What is smallpox?

Smallpox is a contagious infection caused by the variola virus. Smallpox can be deadly, so if an outbreak happens, it is vital to stay away from infected people. Get vaccinated if you have been around someone who has smallpox. And if you develop symptoms, seek medical care.

The telltale signs of smallpox are severe illness with a high fever, then a body rash. Symptoms appear about 12 days after the person is infected.

Before there was a vaccine, smallpox used to cause death all around the world. Thanks to widespread use of the vaccine, the last natural case of smallpox occurred in 1977. And in 1980 the World Health Organization (WHO) declared that the spread of smallpox was stopped and that the disease had been wiped out.

Because there is a slight risk of serious reactions and even death from the smallpox vaccine, routine smallpox immunization ended in the United States in 1972.

Smallpox virus is known to exist in labs at the Centers for Disease Control and Prevention (CDC) in the U.S. and at the Institute of Virus Preparations in Siberia, Russia. But it may also be in other labs. Some people worry that terrorists could release the virus and spread smallpox to many people.

What are the symptoms?

The first symptoms of smallpox include a high fever, fatigue, a headache, and a backache. It takes about 12 days for these symptoms to show. Then after 2 to 3 days of illness, a flat, red rash appears. It usually starts on the face and upper arms, and then it spreads all over your body. Over the next 2 to 3 weeks, the flat, red spots become firm and dome-shaped and fill with pus. Then they scab over. Scabs fall off 3 to 4 weeks after the rash first appears, and they leave pitted scars.

You may mistake a severe chickenpox rash for a smallpox rash at first. But different viruses cause these illnesses.

How is smallpox spread?

Smallpox is contagious. It can be passed from one person to another through coughing, sneezing, or breathing, or by contact with the scabs or the fluid from blisters. It can even spread from an infected person's personal items and bedding. Smallpox is easiest to spread during the first week of the rash. As scabs form, the person is less contagious. But a person can spread the virus from the time the rash first appears until all scabs have fallen off.

If a terrorist were to release a small amount of the virus into the air, it is possible that it could spread among a large number of people. The virus could survive and infect people for 6 to 24 hours, depending on the weather.¹