Smallpox is a contagious and sometimes fatal disease caused by the variola virus. No one has naturally contracted smallpox since 1977. In 1980, the World Health Assembly declared that smallpox was eradicated throughout the world.

The only known stockpiles of the virus exist in labs in the United States and Russia. However, since the Sept. 11 and anthrax attacks, public health officials in Maine and throughout the United States are taking precautions to be able to deal with a bioterrorist attack using smallpox as a weapon.

The symptoms of smallpox begin with high fever, head and body aches, and sometimes vomiting. A rash follows that spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar.

The average time between exposure to the disease and appearance of symptoms is 12 to 14 days. People are most contagious when they develop the rash (two to three days after fever starts). The virus is spread by direct and fairly prolonged face-to-face contact from one person to another. It can also be transmitted by direct contact with infected bodily fluids or contaminated objects like bedding or clothing.

There is no proven treatment, but research to evaluate new antiviral agents is ongoing. Death can occur in up to one of every three cases.

Smallpox can be prevented through the use of smallpox vaccine, which helps the body develop immunity to smallpox. The vaccine is made from “live” vaccinia virus, a “pox”-type virus related to smallpox. The vaccine does not contain smallpox virus and cannot cause smallpox. Vaccination provides high-level immunity for three to five years and decreasing immunity thereafter.

Getting the vaccine before exposure will protect about 95 percent of those vaccinated. In addition, vaccination within three days of exposure may prevent or substantially lessen infection in the majority of people. Vaccination four to seven days after exposure likely offers some protection or may modify the severity.

There are side effects and risks associated with the smallpox vaccine, but most people experience mild reactions that include a sore arm, fever and body aches. Vaccination is also contraindicated for certain groups. A safer vaccinia-based vaccine, produced in cell culture, is expected to become available shortly.

The smallpox vaccine is not available to the public at this time. As part of the national effort, the Maine Bureau of Health has developed a plan to prepare for an outbreak. Teams based in six regions across the state will be prepared to investigate possible cases.

If there were an actual case in Maine, the public health team would be bolstered by hospital-based healthcare teams. If smallpox was detected and it was deemed necessary, the entire population of Maine could be vaccinated in a matter of days to prevent the disease from spreading.

Maine’s public health and healthcare teams need to be vaccinated against smallpox in order to safely investigate and treat possible smallpox cases. There is a multi-phase plan, but to date Phase I (of vaccinating 100 individuals of the Public Health Response Teams) has not started due to liability and side effect problems that are being resolved.



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