Smallpox is an extreme and highly contagious infectious disease. It is caused by viruses and transmitted by droplet infection or dust or direct contact. Typical signs are the infectious and contagious pus blisters or pustules. The often fatal smallpox should not be confused with the more harmless chickenpox in children.


What is smallpox?

Smallpox (variola) is a highly contagious, acute, notifiable infectious disease and should not be confused with the childhood disease chickenpox . The causative agent is the variola virus, which belongs to the Poxviridae family. Transmission occurs through droplet, smear and dust infection. The incubation period is 7-11 days. In 1980, the World Health Organization declared this disease eradicated after a worldwide vaccination program. The general obligation to vaccinate has been lifted; however, international vaccination and quarantine regulations remain in force. See polyhobbies for Meanings of Liver Cirrhosis.

Smallpox (variola major, variola vera) is caused by orthopoxvirus variola. Smallpox has been an endemic disease since about 1000 BC. known in China, India and Arabia. The first known epidemic occurred in Europe in the 6th century, followed by others in England in the 13th century and in Germany at the end of the 15th century. Smallpox was still endemic in Europe in the 19th century; In 1871-73, 175,000 cases with more than 100,000 fatalities were registered in Germany. Although it is assumed today that smallpox has been successfully eradicated, medicine can never be 100% certain that the disease will not break out again at some point or somewhere.


The poxviruses (Poxviridae) are a family of very large, complex viruses with an oval or cuboid shape, which are widespread pathogens in vertebrates and insects. With dimensions of 300 × 200 × 150 nm, smallpox viruses can already be identified with a light microscope. The infection manifests itself on the skin and mucous membranes. The orthopoxvirus genus includes eight related virus strains that lead to infections with skin symptoms and can usually only infect the respective host and closely related host species.

In addition to camel, cow, mouse and monkeypox viruses, the variola and vaccinia viruses are found here. The variola virus is the causative agent of smallpox in humans, which has been feared for centuries. In addition to the viruses that cause hemorrhagic fever (Ebola and Lassa viruses), anthrax, plague, tularemia (rabbit fever) and botulinum toxin, it is classified in category A, the highest danger class of bioterrorist pathogens.

Symptoms, Ailments & Signs

Probably the most typical and conspicuous symptoms of smallpox are the papules, which are perceived as blisters or skin rashes to the unsuspecting layperson. These said papules come in a wide variety of shapes and sizes. But before such a smallpox rash becomes visible, other symptoms and signs appear.

These include, for example, severe back pain, fever, inflammation of the respiratory tract, body aches and even long – lasting headaches. In addition, there are small red blisters on the tongue and in the throat, which are considered to be the harbingers of the said smallpox. In most cases, smallpox occurs directly on the face and is associated with severe itching.

The constant scratching of the face can even cause open wounds, so that inflammation and pus formation are possible. After some time, the papules turn into hard crusts, which will then fall off on their own. Unsightly scars remain, which remain for some time. Smallpox is accompanied by very clear symptoms, which are usually associated with severe itching. The symptoms that occur can only be alleviated with the right medication. Otherwise, a significant aggravation is to be expected.

course of the disease

After an initial stage of 2-4 days with high fever, headache, back pain and body aches, inflammation of the upper respiratory tract and a temporary rash, there is a brief drop in fever in the subsequent eruption stage and the characteristic formation of pale red, itchy spots that develop into nodules, develop vesicles, papules and pustules. They usually spread from the head over the whole body and dry up after a few weeks with the formation of bark and scabs. After the (infectious) crusts are shed, the typical pockmarks remain.


Smallpox has several complications that depend on the intensity of the disease and whether the symptoms are treated. Smallpox is fatal in about 30 percent of cases. In addition, the disease leaves scars on survivors. If the eyes, inner ear, nervous system or other important sensory organs have been severely affected, this often results in blindness, deafness, paralysis or general nerve and brain damage. Smallpox leaves long-term effects on all those affected.

A particular complication is the occurrence of hemorrhagic smallpox (black pox). Its symptoms are more serious than those of other smallpox diseases. They mean the occurrence of internal bleeding, massive bruising and, as a result, damage to vital organs. Those affected usually die within 48 hours, but at the latest after a few days.

