Smallpox

Declared eradicated worldwide in 1980.

Two repositories hold the variola virus: VECTOR in Koltsovo, Novosibirsk, Russia, and the CDC in Atlanta, Georgia, USA.

Potential agent of bioterrorism.

Vaccinations are not administered to the general public.

• In 2007, ACAM2000, the newest version of vaccine made of vaccinia virus, became part of the USA stockpile of smallpox vaccines.

Hemodynamic compromise from dehydration and/or sepsis

Facility and provider contamination

Virus enters respiratory tract, migrates into pulmonary lymph nodes, and spreads into the bloodstream.

Incubation period is 7–17 d; at this point, not contagious.

Prodromal phase is 2–3 d. Abrupt, severe headache, backache, and fever; possibly contagious.

Rash develops, increases, and lasts for weeks; this is contagious:

• Mucous membrane enanthemas, then skin lesions.

• Centrifugal spread.

• Starts on extremities and spreads to trunk.

• Deep-seated, firm, round pustules, leading to rupture and necrosis. leading to scabs.

• Lesions all in same stage of development.

Contagious until resolution of scabs.

Approximate 30% mortality; death primarily from sepsis.

Must be distinguished from chicken pox (varicella):

• No prodrome.

• Lesions centripetal spread.

• Start on trunk.

• Superficial vesicles.

• Lesions in different stages.

Caused by Orthopoxvirus variola

Human vector only

Transmission via prolonged, inhalational contact with infected bodily fluid or contaminated material