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class="vector-toc-list"> </ul> </li> <li id="toc-Hemorrhagic" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hemorrhagic"> <div class="vector-toc-text"> 2.4 Hemorrhagic </div> </a> <ul id="toc-Hemorrhagic-sublist" class="vector-toc-list"> <li id="toc-Early" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Early"> <div class="vector-toc-text"> 2.4.1 Early </div> </a> <ul id="toc-Early-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Late" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Late"> <div class="vector-toc-text"> 2.4.2 Late </div> </a> <ul id="toc-Late-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Cause" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Cause"> <div class="vector-toc-text"> 3 Cause </div> </a> <button aria-controls="toc-Cause-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Cause subsection </button> <ul id="toc-Cause-sublist" class="vector-toc-list"> <li id="toc-Evolution" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Evolution"> <div class="vector-toc-text"> 3.1 Evolution </div> </a> <ul id="toc-Evolution-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Virology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Virology"> <div class="vector-toc-text"> 3.2 Virology </div> </a> <ul id="toc-Virology-sublist" class="vector-toc-list"> <li id="toc-Variola_major" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Variola_major"> <div class="vector-toc-text"> 3.2.1 Variola major </div> </a> <ul id="toc-Variola_major-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Variola_minor" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Variola_minor"> <div class="vector-toc-text"> 3.2.2 Variola minor </div> </a> <ul id="toc-Variola_minor-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Genome_composition" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Genome_composition"> <div class="vector-toc-text"> 3.2.3 Genome composition </div> </a> <ul id="toc-Genome_composition-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Gene_expression" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Gene_expression"> <div class="vector-toc-text"> 3.2.4 Gene expression </div> </a> <ul id="toc-Gene_expression-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> 3.3 Research </div> </a> <ul id="toc-Research-sublist" class="vector-toc-list"> <li id="toc-Genetic_engineering" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Genetic_engineering"> <div class="vector-toc-text"> 3.3.1 Genetic engineering </div> </a> <ul id="toc-Genetic_engineering-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Controversies" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Controversies"> <div class="vector-toc-text"> 3.3.2 Controversies </div> </a> <ul id="toc-Controversies-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Transmission" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transmission"> <div class="vector-toc-text"> 3.4 Transmission </div> </a> <ul id="toc-Transmission-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mechanism" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Mechanism"> <div class="vector-toc-text"> 4 Mechanism </div> </a> <ul id="toc-Mechanism-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> 5 Diagnosis </div> </a> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> 6 Prevention </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> 7 Treatment </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> 8 Prognosis </div> </a> <button aria-controls="toc-Prognosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Prognosis subsection </button> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> <li id="toc-Complications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Complications"> <div class="vector-toc-text"> 8.1 Complications </div> </a> <ul id="toc-Complications-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 9 History </div> </a> <button aria-controls="toc-History-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle History subsection </button> <ul id="toc-History-sublist" class="vector-toc-list"> <li id="toc-Disease_emergence" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Disease_emergence"> <div class="vector-toc-text"> 9.1 Disease emergence </div> </a> <ul id="toc-Disease_emergence-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Eradication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Eradication"> <div