as rashes.

Others are more serious. Only military personnel, health care workers, and emergency responders may receive the vaccine today. Smallpox vaccination policies and practices are currently being reviewed. Clinical Trials Review Date: 6/23/2011 Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation ( A.D.A.M.

Copyright The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited. Smallpox Vaccine: Symptoms, History, Pictures, Eradication Smallpox facts Smallpox is a contagious disease caused by the variola virus. Smallpox was the first disease to be eliminated from the world through public-health efforts and vaccination. Smallpox still poses a threat because existing laboratory strains may be used as biological weapons. Smallpox causes high fever , prostration, and a characteristic rash . The rash usually includes blister-like lesions that occur everywhere on the body. Approximately one-third of people with smallpox died from the disease. Survivors were scarred for life. If the eye was infected, blindness often resulted.

There are new experimental medications that might be effective in smallpox, but these have not been tested in human cases since the disease has been eradicated. The smallpox vaccine contains a live virus called vaccinia. It is administered by dipping a pronged piece of metal into the vaccine and then pricking the skin. The vaccine has uncommon side effects that may be fatal, including infection of the heart and brain with the vaccinia strain. Serious side effects are more common with the initial vaccine and are uncommon with second doses. The vaccine is currently only given to selected military personnel and laboratory workers who handle the smallpox virus. What is smallpox? Smallpox | Define Smallpox at Dictionary.com smallpox noun, Pathology. 1. an acute, highly contagious, febrile disease, caused by the variola virus, and characterized by a pustular eruption that often leaves permanent pits or scars: eradicated worldwide by vaccination programs. Origin of smallpox Examples from the Web for smallpox Expand Contemporary Examples And I certainly hope the geopolitical catastrophe of a single case of smallpox is something nobody ever lives to witness. Social Transformations of the Victorian Age T. H. S.

(Thomas Hay Sweet) Escott Colonel Clarke, who was suffering from the results of smallpox, was too feeble to lead them. Stories Of Georgia Joel Chandler Harris Then she cried that she had got the smallpox—her back ached, her eyes ached—she must have the doctor. Medical Essays Oliver Wendell Holmes, Sr. If this law were faithfully carried out, smallpox would entirely disappear from the state within a few years. Rural Hygiene Henry N. Ogden British Dictionary definitions for smallpox Expand noun 1. an acute highly contagious viral disease characterized by high fever, severe prostration, and a pinkish rash changing in form from papules to pustules, which dry up and form scabs that are cast off, leaving pitted depressions Technical name variola, related adjective variolous Word Origin C16: from small + pox. So called to distinguish it from the Great Pox, an archaic name for syphilis Collins English Dictionary - Complete & Unabridged 2012 Digital Edition © William Collins Sons & Co. Ltd.

1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012 Word Origin and History for smallpox Expand n. acute, highly contagious disease, 1510s, small pokkes, as distinguished from great pox "syphillis;" from small-pock "pustule caused by smallpox" (mid-15c.); see small (adj.) + pox . Cf. French petite vérole. Fatal in a quarter to a third of unvaccinated cases. Online Etymology Dictionary, © 2010 Douglas Harper smallpox (smôl'pŏks') A highly infectious and often fatal disease caused by the variola virus of the genus Orthopoxvirus and characterized by fever, headache, and severely inflamed skin sores that result in extensive scarring.

Once a dreaded killer of children that caused the deaths of millions of Native Americans after the arrival of European settlers in the Americas, smallpox was declared eradicated in 1980 following a worldwide vaccination campaign. Samples of the virus have been preserved in laboratories in the United States and Russia. Also called variola. See Note at Jenner . The American Heritage® Science Dictionary Copyright © 2002. Published by Houghton Mifflin. All rights reserved. Expand smallpox definition An acute and infectious disease caused by a virus and now almost completely eradicated. Smallpox was characterized by high fever and large sores on the body that leave scars. Note: A surface with many blemishes is sometimes said to be “pockmarked” because it resembles the skin of a smallpox sufferer. Note: Smallpox is the first disease of humans to be completely eradicated by a worldwide campaign of inoculation . Note: Today, the smallpox virus exists only in laboratories. Note: The use of smallpox is a major concern in the area of bioterrorism .

The American Heritage® New Dictionary of Cultural Literacy, Third Edition Copyright © 2005 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

Question: If, as is almost impossible now, you had variola, which disease would you have?
Answer: SMALLPOX