Disease Dilemma: Smallpox

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He's just 15 months old, but little Chase Boydstun is getting used to getting vaccinated. His mom, Ginger, wouldn't have it any other way.

“Just went ahead and did it without thinking about it ‘cause I knew he had to have it,” she says.

Dr. Larry Deeb says these days most parents don't question vaccines. He thinks that's a change since September 11.

He says, ”Before then there were a few kids' parents worried about it, worried about vaccines, maybe side effects. Since then, never hear it.”

Vaccines for tuberculosis, measles, and hepatitis are commonplace, though not risk-free. It's a different, and riskier. Vaccine for grownups is getting attention these days.

Smallpox. The question? Whether the shot is worth the risk. It's a question hundreds of Leon County Sheriff's Department employees like Linda Butler must answer, as the state begins smallpox vaccinations for First Responders.

“Once you take the shot, have a chance of exposing family member to virus at that point, you have to take precautions for up to 30 days,” she says.

Plus, workers' compensation may not cover deputies who get sick from the vaccine. Last seen in 1977, smallpox is far deadlier than its cousin chickenpox, with pustules deep-seeded in the skin, killing up to 30 percent of patients, scarring the rest for life. Officials like Dr. Marjorie Kirsch were vaccinated earlier this year.

There are currently no plans to vaccinate the general public.

“It will depend on perceived risk of us being exposed to smallpox and as we find out
About safety of vaccine, that will influence the decision,” says Dr. Kirsch.

It's a vaccination decision that could be much tougher one day for moms and dads. For now, that day is a long way away.

Smallpox vaccine is currently not recommended for anyone under age 18. It's also not for people with heart problems, skin conditions, weakened immune systems or those undergoing cancer treatment. People who have close contact with persons falling into those high-risk categories might also be advised not to take the vaccine.

Click here to view the previous Disease Dilemma story on SARS

WCTV Extended Web Coverage on Smallpox


  • The name smallpox is derived from the Latin word “spotted” and refers to the raised bumps that appear on the body of an infected person.

Forms of Smallpox

  • Two forms of smallpox, variola major and variola minor.

  • Variola Major: The sever and most common form of small pox, with a more extensive rash and higher fever. Four types of variola major smallpox:
    • Ordinary: The most frequent type, accounting for 90 percent of the cases.
    • Modified: Mild and occurring in previously vaccinated persons.
    • Flat: Very fatal. Very hard to recover from this form of smallpox.
    • Hemorrhagic: Very rare and most serious. Extremely fatal form of smallpox.

  • Variola Minor: A less common presentation of smallpox, and a much less sever disease, with death rates historically of one percent or less.

Where Smallpox Originates From

  • Smallpox is caused by the variola virus that emerged in human population thousands of years ago.

  • Except for laboratory stockpiles, the variola virus has been eliminated.


  • Direct and prolonged face-to-face contact is required to spread smallpox.

  • Can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing.

  • Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses and trains.

  • Humans are the only natural hosts of variola. Smallpox is not known to be transmitted by insects or animals.

Stages of Smallpox Disease

  • Incubation Period (7-17 days, not contagious) – Exposure to the virus is followed by an incubation period, which people do not have any symptoms and may feel fine.

  • Initial Symptoms (2-4 days, sometimes contagious) – The first symptoms of smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101° F - 104° F.

  • Early Rash (4 days, most contagious) – A rash emerges first as small red spots on the tongue and in the mouth. 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 feeling better. However, by the fourth day, the bumps fill with a thick fluid, the fever will raise again and will last until scabs begin to form on the bumps.

  • Pustular Rash (5 days, contagious) – The bumps become pustules, sharply raised, usually round and firm to the touch as if there is a small round object under the skin.

  • Pustules and Scabs (5 days, contagious) – 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 (6 days, contagious) – 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.

  • Scabs Resolved (not contagious) – Scabs have fallen off. Person is no longer contagious.

Source: www.bt.cdc.gov (Public Health Emergency Preparedness and Response’s Web site) contributed to this report.