OPHEPR; Smallpox - Frequently Asked Questions

What should I know about smallpox?
Smallpox is an acute, contagious, and sometimes fatal disease caused by the variola virus (an orthopoxvirus), and marked by fever and a distinctive progressive skin rash. In 1980, the disease was declared eradicated following worldwide vaccination programs. However, in the aftermath of the events of September and October, 2001, plans are in place to deal with a bioterrorist attack using smallpox as a weapon.

If I am concerned about a smallpox attack, can I go to my doctor and get the smallpox vaccine?
At the moment, the smallpox vaccine is not available for members of the general public. In the event of a smallpox outbreak, however, there is enough smallpox vaccine to vaccinate everyone who would need it.

What are the symptoms of smallpox?
The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. A rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving pitted scars.

If someone comes in contact with smallpox, how long does it take to show symptoms?
After exposure, it takes between 7 and 17 days for symptoms of smallpox to appear (average incubation time is 12 to 14 days). During this time, the infected person feels fine and is not contagious.

Is smallpox fatal?
The majority of patients with smallpox recover, but death may occur in up to 30% of cases. Many smallpox survivors have permanent scars over large areas of their body, especially their face. Some are left blind.

How is smallpox spread?
Smallpox normally spreads from contact with infected persons. 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. Indirect spread is less common. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Smallpox is not spread by insects or animals.

If smallpox is released in aerosol form, how long does the virus survive?
The smallpox virus is fragile. In laboratory experiments, 90% of aerosolized smallpox virus dies within 24 hours. In the presence of ultraviolet (UV) light, this percentage is even greater. Therefore, if an aerosol release of smallpox were to occur, most of the smallpox virus matter would be inactivated or dissipated within 24 hours.

How many people would have to get smallpox before it is considered an outbreak?
One confirmed case of smallpox is considered a public health emergency.

Is smallpox contagious before the smallpox symptoms show?
A person with smallpox will have a fever and be quite ill for several days before the rash appears. A person is not contagious until the rash begins. The infected person is contagious until the last smallpox scab falls off.

Is there any treatment for smallpox?
Smallpox can be prevented through use of the smallpox vaccine. There is no proven treatment for smallpox, but research to evaluate new antiviral agents is ongoing. Early results from laboratory studies suggest that the drug cidofovir may fight against the smallpox virus; currently, studies with animals are being done to better understand the drug's ability to treat smallpox disease. Patients with smallpox can benefit from supportive therapy (e.g., intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

What is the smallpox vaccine?
The smallpox vaccine is the only way to prevent smallpox. The vaccine is made from a virus called vaccinia, which is another “pox”-type virus related to smallpox. The vaccine cannot cause smallpox. The vaccine helps the body develop immunity to smallpox. It was successfully used to eradicate smallpox from the human population.

Should I get vaccinated against smallpox?
The smallpox vaccine is not available to the public at this time.

Many vaccinations are required. Why don’t people have to get the smallpox vaccine?
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.

If someone is exposed to smallpox, is it too late to get a vaccination?
Vaccination within 3 days of exposure will completely prevent or significantly modify smallpox in the vast majority of persons. Vaccination 4 to 7 days after exposure likely offers some protection from disease or may modify the severity of disease.

How long does a smallpox vaccination last?
Past experience indicates that the first dose of the vaccine offers protection from smallpox for 3 to 5 years, with decreasing immunity thereafter. If a person is vaccinated again later, immunity lasts longer.

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