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Sophie Ochmann and Max Roser (2017) – ‘Smallpox’. Published online at Retrieved from: [Online Resource]


  • First disease to be eradicated entirely, happened in 1977
  • Jenner pioneered the idea of vaccination

# Smallpox

  • Origin of name (connection to syphilis)
  • Type of virus, explain virus name, two types of viruses
    • genus orthopoxvirus (variola, vaccinia, cowpox, monkeypox)
    • variola only one to only affect humans
    • variola major and variola minor (first documented only in 1904)
  • Symptoms
    • incubation period
    • pox
    • at which stages infectious (only when rash appears, not during incubation / prodromal stage, until last smallpox scab fall off, rarely via the air but scabs and fluid from sores were also infectious though!)
    • mode of transmission (face-to-face usually)
  • No treatment
    • Read up on Tecovirimat, Cidofovir and Brincidofovir
  • Mortality rate of each virus type
  • Definition of insufflation, inoculation, variolation and vaccination here or in history section with Jenner??

# History

  • How many people ever died of smallpox
  • Since when do we think is it around?
    • Because smallpox infects only humans, the variola virus only survives if it continuously finds human hosts -> infected humans either develop immunity or die. Egypt hosted one was of the earliest concentrations of civilisation along its river Nile, which makes it a likely candidate for the origin of various infectious diseases, including smallpox.
    • Probably derived from an “ancestral African rodent-borne variola-like virus either 16,000 or 68,000 years before present”1
    • Medical writings in ancient China (1122BC) and India (1500BC) refer to smallpox already. Other countries did not have literature at that stage yet, so we cannot know whether the origin of the disease is East / South Asia.2
    • Striking absence from Old and New Testament and from Greek and Roman literature
    • The Egyptian practice of mummification preserved the skin, bones and muscles of royal figures in their dynasties. Three mummies were found with ‘dome-shaped vesicles […] similar to those found in smallpox’3. One of these bodies was Pharaoh Ramses V who died in 1157BC. A reconstruction of his face is shown below which clearly shows small pustules, especially on his cheeks. At the time of the mummy’s discovery, electron microscopy was not yet available unfortunately and authorities have not allowed investigators to extract tissue from the mummies since then.
    • Unmistakable descriptions of smallpox not until 4th century AD China and 7th century in India and Mediterranean, 10th century in South-Western Asia 4 These authors describe smallpox as a disease of children which shows that the disease went from epidemic (only causing trouble when imported) to endemic (populations were large enough that the virus could have an undisrupted presence)
    • Documentation of spread to Ethiopia during the “Elephant War” in 568AD and Europe, e.g. playing a major role in the “Plague of Athens” in 430BC during the Peloponnesian Wars as described by Thucydides
    • Asia also infected very early
    • Australia, South Africa and the Americas were only exposed with the onset of colonisation in the 16th century -> Figure 5.5 below
  • Introducing smallpox in the Americas shows what happens to a completely unexposed population -> link to potential biological warfare if smallpox was reintroduced these days!
  • Hall of fame of people who suffered / died from smallpox (history written)
  • Lady Mary Wortley Montague who lobbied for live variolation
  • Jenner


# Ramses V is believed to be the first known victim of smallpox after examining the pustules found on his cheeks.5

Ramses V Mummy Smallpox

# The spread of smallpox to the Americas, South Africa and Australia with European exploration and colonisation 6

Spread Smallpox Colonization

# Eradication

  • How many people ever died of smallpox?
  • vaccine at some stage used the vaccinia virus
  • 1966: WHO intensifies smallpox eradication
    • interrupted chain of transmission by isolating smallpox patients
    • strategy = “surveillance and containment” rather than mass vaccination
  • October 1977: last indigenous case
    • map on year of last case for each country
  • 1978: laboratory accident in UK
  • May 1980: world officially certified smallpox free

# Smallpox as a Bioweapon

  • all smallpox stocks in labs supposedly given to CDC in Atlanta and lab in Moscow