Variola Virus

is a double-stranded DNA virus that causes smallpox. Because the virus only infects humans, smallpox was able to
be eradicated. Transmission of Variola can happen in one of several ways, including face-to-face contact, direct
contact with contaminated objects, or through the air. Because of the hazards associated with exposure to this virus,
scientists have not studied it fully.
Variola virus is the virus that causes smallpox. This is a double-stranded DNA virus in the family
Poxviridae and the genus Orthopoxvirus.

History of the Virus

Variola virus infections were described in Asia during the 1st century, in Europe and Africa around 700 A.D., and in
Central, South, and North America during the 16th and 17th centuries.
According to some health experts, these infections are responsible for more deaths than all other infectious diseases
combined over the centuries.
Thanks to the success of a worldwide vaccination program, smallpox has been eradicated. The last naturally
occurring case in the world was in Somalia in 1977. In 1980, the World Health Organization (WHO) officially said
that smallpox was wiped out worldwide, and no cases of naturally occurring smallpox have happened since.
After variola virus was eliminated from the world, routine vaccination against smallpox among the general public
was stopped because it was no longer considered necessary for prevention.

Transmitting the Variola Virus

Variola virus transmission can happen in one of several ways:

Face-to-face contact

Direct contact with infected fluids and contaminated objects

Through the air.

When the virus enters the body, it spreads within the bloodstream to small blood vessels in the
skin. After 7 to 17 days, smallpox symptoms will begin.

What Is the Prognosis?

The outcome of a variola virus infection will depend on the type of smallpox a person develops. For variola major,
the overall fatality rate is about 30 percent. Flat and hemorrhagic smallpox are usually fatal. Variola minor is a less
common presentation of smallpox, and a much less severe disease, with death rates historically of 1 percent or less.

Variola Virus as a Biological Weapon

In the aftermath of the events of September and October 2001, there is heightened concern that the variola virus
might be used as an agent of bioterrorism. The deliberate release of the virus is now regarded as a possibility, and
the United States is taking precautions to deal with this threat. The Centers for Disease Control and Prevention
(CDC) considers the variola virus a Category A agent. Category A agents are believed to present the greatest
potential threat for harming public health and have a moderate to high potential for large-scale dissemination. The
public is generally more aware of Category A agents, and broad-based public health preparedness efforts are
necessary. Other Category A agents are:
 Anthrax

Plague

Botulism

Tularemia

Viral hemorrhagic fevers.

Research on Variola Virus

Scientists have not studied variola virus well because of the hazards associated with potential exposure. In addition,
by international agreement, smallpox may only be studied at the CDC high-containment facility or in the former
USSR (Union of Soviet Socialist Republics), and experiments must be approved in advance by an international
committee.

Comparing the Variola and Vaccinia Viruses

Both vaccinia virus and variola virus are from the same family. The vaccinia virus is used to make a smallpox
vaccine and has been studied thoroughly. There is one major difference between the two viruses: Vaccinia virus can
infect several types of living beings, while variola virus infects only humans naturally and cynomolgus monkeys
under highly artificial laboratory conditions.

Smallpox transmission can happen in one of several ways:

Face-to-face contact

Direct contact with infected fluids and contaminated objects

Through the air.

Humans are the only natural hosts of variola (the virus that causes smallpox). Therefore,
smallpox transmission does not occur through animals or insects.

Face-to-Face Contact-Smallpox is a highly contagious disease. In most cases, smallpox

transmission occurs by inhaling droplets of saliva, which are full of virus, during face-to-face
contact with an infected person. Usually, fairly prolonged face-to-face contact (lasting 3 or more
hours) is required.

Direct Contact-Smallpox transmission can also occur through direct contact with infected
bodily fluids or contaminated objects such as bedding or clothing. Those caring for people with
smallpox need to use special safety measures to ensure that all bedding and clothing from the
infected person is cleaned appropriately with bleach and hot water. Caretakers can use
disinfectants such as bleach and ammonia to clean contaminated surfaces.

Through the Air-Rarely, smallpox has been spread by virus carried in the air (aerosolized) in
enclosed settings such as buildings, buses, and trains. The smallpox virus is fragile. In laboratory
experiments, 90 percent of aerosolized smallpox virus dies within 24 hours; in the presence of
ultraviolet (UV) light, this percentage would be even greater. If an aerosol release of smallpox
occurs, 90 percent of virus matter will be inactivated or dissipated in about 24 hours.

>>Smallpox Transmission and Smallpox Symptoms

When someone becomes infected, they do not immediately feel sick; it takes about 10 to 12 days for
symptoms to start. However, inside the person's body, the smallpox virus is multiplying. This period
between smallpox transmission and the beginning of smallpox symptoms is called the "smallpox
incubation period." During the smallpox incubation period, a person is not contagious. However, once
symptoms of smallpox begin, the infected person becomes contagious. The person becomes most
contagious with the onset of the smallpox rash. At this stage, the infected person is usually very sick and
not able to move around in the community. Some risk of smallpox transmission lasts until all scabs have
fallen off.

