Violence... The story so far

June 2002; Updated July, Dec 2003

Smallpox Symptoms and other information available here.

Sudden onset of chills, high fevers above 104 F (40 C), headache, backache, malaise, delirium, stupor or coma. Do not delay treatment. An early vaccination may be life saving; the sooner the better. It may be too late after the 3rd or 4th day.

Smallpox, variola, was eradicated as a naturally occurring disease in 1977. There are still two small known samples of the virus kept in laboratories for continued study. If these two locations remain secure and there are no others, smallpox will not likely become an instrument of bioterror anytime soon. That statement needs tempering.

Polio virus is the first form of life to be recreated in the laboratory from non-reproducing chemicals (inert snippets of DNA.) This event, of course, has vast terror implications. Once the know-how becomes generally available it will not only enable recreating Smallpox in a well equipped lab, but potentially creating deadly unknown viruses as well. If and when this might happen is anyone's guess.

Smallpox played a role in the American Revolution that is little known. Elizabeth Fenn illuminates this in her book "Pox Americana," published by Wang & Hill.

Routes of infection

Smallpox spreads directly or indirectly from person to person. It is infectious and contagious but not wildly so. Direct transmission is by respiratory droplets, dried scales from virus-containing lesions. Indirect transmission happens through contact with contaminated linen, clothing, or other objects.

Diagnostic Tests

A culture isolated from an aspirate of vesicles and pustules. For speed and accuracy of diagnosis, test batteries should include Smallpox, Chickenpox, Herpes, and Syphilis, each of which can present similar symptoms.

Progression of disease

Sudden onset of chills, high fevers above 104 F (40 C), headache, backache, malaise, delirium, stupor or coma. These symptoms may subside in about three days but is followed by skin lesions that progress from mild pimple-like eruptions to pustules up to 1/3 inch in diameter that eventually rupture. Scabs then form for another week or two leaving scars that are permanently disfiguring.

Past epidemics killed up to 30% of those infected. That number would likely be reduced several fold by modern medical techniques.

Treatment

There is no "cure' known. Hospitalization with strict isolation and antibiotic therapy to prevent secondary infections is indicated. Cowpox (vaccinia virus) was the first effective immunizing agent. Do not delay treatment. An early vaccination may be lifesaving; the sooner the better. It may be too late after the 3rd or 4th day.

It is true that vaccines can have adverse reactions, but they are much less threatening than the disease itself. It is also true that vaccines are not always 100% effective. For these reasons, some authorities do not recommend that everyone be vaccinated simply for precautionary measures.

In the absence of medical assistance, isolation is the best known method of preventing spread. Plenty of fluids is always indicated. Vitamin C, applied intravenously, is helpful in severe cases. Increased dosage is a safe insurance measure. To protect others, wash your own clothing, bed linen and towels if possible. Anti-fever products can relieve discomfort. Fever should be controlled to less than 102F. Antibacterial agents are helpful in preventing secondary infections.

Some Terror Implications

There are no implications unless a terrorist can acquire quantities of the virus -- a very remote possibility. Because that could happen, selective vaccinations against Smallpox are underway in the US for military, public safety, and medical personnel.