Special cases are monkey and cowpox, of which there have been a few cases in recent years. This mild form usually heals on its own within a few weeks. However, since it attacks the nervous system, it can also lead to the complications of smallpox. This is especially true for people with a weakened immune system.

When should you go to the doctor?

Smallpox must always be examined and treated by a doctor. If this disease is not treated, the affected person can die from smallpox in the worst case. In most cases, the symptoms worsen over time and do not heal on their own. A doctor should be consulted for smallpox if a severe rash and papules appear on the affected person’s skin. This often leads to severe back pain, fever or even body aches and headaches.

If these symptoms occur together with the papules, a doctor should be consulted immediately. In some cases, smallpox is also noticeable through diseases of the respiratory tract. The disease can be diagnosed and treated by a general practitioner or in a hospital. A fatal course of smallpox can be avoided with the help of vaccinations. Early treatment by a doctor can also prevent a fatal course.

Treatment & Therapy

The actual vaccine protection against smallpox was made possible in 1796 by E. Jenner through vaccination with cattlepox lymph. He thus created the basis for the successful fight in connection with the later vaccination laws. Smallpox, if used as a biological weapon, poses a serious threat to civilian populations. The mortality rate for unvaccinated individuals is 30% (or more) and there is no specific treatment available.

Although smallpox was the most feared infectious disease for a long time, its risk potential is greater today than in previous centuries. Mandatory vaccinations were discontinued in many countries around 25 years ago. Vaccination given within four days of exposure appears to provide some protection against smallpox infection and significant protection against fatal outcome.

As a countermeasure for the eventuality, a smallpox vaccine is now available worldwide. Vaccinia and smallpox viruses are used in the life sciences as vectors for the expression of foreign proteins and also for the development of new types of vaccines. Surviving the disease confers lifelong immunity. In the case of incomplete immunity, the course in the 2nd phase is greatly reduced (variolois). A milder form of the disease is white pox or milkpox (variola minor or alastrim) caused by orthopoxvirus alastrim; they leave no immunity to the true smallpox.


Smallpox is largely considered eradicated. Patients who have contracted smallpox and have overcome the condition must continue to seek medical attention. After the end of the therapy, the doctors check the patient’s state of health at regular intervals. In this way, accompanying symptoms can be identified at an early stage.

Despite comprehensive treatment, the viruses may have survived in the body and lead to smallpox again. Since the symptoms usually return in the first few weeks or months, follow-up care takes place much more often at the beginning. The dates can be gradually reduced. This is accompanied by rest and bed rest, because the condition has a strong effect on the immune system.

As a precautionary measure, the skin should continue to be protected and any injuries or scarring should be treated according to the doctor’s instructions. Follow-up care is carried out by a resident dermatologist who contacts the family doctor responsible and the internists involved.

For this, the doctor needs all the important documents and medical records. As part of the aftercare, further screenings may be carried out in order to rule out permanent damage to the skin and secondary diseases or to identify any abnormalities in good time. The further follow-up measures always depend on the course of the disease.

You can do that yourself

Since smallpox is one of the diseases that are highly contagious and also fatal if the course is unfavorable, those affected should consult a doctor at the first sign and follow the doctor’s instructions. The disease is considered eradicated in our region. Therefore, there is little evidence of self-help.

However, if irregularities occur, there is a special obligation to act. Due to its explosive nature, smallpox must be reported and is subject to international quarantine regulations. Independent health care is neither recommended nor permitted. Timely vaccination is recommended to protect against the disease. This should be done independently so that immunity to the pathogens occurs. If a case of illness becomes known in the immediate vicinity, consultation with a doctor should also be sought as soon as possible,

The disease is associated with symptoms such as high fever. Although there is a loss of appetite and strength, care must be taken to ensure that the organism has sufficient nutrients. The amount of liquid has to be adapted to the needs of the body and has to be increased compared to normal circumstances. The changes in the skin’s appearance trigger intense itching. Despite the inconvenience, care should be taken not to give in to the itchy feeling if possible. This increases the risk of sepsis and should be prevented.