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Alternative names: red plague

Type of infection: viral

Incubation period: 7 to 15 days

Mortality rate: up to 30% when complications arise

Vector: bodily fluid contact


As a disease, smallpox has been around for longer than recorded history. There have been Egyptian mummies that show the scars of the disease showing that people were suffering from it at least 3,000 years ago. During the 18th century, it was a major problem in Europe where nearly half a million people died from it each year, with a mortality rate up to 60% at the time.

Even so, the most well-known outbreak of smallpox took place in the mid 1770s when it ravaged many populations of Native Americans. Common belief is that the Europeans deliberately infected the locals by giving them blankets infected with smallpox but it is far more likely that the people themselves were carriers of the disease.

Eventually, the practice of using smallpox scabs to create a primitive inoculation against the disease was created with controversial results. Sometimes it worked or it could potentially create a full-blown case of smallpox. The observations from this practice did eventually lead to a proper vaccine being created using cowpox virus.

A massive vaccination campaign against smallpox has accomplished a very rare feat: the complete eradication of the disease in nature. The last known case of smallpox was in 1978, which was actually part of a small outbreak in relation to medical research of the disease. The last known natural case of smallpox was in Somalia, in 1977.

Catching Smallpox

Smallpox spreads much like the common cold. Contact with bodily fluids, including droplets from coughing and sneezing can spread the disease.

Signs and Symptoms

The first symptoms of smallpox are much like the flu, with overall body aches, headache, fatigue and fever. In some cases, there can be nausea and vomiting as well. After about 2 days of these, the trademark mark rash will start to develop.

Red spots and sores first appear in the mouth and inside the throat, and it's at this point that the disease is its most contagious. The sores spread over the face and then down the rest of the body over the course of 24 hours. The spots will get larger, and develop into raised blisters that usually have a small dimple in the center. It can be severe and uncomfortable. This last for about 5 days.

Then the sores dry, scab and fall off, leaving the patient covered in scars. Simple smallpox is generally not fatal though if the sores form on the eyes, blindness will result. When complications develop, it can lead to infections of the heart or brain, and in these cases there can be a 30% fatality rate.


Smallpox has no cure, except to keep the patient hydrated and treated with painkillers for comfort from some of the body aches. Antibiotics are sometimes used when the rash sores are very severe to prevent any further secondary skin infections.


Since the disease is considered to be naturally extinct, there are no current vaccination programs in place. But theoretically, a vaccine does exist even if it's not readily available the moment to the public. Besides that, the only way to prevent the disease to to stay out of contact with an infected person.

Risk Assessment

As mentioned, there is no known reservoirs of smallpox left in nature, so you really aren't likely to come across it even in a serious disaster scenario. But on the other hand, that has led to speculation that smallpox would make an ideal biological weapon due to the fact that the population would be so unprepared for it. Since samples do exist in secure laboratory settings, there is a real possibility that the disease could fall into the wrong hands for this purpose.

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