Smallpox Incubation Period

A Summary of the Smallpox Incubation Period
When a person becomes infected with the virus that causes smallpox (variola), the virus begins
to multiply within the body. After approximately 12 to 14 days, smallpox symptoms can begin
(symptoms can begin as early as 7 days or as late as 17 days). This period between the
transmission of smallpox and the start of smallpox symptoms is the "smallpox incubation
period."

Is a Person Contagious During the Smallpox Incubation Period?

A person is not contagious during the smallpox incubation period. He or she will typically
become mildly contagious at the point when symptoms begin. A person is most contagious at the
onset of the smallpox rash. At this stage, the infected person is usually very sick and not able to
move around in the community. Risks of smallpox transmission may last until all scabs have
fallen off.

Smallpox Symptoms
One to two weeks after initial exposure to the smallpox virus, signs and symptoms of the
disease typically appear. Early smallpox symptoms are often difficult to diagnose because
they are similar to symptoms of the flu. Common symptoms may include high fever, body
aches, and vomiting.

An Introduction to Smallpox Symptoms

Symptoms of smallpox usually appear within 7 to 17 days after transmission of the smallpox virus
(variola). This period between smallpox transmission and symptoms is called the smallpox incubation
period. During this time, the smallpox virus is multiplying inside of the body.
Early Symptoms of Smallpox
Once symptoms begin, the first smallpox symptoms may be hard to distinguish from the symptoms of
other flu-like illnesses. Early symptoms can include:

High fever

Tiredness

Body aches

Headache

Backache

Vomiting.

At this time, people are usually too sick to carry on their normal activities. This is called the prodrome
phase, and it may last for two to four days. A person is somewhat contagious during this period (people
are most contagious during the first seven to ten days following appearance of a rash). After a couple of
days, a person with smallpox symptoms will begin to develop a smallpox rash. Over the next couple of
weeks, this rash will go through various stages, including:

Early rash

Pustular rash

Pustules and scabs

Resolving scabs

Scabs resolved.

Early Rash--A rash emerges first as small red spots on the tongue and in the mouth. These spots develop
into sores that break open, and large amounts of the virus are spread into the mouth and throat. At this
time, the person becomes highly contagious.

Around the time the sores in the mouth break down, a rash appears on the skin, starting on the face,
spreading to the arms and legs, and then to the hands and feet. Usually, the rash spreads to all parts of the
body within 24 hours. As the rash appears, the fever usually falls and the person may start to feel better.

By the third day of the rash, it becomes raised bumps. By the fourth day, the bumps fill with a thick,
opaque fluid and often have a depression in the center that looks like a belly button (this is a major
distinguishing characteristic of smallpox).

Fever often will rise again at this time and remain high until scabs form over the bumps.
Pustular Rash--During this stage of smallpox symptoms, the bumps become pustules -- sharply raised
and usually round and firm to the touch, as if there's a small, round object under the skin. People often say
the bumps feel like BB pellets embedded in the skin. These symptoms of smallpox last about five days. A
person is still contagious during this period.

Pustules and Scabs--During this stage of smallpox symptoms, the pustules begin to form a crust and
then scab. By the end of the second week after the rash appears, most of the sores have scabbed over.

Resolving ScabS--During this stage, the scabs begin to fall off, leaving marks on the skin that eventually
become pitted scars. Most scabs will have fallen off three weeks after the rash appears. The person is
contagious until all of the scabs have fallen off.

Scabs Resolved--During this final stage of symptoms of smallpox, scabs have fallen off and the person is
no longer contagious.

Final Thoughts on Smallpox Symptoms

The majority of people with smallpox recover, but death may occur in up to 30 percent of cases. Those
who do recover are often left with disfiguring scars.

Diagnosis of Smallpox ---Before making a diagnosis of smallpox, your healthcare

provider will consider other illnesses that can mimic the signs and symptoms of smallpox.
These illnesses include chickenpox, monkeypox, and shingles. Your healthcare provider will
also consider your medical history, physical exam, and test results before making a
diagnosis.

How Is Smallpox Diagnosed?

In order to make a smallpox diagnosis, your doctor will ask a number of questions, including questions
about:

Current symptoms

History of medical conditions

Family history of medical conditions or illnesses

Current medications.

Your healthcare provider will also perform a physical exam, looking for signs and symptoms of smallpox.
This will include a skin and mouth exam to look for the smallpox rash.
If there is a moderate or high suspicion of smallpox, the doctor may order certain lab tests, refer you to a
dermatologist or infectious disease doctor, and/or call health authorities for their recommendations.

Diagnosing Smallpox Versus Other Conditions

Before a smallpox diagnosis is made, your healthcare provider will consider other illnesses that can
mimic the signs and symptoms of smallpox. Some of these illnesses include:

Chickenpox
 Monkeypox

Herpes zoster (also called shingles)

Impetigo

Adverse reaction to medications

Contact dermatitis

Erythema multiforme

Hand, foot, and mouth disease

Scabies

Molluscum contagiosum.

