10855 Smallpox

Overview

Smallpox is a very serious infectious illness caused by a virus called variola. It used to make people very sick with high fever and a distinctive rash that turned into fluid-filled blisters. Thanks to worldwide vaccination efforts, smallpox was completely wiped out from nature in 1980. There have been no natural cases anywhere in the world since that time.

No. Smallpox is not common at all. In fact, it no longer exists in nature. The last natural case was in 1977, and the World Health Organization declared the world free of smallpox in 1980.

Historically, smallpox affected anyone who was exposed, but especially children and young adults. Today, the only people who might be at risk are researchers who work with the virus in special high-security laboratories, or in the unlikely event of an accidental or deliberate release.

Symptoms

Common symptoms

• High fever
• Headache and body aches
• Extreme tiredness (fatigue)
• A rash that begins as flat red spots and then turns into raised bumps filled with clear fluid (blisters)
• The rash usually appears first on the face, mouth, and throat, then spreads to the arms, hands, legs, and feet

Symptoms in children

• Children usually had the same symptoms as adults, but they could become dehydrated more quickly from fever and poor drinking.
• In the past, smallpox in children was often more severe, and they were more likely to develop complications.

Symptoms in older adults

• Older adults may have a weaker immune system, so severe illness was more likely.
• They could also have more difficulty recovering from dehydration or secondary infections.

Causes

Main causes

• Smallpox is caused by the variola virus.
• It spreads from person to person through droplets in the air when an infected person coughs, sneezes, or talks.
• It can also spread by touching clothing, bedding, or other objects that have the virus on them.
• Once a person catches it, the virus multiplies in the body and causes the typical symptoms.

Risk factors

• Being in a high-security laboratory where the virus is stored
• Working directly with the variola virus in a research setting
• In the unlikely event of an intentional release (bioterrorism), being exposed to infected droplets or items

When to see a doctor

See a doctor urgently if:

• If you develop a sudden high fever with a blistering rash that looks like smallpox, especially if you have been in a laboratory that works with variola virus.
• If you have been in contact with someone who may have smallpox or with a suspected contaminated item.
• If you are feeling very unwell, confused, or have trouble breathing.

Book a routine appointment if:

• If you have any concerns about a rash or unexplained symptoms, contact your GP or local health service for advice.
• If you need travel advice or information about vaccines, talk to your doctor or a travel health clinic.

Diagnosis

A doctor would suspect smallpox only if the symptoms are very typical and there is a clear exposure risk. Because smallpox is so rare and dangerous, any suspected case would be treated as an emergency and investigated by public health specialists. The doctor would ask about recent travel, contact with sick people, and any work in a laboratory.

Tests that may be done

• Swabs from the rash blisters or fluid
• Blood tests to look for the virus or antibodies
• Samples are sent to a very high-security reference laboratory for confirmation

What to expect at your appointment

If a doctor suspects smallpox, you would be isolated immediately in a special room to protect others. Public health officials would be called in. Tests are usually quick, but results may take a few hours or days. You would remain in isolation until the diagnosis is confirmed or ruled out.

Treatment

Treatment for smallpox is mostly supportive. That means doctors focus on keeping you comfortable and helping your body fight the infection. Because smallpox is so rare, treatment plans would be made by specialist infectious disease teams in consultation with public health authorities.

Self-care at home

• Rest as much as possible to help your body recover.
• Drink plenty of fluids to avoid dehydration.
• Take simple steps to lower fever, such as using a cool cloth, but always ask a doctor before taking any medicine.
• Keep the skin clean and dry to help prevent infection.

Medical treatments

In a hospital isolation unit, doctors may give antiviral medicines to try to stop the virus from spreading in the body, though no treatment is proven for smallpox. They might also give fluids through a drip to keep you hydrated and medicines to control pain or fever. In severe cases, intensive care might be needed to support breathing or circulation.

When is surgery considered?

Not applicable. Surgery is not used to treat smallpox.

Living with this condition

Living with smallpox is not something people need to think about today, because the disease no longer exists in nature. The only exception would be in a very unusual emergency situation, and in that case, strict hospital isolation and public health monitoring would guide every step.

Lifestyle tips

• You do not need to change your lifestyle because of smallpox.
• Keep up with general good hygiene, like washing your hands regularly.
• Stay informed about public health advice if you ever travel to areas where there are rumours of a smallpox outbreak.

Diet and exercise

Eating a healthy balanced diet and staying active are always good for your immune system, but they have no special power against smallpox. If you were ever ill with it, you would need to rest and eat light, easy-to-digest foods.

Mental health and emotional wellbeing

Having a serious illness like smallpox would obviously be frightening, and being in isolation could affect your mood. In the unlikely event that you ever face this, know that it is normal to feel scared or anxious. Talking to a mental health professional can help.

Prevention

Yes, smallpox can be prevented. The main prevention is a vaccine, which was used to wipe out the disease. But because smallpox no longer exists, that vaccine is not given routinely to the public. In the unlikely event of an outbreak, public health officials could use the vaccine to protect people who are exposed.

Vaccines

There is a smallpox vaccine, but it is not part of the usual childhood immunisation schedule. It is only recommended for people who work directly with the variola virus in special laboratories, or in an emergency outbreak situation. The vaccine is not available in regular clinics.

Screening programmes

There is no screening test for smallpox in the general population because the disease is eradicated.

Complications

If left untreated

• If smallpox were left untreated, it could lead to blindness from eye infection.
• Skin infections from the blisters could become serious.
• Lung infection (pneumonia) could make breathing difficult.
• Inflammation of the brain (encephalitis) could cause seizures or brain damage.
• The virus is often fatal in severe cases.

Long-term outlook

Thankfully, smallpox is gone from the natural world, and the risk to you personally is essentially zero. If a rare case were ever to happen again, public health systems have plans to isolate, vaccinate, and treat people quickly to stop it from spreading. With today's medicine, even if someone were unfortunate enough to get sick, there is a good chance of recovery with proper hospital care.

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