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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.

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Section 3. Summaries of Infectious Diseases

Smallpox (Variola)

In 1979, the World Health Organization declared that smallpox (variola) had been eradicated successfully worldwide. The last naturally occurring case of smallpox occurred in Somalia in 1977, followed by 2 cases attributable to laboratory exposure in 1978. The United States discontinued routine childhood immunization against smallpox in 1972 and routine immunization of health care professionals in 1976. The US military continued to immunize military personnel until 1995. Since 1980, the vaccine has been recommended only for people working with nonvariola orthopoxviruses. Two World Health Organization reference laboratories were authorized to maintain stocks of variola virus. There is concern that the virus and the expertise to use it as a weapon of bioterrorism may have been misappropriated.

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient

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CLINICAL MANIFESTATIONS: An individual infected with variola major develops a severe prodromal illness characterized by high fever (102°F–104°F [38.9°C–40.0°C]) and constitutional symptoms, including malaise, severe headache, backache, abdominal pain, and prostration, lasting for 2 to 5 days. Abdominal pain and back pain may be mistaken for focal pathology. Infected children may suffer from vomiting and seizures during this prodromal period. Most patients with smallpox tend to be severely ill and bedridden during the febrile prodrome. The prodromal period is followed by enanthemas (lesions on the mucosa of the mouth or pharynx), which may not be noticed by the patient. This stage occurs less than 24 hours before the onset of rash, which usually is the first recognized manifestation of infectiousness. With the onset of enanthemas, the patient becomes infectious and remains so until all skin crust lesions have separated. The exanthem, or rash, typically begins on the face and rapidly progresses to involve the forearms, trunk, and legs in a centrifugal distribution (greatest concentration . . . [Go to Full Text]