Smallpox: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr Vamsi Krishna Kedarisetti , General Medicine



The variola virus, which only affects humans, is responsible for smallpox. The variola virus has been eliminated thanks to a careful immunization program. Smallpox is a potentially fatal infection spread through human contact and is highly infectious. It is often spread by direct touch with an infected person or through contact with the fluids from a patient's rash. The best way to avoid smallpox is to get vaccinated as soon as possible after exposure because a report suggests that 30% of smallpox cases are fatal.


What are the Symptoms of Smallpox?

Usually, 17 days after the variola virus infection, symptoms start to show. Following the incubation period, the general symptoms listed below emerge.

  • Vomiting or nausea.
  • High fever followed by chills.
  • Severe headache followed by other body pains.
  • Formation of pus- or fluid-filled rashes on the face, legs, hands, arms, etc.

A few days later, the body develops flat, red patches, which could begin on the tongue and mouth before moving to the skin. Most frequently, the face, arms, and legs are affected first, then the torso, hands, and feet.

Many spots develop into little blisters filled with clear fluid within a day. Later, pus begins to fill the blisters. 8 to 9 days later, scabs develop and finally break off, leaving behind deep, pitted scars. When the rash appears and during the period after the scabs break off, smallpox can be spread from one person to another.


What are the Causes of Smallpox?

The variola virus causes smallpox. The virus comes in two different forms. Variola major, a more virulent variant driving smallpox disease, leads to fatality in over 30% of those who caught it. A less lethal variant of Variola minor harmed 1% of people who contracted it. Hemorrhagic and malignant smallpox were more destructive than the usual strain.

Adults, especially pregnant women, were more frequently affected by hemorrhagic smallpox than children. People experienced more severe symptoms, including fever, discomfort, headaches, and bleeding from their blisters and mucosal membranes. Blood poisoning typically was fatal within a week.

Children more often than adults often develop malignant smallpox. People had flat lesions that blended on the skin's surface rather than raised blisters. Blood poisoning also claimed most of those who contracted this kind of smallpox.


When to See a Doctor for Smallpox?

Although naturally occurring smallpox has been eradicated, any suspected case of a smallpox-like illness would require immediate evaluation by an General Medicine and urgent public health intervention. Rapid identification is critical to prevent potential outbreaks and ensure appropriate containment measures.

You should see a doctor if you have:

  • High fever with a widespread rash
  • Symptoms resembling a pox-like illness
  • Exposure to a suspected infectious outbreak

Get medical help immediately if:

  • Rapidly spreading skin lesions with fever
  • Severe dehydration or breathing difficulties
  • Signs of serious systemic infection

These could be signs of a serious complication like Smallpox, which needs urgent care.

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How is Smallpox Diagnosed?

Historically, diagnosing smallpox involved identifying its characteristic symptoms and confirming infection through laboratory testing. Modern diagnostic techniques focus on detecting the variola virus using specialized laboratory methods.

Rapid diagnosis was essential for isolating affected individuals and controlling disease spread.

Diagnostic Methods

  • Clinical examination of skin lesions
  • Review of symptom history
  • Laboratory testing for variola virus
  • Polymerase chain reaction (PCR) testing
  • Electron microscopy of lesion samples
  • Public health surveillance investigations

What are the Treatment Options for Smallpox?

Historically, treatment for smallpox focused on supportive care because no specific cure existed. Modern antiviral medications have been developed for emergency preparedness and may be used in the event of a future outbreak.

Treatment aims to manage symptoms, prevent complications, and support recovery.

Supportive Care

  • Hydration and fluid replacement
  • Fever management
  • Nutritional support
  • Treatment of secondary infections

Antiviral Therapy

  • Tecovirimat in specific situations
  • Other antiviral agents under medical supervision
  • Careful monitoring for treatment response

Preventive Measures

  • Vaccination for outbreak control
  • Isolation of affected individuals
  • Contact tracing and monitoring

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What is the Recovery Process for Smallpox?

Recovery from smallpox historically depended on the severity of infection. Individuals who survived often developed lifelong immunity but could be left with permanent scars and other complications.

Supportive care, infection control measures, and monitoring for complications were important aspects of recovery management.

Recovery Includes

  • Gradual healing of skin lesions
  • Management of dehydration and nutritional needs
  • Treatment of secondary infections
  • Monitoring for long-term complications
  • Psychological and physical rehabilitation when needed

Frequently Asked Questions

1. What are the symptoms of Smallpox?

Smallpox symptoms usually begin with high fever, fatigue, headache, back pain, and body aches. A few days later, a characteristic rash develops, progressing from red spots to fluid-filled and pus-filled lesions before forming scabs.

2. What causes Smallpox?

Smallpox is caused by the variola virus. The infection spreads from person to person through respiratory droplets, direct contact with infected individuals, or contaminated objects such as bedding and clothing.

3. How is Smallpox diagnosed?

Smallpox is diagnosed based on clinical symptoms, exposure history, and laboratory tests that identify the variola virus. Since the disease has been eradicated, any suspected case would require immediate public health investigation.

4. What treatments are available for Smallpox?

There is no specific cure for smallpox. Treatment focuses on supportive care, managing symptoms, preventing complications, and using antiviral medications when appropriate. Early medical intervention can improve outcomes.

5. How was Smallpox eradicated?

Smallpox was eradicated through a worldwide vaccination program led by the World Health Organization (WHO). The last naturally occurring case was reported in 1977, and the disease was officially declared eradicated in 1980.

6. Can Smallpox be prevented?

Yes. Smallpox can be prevented through vaccination. Although routine vaccination is no longer recommended for the general public due to eradication, vaccines are maintained for emergency preparedness.

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