Small Pox: Symptoms, Causes and Treatment

Smallpox, an infectious disease caused by the variola virus, has been one of humanity’s most devastating illnesses. Eradicated globally by 1980 through an extensive vaccination campaign led by the World Health Organization (WHO), smallpox history offers valuable lessons in public health, vaccination, and disease control. This blog post delves into the symptoms, causes, types, and treatment of smallpox, providing a comprehensive understanding of this historic disease.

Symptoms

Smallpox symptoms typically appear 7-17 days after exposure to the virus, a period known as the incubation period. The disease progresses through several distinct stages:

1. Initial Symptoms (Prodrome Phase):
   • High fever (101-104°F)
   • Severe headache
   • Backache
   • Vomiting
   • Abdominal pain
   • Malaise and fatigue
2. Early Rash Phase:
   • A rash appears first on the tongue and in the mouth.
   • Red spots turn into sores that break open and spread the virus into the mouth and throat.
   • The rash then spreads to the face, arms, legs, hands, and feet within 24 hours.
   • The rash progresses to raised bumps filled with a thick, opaque fluid and a characteristic dent in the center.
3. Pustular Rash Phase:
   • Bumps become pustules, sharply raised, and firm to the touch.
   • The pustules are round and firm, like peas under the skin.
4. Scabbing Phase:
   • The pustules begin to form a crust and then scab.
   • Scabs fall off, leaving pitted scars.
5. Recovery Phase:
   • Once all the scabs fall off, the person is no longer contagious.
   • This entire process from rash onset to the last scab falling off takes about three weeks.

Causes

Smallpox is caused by the variola virus, a member of the orthopoxvirus family. The virus spreads through:

• Direct Contact: With infected bodily fluids or contaminated objects like bedding or clothing.
• Respiratory Droplets: Via prolonged face-to-face contact with an infected person, especially during the first week of illness when the virus is most contagious.
• Airborne Transmission: In rare cases, smallpox can spread through the air in enclosed settings like buildings, buses, and trains.

Types

There are two main forms of smallpox, each with varying severity and mortality rates:

1. Variola Major:
   • The more severe and common form.
   • Symptoms are more pronounced, and it has a higher mortality rate (about 30%).
   • Variola major includes several clinical forms:
     • Ordinary Smallpox: The most frequent type, accounting for 90% of cases.
     • Modified Smallpox: Milder and occurs in previously vaccinated individuals.
     • Flat Smallpox: Rare and severe, with lesions that do not rise above the skin surface.
     • Hemorrhagic Smallpox: Rare, severe, and often fatal, characterized by extensive bleeding.
2. Variola Minor:
   • A milder form of the disease.
   • Mortality rate of less than 1%.
   • Symptoms are similar to variola major but less severe.

Treatment

No specific treatment for smallpox exists; however, several measures can help manage symptoms and prevent the spread of the virus:

1. Vaccination:
   • Preventative Vaccination: The smallpox vaccine is effective if given before exposure or within a few days after exposure to the virus.
   • Post-Exposure Vaccination: Can lessen the severity of the disease if administered within four days of exposure.
   • Ring Vaccination: A strategy used during outbreaks where immediate contacts of infected individuals are vaccinated to prevent further spread.
2. Supportive Care:
   • Isolation: Infected individuals should be isolated to prevent the virus from spreading.
   • Hydration and Nutrition: Ensure adequate fluid intake and nutrition.
   • Symptom Management: Medications may be given to relieve pain, fever, and other symptoms.
3. Antiviral Drugs:
   • Although there is no cure, certain antiviral drugs, like cidofovir, tecovirimat (ST-246), and brincidofovir, show promise in treating smallpox and related viruses in laboratory settings. Their effectiveness in treating smallpox in humans remains under investigation.
4. Historical Treatments:
   • Prior to eradication, treatment focused on quarantine and supportive care.
   • Traditional practices, such as variolation (deliberate infection with a mild form of the virus), were used before the development of the modern vaccine.

Prevention and Eradication

The eradication of smallpox stands as a monumental achievement in medical history. Prevention strategies included:

1. Global Vaccination Campaigns:
   • The WHO-led global vaccination campaign, launched in 1967, was instrumental in eradicating smallpox.
   • Mass vaccination and surveillance systems were established worldwide.
2. Surveillance and Containment:
   • Rigorous monitoring and immediate response to outbreaks were critical.
   • Infected individuals were isolated, and their contacts were traced and vaccinated.
3. Public Awareness and Education:
   • Educating communities about smallpox and the importance of vaccination played a vital role.

Conclusion

Smallpox, once a feared and deadly disease, has been eradicated, thanks to global efforts in vaccination and public health. Understanding the symptoms, causes, types, and treatment of smallpox not only provides historical insight but also highlights the importance of vaccination and preparedness in combating infectious diseases. The success story of smallpox eradication serves as a beacon of hope and a model for tackling other diseases that continue to affect humanity.