Infectious Diseases Infectious Disease Basics

The Big Debate On Smallpox Vaccination

By Dr. Ronald Viggiani

The last time smallpox made headlines was over 20 years ago, when medical and public health experts declared that the disease had been eradicated from the earth-due in large part to a highly successful worldwide vaccination campaign. It was considered a major medical achievement of the 20th century. But smallpox is back in the news: this time for ominous reasons.

Although the disease was eradicated, special laboratories in the United States and the former Soviet Union were allowed to keep smallpox specimens under tightly-guarded control for scientific purposes. But many officials believe that Soviet samples may have fallen into the hands of governments hostile to the United States and many of its allies, such as Iraq and North Korea, and there is concern that smallpox is being prepared as a biological weapon. The concern is not unwarranted since large quantities of the virus, disseminated in liquid or powder form, could rapidly infect huge numbers of people, the results of which could be catastrophic. The United States government, in response to this concern, is working on a controversial plan to vaccinate all of its citizens against the disease.

But what is smallpox and why is this new vaccination plan so hotly contested?

What is smallpox?

Smallpox is a highly infectious disease that is caused by two forms of the variola virus: variola major (the most common and most severe form) and variola minor.

Of the four subtypes of variola major-ordinary, modified, flat and hemorrhagic-the last two are rare but almost always fatal. In general, when people talk about smallpox, they are referring to the most common type, ordinary variola major.

How does it spread?

The smallpox virus is spread through the air when an infected person coughs, sneezes, or just talks. It can also be spread through direct contact with contaminated clothing or bedding. The inhaled virus attaches to the lining of the throat and/or lung and then enters the bloodstream, where it can infect the internal organs and skin.

The infected person usually is not contagious until symptoms appear, specifically after the appearance of the rash, which occurs about two weeks after exposure to the virus.

What are the symptoms of the disease?

Approximately ten days after someone is exposed to the virus they will begin to experience vague symptoms such as high fever, headache, backache, nausea, vomiting, and general malaise.

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