SMALLPOX

ARRANGED BY:

GROUP 5

1. Aisyah Sukma Kurnia Wardhani 02190200003

2. Ratna Andaryani 02190200002
3. Septriyanti 02190200035

PUBLIC HEALTH BACHELOR STUDY PROGRAM

PUBLIC HEALTH DEPARTMENT
INDONESIA MAJU INSTITUTE OF HEALTH SCIENCE
JAKARTA
2021
 PREFACE

First of all the writer wants to express her thanks to Allah SWT, because of
His bless and grace the entitled ”Smallpox” can be finished on time.
This paper is a requirement to fulfill the assignment from Mrs. Lesnasari
Dalimunthe, M.Pd., the english lecturer of Indonesia Maju Institute of Health
Science. The writer also thanks to her for all the guidance to complete it.
In completing this paper the writer faced many problems, but with the help
of many people all the problems could be passed, May Allah SWT. give the blessing
for them. It describes smallpox with detail explanation. Although this paper has
many deficiencies in the arrangement and explanation, the writer hope that it can
be used as a reference for the reader to understand smallpox.

Jakarta, May 17th, 2021

Author

ii
 TABLE OF CONTENTS

PREFACE .......................................................................................................... ii
TABLE OF CONTENTS .................................................................................. iii
CHAPTER I INTRODUCTION ....................................................................... 1
1.1. Background .......................................................................................... 1
1.2. Questions of The Problems .................................................................. 1
CHAPTER II THEORETICAL STUDY .......................................................... 2
2.1. Definition of Smallpox ......................................................................... 2
2.2. History of Smallpox ............................................................................. 2
2.3. Types of Smallpox ................................................................................ 5
2.4. Signs And Symptoms of Smallpox ....................................................... 7
2.5. Prevention and Treatment For Smallpox ........................................... 8
CHAPTER III CONCLUSION ....................................................................... 12
3.1. Conclusion .......................................................................................... 12
BIBLIOGRAPHY

iii
 CHAPTER I INTRODUCTION

1.1. Background
Smallpox has been a scourge against humanity for at least the past
1500 years, and perhaps much longer than that. There is no mention of the
disease in ancient Greek writings, but plagues of pustular disease in the
Roman Empire bore a strong resemblance to smallpox. The literary record
suggests that smallpox became established in the Mediterranean by the third
century AD, and it was described in China around the same time. Smallpox
subsequently changed the course of history and killed millions of people in
both the New World and the Old World (Belongia and Naleway, 2003).

1.2. Questions of The Problems

1. What is smallpox?
2. What is the history of smallpox?
3. What is the types of smallpox?
4. What is the signs and symptoms of smallpox?
5. What is the prevention and treatment for smallpox?

1
 CHAPTER II THEORETICAL STUDY

2.1. Definition of Smallpox

Before smallpox was eradicated, it was a serious infectious disease
caused by the variola virus. It was contagious-meaning, it spread from one
person to another. People who had smallpox had a fever and a distinctive,
progressive skin rash.
Most people with smallpox recovered, but about 3 out of every 10
people with the disease died. Many smallpox survivors have permanent
scars over large areas of their body, especially their faces. Some are left
blind.
Thanks to the success of vaccination, smallpox was eradicated, and
no cases of naturally occurring smallpox have happened since 1977. The
last natural outbreak of smallpox in the United States occurred in 1949.

2.2. History of Smallpox

2.2.1. Origin of Smallpox
The origin of smallpox is unknown. The finding of smallpox-like
rashes on Egyptian mummies suggests that smallpox has existed for
at least 3,000 years. The earliest written description of a disease like
smallpox appeared in China in the 4th century CE (Common Era).
Early written descriptions also appeared in India in the 7th century
and in Asia Minor in the 10th century.
2.2.2. Highlights from History
1. 6th Century—Increased trade with China and Korea brings
smallpox to Japan.
2. 7th Century—Arab expansion spreads smallpox into northern
Africa, Spain, and Portugal.
3. 11th Century—Crusades further spread smallpox in Europe.

2
 4. 15th Century—Portugal occupies part of western Africa,
bringing smallpox.
5. 16th Century—European settlers and the African slave trade
import smallpox into:
a. The Caribbean
b. Central and South America
6. 17th Century—European settlers bring smallpox to North
America.
7. 18th Century—Explorers from Great Britain bring smallpox to
Australia.
2.2.3. Spread of Smallpox
Historians trace the global spread of smallpox to the growth
of civilizations and exploration. Expanding trade routes over the
centuries also led to the spread of the disease.
Before smallpox was eradicated, it was mainly spread by
direct and fairly prolonged face-to-face contact between people.
Smallpox patients became contagious once the first sores appeared
in their mouth and throat (early rash stage). They spread the virus
when they coughed or sneezed and droplets from their nose or mouth
spread to other people. They remained contagious until their last
smallpox scab fell off.
These scabs and the fluid found in the patient’s sores also
contained the variola virus. The virus can spread through these
materials or through the objects contaminated by them, such as
bedding or clothing. People who cared for smallpox patients and
washed their bedding or clothing had to wear gloves and take care
to not get infected.
Rarely, smallpox has spread through the air in enclosed
settings, such as a building (airborne route).
Smallpox can be spread by humans only. Scientists have no
evidence that smallpox can be spread by insects or animals.

