The first symptoms of smallpox usually appear 12 to 14 days after you're infected. During the incubation period of seven to 17 days, you look and feel healthy and can't infect others.
Following the incubation period, a sudden onset of flu-like signs and symptoms occurs. These include:
- Overall discomfort
- Severe fatigue
- Severe back pain
- Vomiting, possibly
A few days later, flat, red spots appear first on your face, hands and forearms, and later on your trunk. Within a day or two, many of these lesions turn into small blisters filled with clear fluid, which then turns into pus. Scabs begin to form eight to nine days later and eventually fall off, leaving deep, pitted scars.
Lesions also develop in the mucous membranes of your nose and mouth and quickly turn into sores that break open.
Smallpox is caused by infection with the variola virus. The virus can be transmitted:
- Directly from person to person. Direct transmission of the virus requires fairly prolonged face-to-face contact. The virus can be transmitted through the air by droplets that escape when an infected person coughs, sneezes or talks.
- Indirectly from an infected person. In rare instances, airborne virus can spread farther, possibly through the ventilation system in a building, infecting people in other rooms or on other floors.
- Via contaminated items. Smallpox can also spread through contact with contaminated clothing and bedding, although the risk of infection from these sources is less common.
- As a terrorist weapon, potentially. A deliberate release of smallpox is a remote threat. However, because any release of the virus could spread the disease quickly, government officials have taken numerous precautions to protect against this possibility, such as stockpiling smallpox vaccine.
Most people who get smallpox survive. However, a few rare varieties of smallpox are almost always fatal. These more-severe forms most commonly affect pregnant women and people with impaired immune systems.
People who recover from smallpox usually have severe scars, especially on the face, arms and legs. In some cases, smallpox may cause blindness.
In the event of an outbreak, people who had smallpox would be kept in isolation in an effort to control the spread of the virus. Anyone who had contact with someone who developed an infection would need the smallpox vaccine, which can prevent or lessen the severity of the disease if given within four days of exposure to the smallpox virus.
The vaccine uses a live virus that's related to smallpox, and it can occasionally cause serious complications, such as infections affecting the heart or brain. That's why a general vaccination program for everyone isn't recommended at this time. The potential risks of the vaccine outweigh the benefits, in the absence of an actual smallpox outbreak.
If you were vaccinated as a child
It's not known how long immunity lasts after a smallpox vaccine. It's likely that a previous vaccination would offer partial immunity, which might protect against the disease's most-serious complications. But if an outbreak ever occurred, people who were vaccinated as children would still likely receive a new vaccination after direct exposure to someone with the virus.