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Information & Prevention
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Click here for the History
of Smallpox
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Smallpox Vaccination Reactions
Smallpox (vaccinia) vaccination is a
generally safe, effective preventative against smallpox. Some individuals
may experience an adverse event; many are harmless, a few are mild to
moderate and require specific treatment, and rarely, more serious adverse
events occur in susceptible individuals. Post-Vaccinial Encephalitis: rare
complication of primary vaccination (15/million). Encephalitis occurs 10-14
days after vaccination w/ headache, vomiting, drowsiness and fever as first
symptoms. In severe cases life-threatening complications can develop. |
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 Bifurcated
Needle
NO alcohol: vaccination will be inhibited.
No skin preparation is required prior to
vaccination. Use only new, individually wrapped, and sterile bifurcated
needle. |
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Days 6/8
No Reaction: Means no immunity and vaccination must be
repeated.
Systemic Symptoms: Fever, Malaise, Myalgia, soreness at
vaccination site, local lymphadenopathy, intense erythema ringing the
vaccination |
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 Normal
Variants: not adverse events and require no specific treatment. Include:
satellite lesions, lymphangitis from site to regional nodes, regional
lymphadenopathy, considerable local edema at site, intense erythema (viral
cellulitis) |
 Accidental
Implantation by autoinoculation or contact is one of the most common adverse
events. Although no age group is spared, infants and children are most
susceptible to more extensive inoculations because of their tendency to
scratch an itching vaccination site. This surface virus is easily
transferred to the hands and to fomites. Either may be the source of
inoculation elsewhere, but most implantations occur as a result of transfer
from hand to skin or to mucosa. Lesions follow same course as primary
vaccination, except in patients w/ cell-meditated immune dysfunction where
each lesion progresses without an inflammatory response, does not heal, and
expands. If there are only one or a few lesions, no specific treatment is
required. Multiple lesions, especially if they are confluent and cover large
portions of the body warrant treatment w/ Vaccinia Immune Globulin (VIG). |
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Smallpox is a serious,
contagious, and sometimes fatal infectious disease. There is no specific
treatment for smallpox disease, and the only prevention is vaccination. The name
smallpox is derived from the
Latin word for “spotted” and refers to the raised bumps that appear on the face
and body of an infected person.
There are two clinical
forms of smallpox. Variola major is the severe and most common form of smallpox,
with a more extensive rash and higher fever. There are four types of variola
major smallpox: ordinary (the most frequent type, accounting for 90% or more of
cases); modified (mild and occurring in previously vaccinated persons); flat;
and hemorrhagic (both rare and very severe). Historically, variola major has an
overall fatality rate of about 30%; however, flat and hemorrhagic smallpox
usually are fatal. Variola minor is a less common presentation of smallpox, and
a much less severe disease, with death rates historically of 1% or less.
Smallpox outbreaks have
occurred from time to time for thousands of years, but the disease is now
eradicated after a successful worldwide vaccination program. The last case of
smallpox in the United States
was in 1949. The last 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.
Where Smallpox Comes
From
Smallpox is caused
by the variola virus that emerged in human populations thousands of years ago.
Except for laboratory stockpiles, the variola virus has been eliminated.
However, in the aftermath of the events of September and October, 2001, there is
heightened concern that the variola virus might be used as an agent of
bioterrorism. For this reason, the U.S. government is taking precautions for
dealing with a smallpox outbreak.
Transmission
Generally, direct
and fairly prolonged face-to-face contact is required to spread smallpox from
one person to another. Smallpox also can be spread through direct contact with
infected bodily fluids or contaminated objects such as bedding or clothing.
Rarely, smallpox has been spread by virus carried in the air in enclosed
settings such as buildings, buses, and trains. Humans are the only natural hosts
of variola. Smallpox is not known to be transmitted by insects or animals.
A person with smallpox is
sometimes contagious with onset of fever (prodrome phase), but the person
becomes most contagious with the onset of rash. At this stage the infected
person is usually very sick and not able to move around in the community. The
infected person is contagious until the last smallpox scab falls off.
Man with smallpox. Public Health Images Library (PHIL) id# 131. Source:
CDC/Barbra Rice
Smallpox lesions on skin of trunk. Picture taken in Bangladesh, 1973. Public
Health Images Library (PHIL) ID # 284. Source: CDC/James Hicks
Face lesions on boy with smallpox. Public Health Images Library (PHIL) ID # 3.
Source: CDC/Cheryl Tyron
Incubation Period
(Duration: 7 to 17 days)
Not contagious |
Exposure to the virus
is followed by an incubation period during which people do not have any
symptoms and may feel fine. This incubation period averages about 12 to
14 days but can range from 7 to 17 days. During this time, people are
not contagious. |
Initial Symptoms
(Prodrome)
(Duration: 2 to 4 days)
Sometimes contagious* |
The first symptoms of smallpox include fever, malaise, head and
body aches, and sometimes vomiting. The fever is usually high, in the
range of 101 to 104 degrees Fahrenheit. At this time, people are usually
too sick to carry on their normal activities. This is called the
prodrome phase and may last for 2 to 4 days. |
Early Rash
(Duration: about 4 days)
Most contagious
Rash distribution:
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A rash emerges
first as small red spots on the tongue and in the mouth.
These spots develop
into sores that break open and spread large amounts of the virus into
the mouth and throat. At this time, the person becomes most
contagious.
Around the time
the sores in the mouth break down, a rash appears on the skin, starting
on the face and spreading to the arms and legs and then to the hands and
feet. Usually the rash spreads to all parts of the body within 24 hours.
As the rash appears, the fever usually falls and the person may start to
feel better.
By the third day
of the rash, the rash becomes raised bumps.
By the fourth day,
the bumps fill with a thick, opaque fluid and often have a depression in
the center that looks like a bellybutton. (This is a major
distinguishing characteristic of smallpox.)
Fever often will
rise again at this time and remain high until scabs form over the bumps. |
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Pustular Rash
(Duration: about 5 days)
Contagious |
The bumps become
pustules—sharply raised, usually round and firm to the touch as if
there’s a small round object under the skin. People often say the bumps
feel like BB pellets embedded in the skin. |
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Pustules and Scabs
(Duration: about 5 days)
Contagious |
The pustules begin to
form a crust and then scab.
By the end of the
second week after the rash appears, most of the sores have scabbed over. |
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Resolving Scabs
(Duration: about 6 days)
Contagious |
The scabs begin to
fall off, leaving marks on the skin that eventually become pitted
scars. Most scabs will have fallen off three weeks after the rash
appears. The
person is contagious to others until all of the scabs have fallen off. |
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Scabs resolved
Not contagious |
Scabs have fallen off. Person is no longer contagious. |
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