3
2.2.4. Last Cases of Smallpox
In late 1975, three-year-old Rahima Banu from Bangladesh
was the last person in the world to have naturally acquired variola
major. She was also the last person in Asia to have active smallpox.
She was isolated at home with house guards posted 24 hours a day
until she was no longer infectious. A house-to-house vaccination
campaign within a 1.5-mile radius of her home began immediately.
A member of the Smallpox Eradication Program team visited every
house, public meeting area, school, and healer within 5 miles to
ensure the illness did not spread. They also offered a reward to
anyone who reported a smallpox case.
Ali Maow Maalin was the last person to have naturally
acquired smallpox caused by variola minor. Maalin was a hospital
cook in Merca, Somalia. On October 12, 1977, he rode with two
smallpox patients in a vehicle from the hospital to the local smallpox
office. On October 22, he developed a fever. At first healthcare
workers diagnosed him with malaria, and then chickenpox. The
smallpox eradication staff then correctly diagnosed him with
smallpox on October 30. Maalin was isolated and made a full
recovery. Maalin died of malaria on July 22, 2013, while working in
the polio eradication campaign.
Janet Parker was the last person to die of smallpox. In 1978,
Parker was a medical photographer at England’s Birmingham
University Medical School. She worked one floor above the Medical
Microbiology Department where staff and students conducted
smallpox research. She became ill on August 11 and developed a
rash on August 15 but was not diagnosed with smallpox until 9 days
later. She died on September 11, 1978. Her mother, who was
providing care for her, developed smallpox on September 7, despite
having been vaccinated two weeks earlier. An investigation
suggested that Janet Parker had been infected either via an airborne

4
 route through the medical school building’s duct system or by direct
contact while visiting the microbiology corridor.
2.2.5. World Free of Smallpox
Almost two centuries after Jenner hoped that vaccination
could annihilate smallpox, the 33rd World Health Assembly
declared the world free of this disease on May 8, 1980. Many people
consider smallpox eradication to be the biggest achievement in
international public health.

2.3. Types of Smallpox

Smallpox is a serious, highly contagious, and sometimes fatal infectious
disease. There is no specific treatment for smallpox disease, and the only
prevention is vaccination. The name is derived from the Latin word for
"spotted" and refers to the raised bumps that appear on the face and body of
an infected person. Two clinical forms of smallpox have been described.
Variola major is the severe form of smallpox, with a more extensive rash
and higher fever. It is also the most common form of smallpox. There are
four types of variola major smallpox: ordinary (the most frequent); modified
(mild and occurring in previously vaccinated persons); flat; and
hemorrhagic. Historically, variola major has a case-fatality rate of about
30%. However, flat and hemorrhagic smallpox, which are uncommon types
of smallpox, are usually fatal. Hemorrhagic smallpox has a much shorter
incubation period and is likely not to be initially recognized as smallpox
when presenting to medical care. Smallpox vaccination also does not
provide much protection, if any, against hemorrhagic smallpox. Variola
minor is a less common clinical presentation, and much less severe disease
(for example, historically, death rates from variola minor are 1% or less).

5
6
2.4. Signs And Symptoms of Smallpox
A person with smallpox goes through several stages as the disease
progresses. Each stage has its own signs and symptoms.
1. Incubation Period
This stage can last anywhere from 7 to 19 days (although the average
length is 10 to 14 days). Contagious? No. The incubation period is the
length of time the virus is in a person’s body before they look or feel
sick. During this period, a person usually has no symptoms and may feel
fine.
2. Initial Symptoms
This stage lasts anywhere from 2 to 4 days. Contagious? Sometimes.
Smallpox may be contagious during this phase, but is most contagious
during the next 2 stages (early rash and pustular rash and scabs). The
first symptoms include:
a. High fever
b. Head and body aches
c. Sometimes vomiting
At this time, people are usually too sick to carry on their normal
activities.
3. Early Rash
This stage lasts about 4 days. Contagious? Yes. At this time, the
person is most contagious.
A rash starts as small red spots on the tongue and in the mouth. These
spots change into sores that break open and spread large amounts of the
virus into the mouth and throat. The person continues to have a fever.
Once the sores in the mouth start breaking down, a rash appears on
the skin, starting on the face and spreading to the arms and legs, and
then to the hands and feet. Usually, it spreads to all parts of the body
within 24 hours. As this rash appears, the fever begins to decline, and
the person may start to feel better.