Treatments for Smallpox

The goal of smallpox treatments is to provide relief of symptoms as the body fights the virus.
Since there are currently no proven methods that can kill the virus, supportive care is the
best solution in alleviating symptoms. Supportive care can include intravenous fluids,
medications to control fever or pain, and antibiotics to prevent secondary infection.

An Introduction to Smallpox Treatment

There are currently no proven remedies that can kill the smallpox virus. Therefore, treatments for
smallpox focus on providing relief of symptoms as the body fights the virus. This is called supportive
care.

Supportive Care for Smallpox

Using supportive care to treat smallpox can include:

Intravenous (IV) fluids

Medications to control fever or pain

Antibiotics to prevent secondary infections from bacteria

Good nursing care.

Also, if an infected person gets the smallpox vaccine within four days after exposure to the virus, it may
lessen the severity of the disease or even prevent it.
Outcome Following Treatments for Smallpox
The majority of people with smallpox recover, but death may occur in up to 30 percent of cases. Those
who do recover from the disease are often left with disfiguring scars over large areas of their body,
especially their face. Some are left blind.

Researching New Smallpox Treatments

Research to evaluate new antiviral agents for the treatment of smallpox is ongoing. Early results from
laboratory studies suggest that the drug cidofovir (Vistide ) may fight the virus. Smallpox research
scientists are doing studies with animals to better understand the drug's ability to treat this disease

In addition, the National Institute of Allergy and Infectious Diseases (NIAID) has applied to the U.S.
Food and Drug Administration (FDA) to use the antiviral drug cidofovir as an experimental smallpox
treatment in the event of a bioterrorist-initiated reemergence of the disease.

Prevention Against Smallpox

Vaccination and certain health authority measures are among the primary ways to prevent
smallpox. The most effective method is to administer the smallpox vaccine; in the event of
an emergency, there is enough vaccine for every person in the United States. Health
authorities have also devised a detailed plan to protect Americans against the use of
smallpox as a biological weapon.

Can Smallpox Be Prevented?

There are no proven treatments for smallpox. Therefore, if smallpox were to return, prevention of
smallpox would include:

Vaccination with the smallpox vaccine

Certain measures taken by the health authority.

Vaccination
One of the best ways to prevent smallpox is through vaccination. If given to a person before exposure to
smallpox, the vaccine can completely protect him or her. Vaccination within three days of exposure will
prevent or greatly lessen the severity of smallpox in most people. Vaccination four to seven days after
exposure likely offers some protection from the disease or may decrease the severity of disease.
Vaccination will not protect smallpox patients who already have a rash.

Currently, the smallpox vaccine is not widely available to the general public. However, there is enough
smallpox vaccine to vaccinate every person in the United States in the event of a smallpox emergency.

Health Response

The Centers for Disease Control (CDC) has a detailed plan to protect Americans against the use of
smallpox as a biological weapon. This plan includes the creation and use of special teams of healthcare
and public health workers. If a smallpox case is found, these teams will take immediate steps to control
the spread of the disease. Smallpox was wiped out through specific public health actions, including
vaccination, and these actions could be used again.

In the event of a smallpox outbreak, public health officials will use television, radio, newspapers, the
Internet, and other channels to inform members of the public about what to do to protect themselves and
their families.

Officials will tell people where to go for care if they think they have smallpox.

Smallpox patients will be isolated (kept away from other people who could get sick from them) and will
receive the best medical care possible. Isolation prevents the virus from spreading to others.

Anyone who has had contact with a smallpox patient will be offered the smallpox vaccination as soon as
possible. Then, the people who have had contact with those individuals will also be vaccinated. Following
vaccination, these people will need to watch for any signs of smallpox. People who have been exposed to
smallpox may be asked to take their temperatures regularly and report the results to their health
department.

The smallpox vaccine may also be offered to those who have not been exposed, but would like to be
vaccinated. At local clinics, the risks and benefits of the vaccine will be explained, and professionals will
be available to answer questions.

No one will be forced to be vaccinated, even if an individual has been exposed to smallpox. To prevent
smallpox from spreading, anyone who has been in contact with a person with smallpox but who decides
not to get the vaccine may need to be isolated for at least 18 days. During this time, they will be checked
for symptoms of smallpox.

People placed in isolation will not be able to go to work. Steps will be taken to care for their everyday
needs (food, etc.).

Protecting Your Family Against Smallpox

You can protect yourself and your family during a smallpox outbreak by:

Staying informed. Listen to the news to learn how the outbreak is affecting your community.
Public health officials will share important information, including areas where smallpox cases
have been found, whom to call, and where to go if you think you have been exposed to smallpox.

Following the instructions of public health authorities.

Staying away from, and keeping your children away from, anyone who might have smallpox.
This is especially important if you or your children have not been vaccinated.

Staying away from others if you think you have been exposed to smallpox. It is important to call
your health department or healthcare provider immediately; they will tell you where to go.