7
 By the fourth day, the skin sores fill with a thick, opaque fluid and
often have a dent in the center.
Once the skin sores fill with fluid, the fever may rise again and
remain high until scabs form over the bumps.
4. Pustular Rash and Scabs
This stage lasts about 10 days. Contagious? Yes. The sores become
pustules (sharply raised, usually round and firm to the touch, like peas
under the skin). After about 5 days, 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.
5. Scabs Fall Off
This stage lasts about 6 days. Contagious? Yes. The scabs begin to fall
off, leaving marks on the skin. Three weeks after the rash appears, most
scabs will have fallen off.
6. No Scabs
Contagious? No. Four weeks after the rash appears, all scabs should
have fallen off. Once all scabs have fallen off, the person is no longer
contagious.

2.5. Prevention and Treatment For Smallpox

2.5.1. Early Control Efforts
Smallpox was a terrible disease. On average, 3 out of every
10 people who got it died. People who survived usually had scars,
which were sometimes severe.
One of the first methods for controlling smallpox was
variolation, a process named after the virus that causes smallpox
(variola virus). During variolation, people who had never had
smallpox were exposed to material from smallpox sores (pustules)
by scratching the material into their arm or inhaling it through the
nose. After variolation, people usually developed the symptoms
associated with smallpox, such as fever and a rash. However, fewer

8
 people died from variolation than if they had acquired smallpox
naturally.
The basis for vaccination began in 1796 when the English
doctor Edward Jenner noticed that milkmaids who had gotten
cowpox were protected from smallpox. Jenner also knew about
variolation and guessed that exposure to cowpox could be used to
protect against smallpox. To test his theory, Dr. Jenner took material
from a cowpox sore on milkmaid Sarah Nelmes’ hand and
inoculated it into the arm of James Phipps, the 9-year-old son of
Jenner’s gardener. Months later, Jenner exposed Phipps several
times to variola virus, but Phipps never developed smallpox. More
experiments followed, and, in 1801, Jenner published his treatise
“On the Origin of the Vaccine Inoculation.” In this work, he
summarized his discoveries and expressed hope that “the
annihilation of the smallpox, the most dreadful scourge of the human
species, must be the final result of this practice.”
Vaccination became widely accepted and gradually replaced
the practice of variolation. At some point in the 1800s, the virus used
to make the smallpox vaccine changed from cowpox to vaccinia
virus.
2.5.2. Vaccine For Smallpox
Smallpox can be prevented by the smallpox vaccine, also
called vaccinia virus vaccine. The vaccine is made from a virus
called vaccinia, which is a poxvirus similar to smallpox, but less
harmful. There are two licensed smallpox vaccines in the United
States and one investigational vaccine that may be used in a
smallpox emergency.
The replication-competent smallpox vaccines (i.e.,
ACAM2000 and APSV) can protect people from getting sick or
make the disease less severe if they receive the vaccine either before

9
 or within a week of coming in contact with smallpox virus. If you
get the vaccine:
Before contact with the virus, the vaccine can protect you
from getting sick.
Within 3 days of being exposed to the virus, the vaccine
might protect you from getting the disease. If you still get the
disease, you might get much less sick than an unvaccinated person
would.
Within 4 to 7 days of being exposed to the virus, the vaccine
likely gives you some protection from the disease. If you still get the
disease, you might not get as sick as an unvaccinated person would.
Once you have developed the smallpox rash, the vaccine will
not protect you.
Currently, the smallpox vaccine is not available to the
general public because smallpox has been eradicated, and the virus
no longer exists in nature. However, there is enough smallpox
vaccine to vaccinate every person in the United States if a smallpox
outbreak were to occur.
2.5.3. Stocks of Variola Virus
Following the eradication of smallpox, scientists and public
health officials determined there was still a need to perform research
using the variola virus. They agreed to reduce the number of
laboratories holding stocks of variola virus to only four locations. In
1981, the four countries that either served as a WHO collaborating
center or were actively working with variola virus were the United
States, England, Russia, and South Africa. By 1984, England and
South Africa had either destroyed their stocks or transferred them to
other approved labs. There are now only two locations that officially
store and handle variola virus under WHO supervision: the Centers
for Disease Control and Prevention in Atlanta, Georgia, and the

10
State Research Center of Virology and Biotechnology (VECTOR
Institute) in Koltsovo, Russia.

11
 CHAPTER III CONCLUSION

3.1. Conclusion
Smallpox inarguably shaped the course of human history by killing
countless millions in both the Old World and the New World. Dr. Edward
Jenner’s discovery of vaccination in the late 18th century, and the global
eradication of smallpox in the 1970s, rank among the greatest achievements
in human history. Inoculation with vaccinia virus is highly effective for the
prevention of smallpox infection. It is important to fully understand and
appreciate the history and benefits of smallpox vaccination.

12
 BIBLIOGRAPHY

Belongia, E. A. and Naleway, A. L. (2003) ‘Smallpox Vaccine:The Good, the Bad,

and the Ugly’, 1(2), pp. 87–92.
Centers for Disease Control and Prevention (CDC). (2016). Smallpox.
https://www.cdc.gov/smallpox/about/index.html, accessed on May 17th, 2021.
Food and Drug Administration (FDA). (2018). Smallpox.
https://www.fda.gov/vaccines-blood-biologics/vaccines/smallpox, accessed on
May 17th, 2021.