class="vector-toc-text"> 9.2 Eradication </div> </a> <ul id="toc-Eradication-sublist" class="vector-toc-list"> <li id="toc-Costs_and_benefits" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Costs_and_benefits"> <div class="vector-toc-text"> 9.2.1 Costs and benefits </div> </a> <ul id="toc-Costs_and_benefits-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Since_eradication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Since_eradication"> <div class="vector-toc-text"> 9.3 Since eradication </div> </a> <ul id="toc-Since_eradication-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> 10 Society and culture </div> </a> <button aria-controls="toc-Society_and_culture-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Society and culture subsection </button> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> <li id="toc-Biological_warfare" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Biological_warfare"> <div class="vector-toc-text"> 10.1 Biological warfare </div> </a> <ul id="toc-Biological_warfare-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Notable_cases" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Notable_cases"> <div class="vector-toc-text"> 10.2 Notable cases </div> </a> <ul id="toc-Notable_cases-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Tradition_and_religion" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Tradition_and_religion"> <div class="vector-toc-text"> 10.3 Tradition and religion </div> </a> <ul id="toc-Tradition_and_religion-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 11 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 12 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> 13 Further reading </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 14 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Smallpox</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 133 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-133" aria-hidden="true" > 133 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Pokke" title="Pokke – Afrikaans" lang="af" hreflang="af" data-title="Pokke" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target">Afrikaans</a></li><li class="interlanguage-link interwiki-als mw-list-item"><a href="https://als.wikipedia.org/wiki/Pocken" title="Pocken – Alemannic" lang="gsw" hreflang="gsw" data-title="Pocken" data-language-autonym="Alemannisch" data-language-local-name="Alemannic" class="interlanguage-link-target">Alemannisch</a></li><li class="interlanguage-link interwiki-anp mw-list-item"><a href="https://anp.wikipedia.org/wiki/%E0%A4%AE%E0%A4%B8%E0%A5%82%E0%A4%B0%E0%A4%BF%E0%A4%95%E0%A4%BE" title="मसूरिका – Angika" lang="anp" hreflang="anp" data-title="मसूरिका" data-language-autonym="अंगिका" data-language-local-name="Angika" class="interlanguage-link-target">अंगिका</a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AC%D8%AF%D8%B1%D9%8A" title="جدري – Arabic" lang="ar" hreflang="ar" data-title="جدري" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-an mw-list-item"><a href="https://an.wikipedia.org/wiki/Picueta" title="Picueta – Aragonese" lang="an" hreflang="an" data-title="Picueta" data-language-autonym="Aragonés" data-language-local-name="Aragonese" class="interlanguage-link-target">Aragonés</a></li><li class="interlanguage-link interwiki-hyw mw-list-item"><a href="https://hyw.wikipedia.org/wiki/%D4%BE%D5%A1%D5%B2%D5%AF%D5%A1%D5%AD%D5%BF" title="Ծաղկախտ – Western Armenian" lang="hyw" hreflang="hyw" data-title="Ծաղկախտ" data-language-autonym="Արեւմտահայերէն" data-language-local-name="Western Armenian" class="interlanguage-link-target">Արեւմտահայերէն</a></li><li class="interlanguage-link interwiki-as mw-list-item"><a href="https://as.wikipedia.org/wiki/%E0%A6%AC%E0%A7%B0%E0%A6%86%E0%A6%87" title="বৰআই – Assamese" lang="as" hreflang="as" data-title="বৰআই" data-language-autonym="অসমীয়া" data-language-local-name="Assamese" class="interlanguage-link-target">অসমীয়া</a></li><li class="interlanguage-link interwiki-ast mw-list-item"><a href="https://ast.wikipedia.org/wiki/Viruela" title="Viruela – Asturian" lang="ast" hreflang="ast" data-title="Viruela" data-language-autonym="Asturianu" data-language-local-name="Asturian" class="interlanguage-link-target">Asturianu</a></li><li class="interlanguage-link interwiki-gn mw-list-item"><a href="https://gn.wikipedia.org/wiki/Mbiru%27a" title="Mbiru'a – Guarani" lang="gn" hreflang="gn" data-title="Mbiru'a" data-language-autonym="Avañe'ẽ" data-language-local-name="Guarani" class="interlanguage-link-target">Avañe'ẽ</a></li><li class="interlanguage-link interwiki-ay mw-list-item"><a href="https://ay.wikipedia.org/wiki/Chuqu_usu" title="Chuqu usu – Aymara" lang="ay" hreflang="ay" data-title="Chuqu usu" data-language-autonym="Aymar aru" data-language-local-name="Aymara" class="interlanguage-link-target">Aymar aru</a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/T%C9%99bii_%C3%A7i%C3%A7%C9%99k" title="Təbii çiçək – Azerbaijani" lang="az" hreflang="az" data-title="Təbii çiçək" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target">Azərbaycanca</a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%DA%86%DB%8C%DA%86%DA%A9_%D9%85%D8%B1%DB%8C%D8%B6%D9%84%DB%8C%DA%AF%DB%8C" title="چیچک مریضلیگی – South Azerbaijani" lang="azb" hreflang="azb" data-title="چیچک مریضلیگی" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target">تۆرکجه</a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%97%E0%A7%81%E0%A6%9F%E0%A6%BF%E0%A6%AC%E0%A6%B8%E0%A6%A8%E0%A7%8D%E0%A6%A4" title="গুটিবসন্ত – Bangla" lang="bn" hreflang="bn" data-title="গুটিবসন্ত" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target">বাংলা</a></li><li class="interlanguage-link interwiki-zh-min-nan mw-list-item"><a href="https://zh-min-nan.wikipedia.org/wiki/Thian-hoa" title="Thian-hoa – Minnan" lang="nan" hreflang="nan" data-title="Thian-hoa" data-language-autonym="閩南語 / Bân-lâm-gú" data-language-local-name="Minnan" class="interlanguage-link-target">閩南語 / Bân-lâm-gú</a></li><li class="interlanguage-link interwiki-ba mw-list-item"><a href="https://ba.wikipedia.org/wiki/%D2%A0%D0%B0%D1%80%D0%B0_%D1%81%D3%99%D1%81%D3%99%D0%BA" title="Ҡара сәсәк – Bashkir" lang="ba" hreflang="ba" data-title="Ҡара сәсәк" data-language-autonym="Башҡортса" data-language-local-name="Bashkir" class="interlanguage-link-target">Башҡортса</a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%9D%D0%B0%D1%82%D1%83%D1%80%D0%B0%D0%BB%D1%8C%D0%BD%D0%B0%D1%8F_%D0%B2%D0%BE%D1%81%D0%BF%D0%B0" title="Натуральная воспа – Belarusian" lang="be" hreflang="be" data-title="Натуральная воспа" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target">Беларуская</a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%9D%D0%B0%D1%82%D1%83%D1%80%D0%B0%D0%BB%D1%8C%D0%BD%D0%B0%D1%8F_%D0%B2%D0%BE%D1%81%D0%BF%D0%B0" title="Натуральная воспа – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Натуральная воспа" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target">Беларуская (тарашкевіца)</a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%95%D0%B4%D1%80%D0%B0_%D1%88%D0%B0%D1%80%D0%BA%D0%B0" title="Едра шарка – Bulgarian" lang="bg" hreflang="bg" data-title="Едра шарка" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target">Български</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Boginje" title="Boginje – Bosnian" lang="bs" hreflang="bs" data-title="Boginje" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-br mw-list-item"><a href="https://br.wikipedia.org/wiki/Brec%27h_(kle%C3%B1ved)" title="Brec'h (kleñved) – Breton" lang="br" hreflang="br" data-title="Brec'h (kleñved)" data-language-autonym="Brezhoneg" data-language-local-name="Breton" class="interlanguage-link-target">Brezhoneg</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Verola" title="Verola – Catalan" lang="ca" hreflang="ca" data-title="Verola" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Prav%C3%A9_ne%C5%A1tovice" title="Pravé neštovice – Czech" lang="cs" hreflang="cs" data-title="Pravé neštovice" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-sn mw-list-item"><a href="https://sn.wikipedia.org/wiki/Chibhokisi" title="Chibhokisi – Shona" lang="sn" hreflang="sn" data-title="Chibhokisi" data-language-autonym="ChiShona" data-language-local-name="Shona" class="interlanguage-link-target">ChiShona</a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Brech_wen" title="Brech wen – Welsh" lang="cy" hreflang="cy" data-title="Brech wen" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target">Cymraeg</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Kopper" title="Kopper – Danish" lang="da" hreflang="da" data-title="Kopper" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Pocken" title="Pocken – German" lang="de" hreflang="de" data-title="Pocken" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%86%DE%A6%DE%81%DE%A8_%DE%88%DE%A8%DE%8B%DE%AA%DE%83%DE%A8" title="ކަށި ވިދުރި – Divehi" lang="dv" hreflang="dv" data-title="ކަށި ވިދުރި" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target">ދިވެހިބަސް</a></li><li class="interlanguage-link interwiki-nv mw-list-item"><a href="https://nv.wikipedia.org/wiki/%C5%81%C3%B3%C3%B3dtsoh" title="Łóódtsoh – Navajo" lang="nv" hreflang="nv" data-title="Łóódtsoh" data-language-autonym="Diné bizaad" data-language-local-name="Navajo" class="interlanguage-link-target">Diné bizaad</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/R%C3%B5uged" title="Rõuged – Estonian" lang="et" hreflang="et" data-title="Rõuged" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%95%CF%85%CE%BB%CE%BF%CE%B3%CE%B9%CE%AC" title="Ευλογιά – Greek" lang="el" hreflang="el" data-title="Ευλογιά" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-eml mw-list-item"><a href="https://eml.wikipedia.org/wiki/Var%C5%8Dl" title="Varōl – Emiliano-Romagnolo" lang="egl" hreflang="egl" data-title="Varōl" data-language-autonym="Emiliàn e rumagnòl" data-language-local-name="Emiliano-Romagnolo" class="interlanguage-link-target">Emiliàn e rumagnòl</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Viruela" title="Viruela – Spanish" lang="es" hreflang="es" data-title="Viruela" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Variolo" title="Variolo – Esperanto" lang="eo" hreflang="eo" data-title="Variolo" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Baztanga" title="Baztanga – Basque" lang="eu" hreflang="eu" data-title="Baztanga" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A2%D8%A8%D9%84%D9%87" title="آبله – Persian" lang="fa" hreflang="fa" data-title="آبله" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-hif mw-list-item"><a href="https://hif.wikipedia.org/wiki/Barraa_maata" title="Barraa maata – Fiji Hindi" lang="hif" hreflang="hif" data-title="Barraa maata" data-language-autonym="Fiji Hindi" data-language-local-name="Fiji Hindi" class="interlanguage-link-target">Fiji Hindi</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Variole" title="Variole – French" lang="fr" hreflang="fr" data-title="Variole" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-fur mw-list-item"><a href="https://fur.wikipedia.org/wiki/Vuarvuele" title="Vuarvuele – Friulian" lang="fur" hreflang="fur" data-title="Vuarvuele" data-language-autonym="Furlan" data-language-local-name="Friulian" class="interlanguage-link-target">Furlan</a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Bolgach" title="Bolgach – Irish" lang="ga" hreflang="ga" data-title="Bolgach" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target">Gaeilge</a></li><li class="interlanguage-link interwiki-gd mw-list-item"><a href="https://gd.wikipedia.org/wiki/Breac_(tinneas)" title="Breac (tinneas) – Scottish Gaelic" lang="gd" hreflang="gd" data-title="Breac (tinneas)" data-language-autonym="Gàidhlig" data-language-local-name="Scottish Gaelic" class="interlanguage-link-target">Gàidhlig</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Var%C3%ADola" title="Varíola – Galician" lang="gl" hreflang="gl" data-title="Varíola" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-gu mw-list-item"><a href="https://gu.wikipedia.org/wiki/%E0%AA%B6%E0%AB%80%E0%AA%A4%E0%AA%B3%E0%AA%BE" title="શીતળા – Gujarati" lang="gu" hreflang="gu" data-title="શીતળા" data-language-autonym="ગુજરાતી" data-language-local-name="Gujarati" class="interlanguage-link-target">ગુજરાતી</a></li><li class="interlanguage-link interwiki-hak mw-list-item"><a href="https://hak.wikipedia.org/wiki/Thi%C3%AAn-f%C3%A2" title="Thiên-fâ – Hakka Chinese" lang="hak" hreflang="hak" data-title="Thiên-fâ" data-language-autonym="客家語 / Hak-kâ-ngî" data-language-local-name="Hakka Chinese" class="interlanguage-link-target">客家語 / Hak-kâ-ngî</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%B2%9C%EC%97%B0%EB%91%90" title="천연두 – Korean" lang="ko" hreflang="ko" data-title="천연두" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-ha mw-list-item"><a href="https://ha.wikipedia.org/wiki/Agana" title="Agana – Hausa" lang="ha" hreflang="ha" data-title="Agana" data-language-autonym="Hausa" data-language-local-name="Hausa" class="interlanguage-link-target">Hausa</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%B2%D5%B6%D5%A1%D5%AF%D5%A1%D5%B6_%D5%AE%D5%A1%D5%B2%D5%AB%D5%AF" title="Բնական ծաղիկ – Armenian" lang="hy" hreflang="hy" data-title="Բնական ծաղիկ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%9A%E0%A5%87%E0%A4%9A%E0%A4%95" title="चेचक – Hindi" lang="hi" hreflang="hi" data-title="चेचक" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target">हिन्दी</a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Boginje" title="Boginje – Croatian" lang="hr" hreflang="hr" data-title="Boginje" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-io mw-list-item"><a href="https://io.wikipedia.org/wiki/Variolo" title="Variolo – Ido" lang="io" hreflang="io" data-title="Variolo" data-language-autonym="Ido" data-language-local-name="Ido" class="interlanguage-link-target">Ido</a></li><li class="interlanguage-link interwiki-ilo mw-list-item"><a href="https://ilo.wikipedia.org/wiki/Burtong" title="Burtong – Iloko" lang="ilo" hreflang="ilo" data-title="Burtong" data-language-autonym="Ilokano" data-language-local-name="Iloko" class="interlanguage-link-target">Ilokano</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Variola" title="Variola – Indonesian" lang="id" hreflang="id" data-title="Variola" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-os mw-list-item"><a href="https://os.wikipedia.org/wiki/%D0%A5%C3%A6%D0%B1%D1%83%D0%B7" title="Хæбуз – Ossetic" lang="os" hreflang="os" data-title="Хæбуз" data-language-autonym="Ирон" data-language-local-name="Ossetic" class="interlanguage-link-target">Ирон</a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/B%C3%B3lus%C3%B3tt" title="Bólusótt – Icelandic" lang="is" hreflang="is" data-title="Bólusótt" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target">Íslenska</a></li><li class="interlanguage-link interwiki-it badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://it.wikipedia.org/wiki/Vaiolo" title="Vaiolo – Italian" lang="it" hreflang="it" data-title="Vaiolo" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%90%D7%91%D7%A2%D7%91%D7%95%D7%A2%D7%95%D7%AA_%D7%A9%D7%97%D7%95%D7%A8%D7%95%D7%AA" title="אבעבועות שחורות – Hebrew" lang="he" hreflang="he" data-title="אבעבועות שחורות" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-kbp mw-list-item"><a href="https://kbp.wikipedia.org/wiki/%C6%90s%C9%94_k%CA%8Ad%C9%94%C5%8B_(Variole)" title="Ɛsɔ kʊdɔŋ (Variole) – Kabiye" lang="kbp" hreflang="kbp" data-title="Ɛsɔ kʊdɔŋ (Variole)" data-language-autonym="Kabɩyɛ" data-language-local-name="Kabiye" class="interlanguage-link-target">Kabɩyɛ</a></li><li class="interlanguage-link interwiki-kn mw-list-item"><a href="https://kn.wikipedia.org/wiki/%E0%B2%B8%E0%B2%A3%E0%B3%8D%E0%B2%A3_%E0%B2%B8%E0%B2%BF%E0%B2%A1%E0%B3%81%E0%B2%AC%E0%B3%81" title="ಸಣ್ಣ ಸಿಡುಬು – Kannada" lang="kn" hreflang="kn" data-title="ಸಣ್ಣ ಸಿಡುಬು" data-language-autonym="ಕನ್ನಡ" data-language-local-name="Kannada" class="interlanguage-link-target">ಕನ್ನಡ</a></li><li class="interlanguage-link interwiki-ks mw-list-item"><a href="https://ks.wikipedia.org/wiki/%D8%B4%D9%8F%D8%AA%D9%95%D9%84%D8%A0" title="شُتٕلؠ – Kashmiri" lang="ks" hreflang="ks" data-title="شُتٕلؠ" data-language-autonym="कॉशुर / کٲشُر" data-language-local-name="Kashmiri" class="interlanguage-link-target">कॉशुर / کٲشُر</a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D2%9A%D0%B0%D1%80%D0%B0_%D1%88%D0%B5%D1%88%D0%B5%D0%BA" title="Қара шешек – Kazakh" lang="kk" hreflang="kk" data-title="Қара шешек" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target">Қазақша</a></li><li class="interlanguage-link interwiki-sw mw-list-item"><a href="https://sw.wikipedia.org/wiki/Ndui" title="Ndui – Swahili" lang="sw" hreflang="sw" data-title="Ndui" data-language-autonym="Kiswahili" data-language-local-name="Swahili" class="interlanguage-link-target">Kiswahili</a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%A7%D0%B5%D1%87%D0%B5%D0%BA" title="Чечек – Kyrgyz" lang="ky" hreflang="ky" data-title="Чечек" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target">Кыргызча</a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Variola" title="Variola – Latin" lang="la" hreflang="la" data-title="Variola" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target">Latina</a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Bakas" title="Bakas – Latvian" lang="lv" hreflang="lv" data-title="Bakas" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target">Latviešu</a></li><li class="interlanguage-link interwiki-lez mw-list-item"><a href="https://lez.wikipedia.org/wiki/%D0%A6%D3%80%D0%B5%D0%B3%D1%8C%D0%B5%D1%80" title="ЦӀегьер – Lezghian" lang="lez" hreflang="lez" data-title="ЦӀегьер" data-language-autonym="Лезги" data-language-local-name="Lezghian" class="interlanguage-link-target">Лезги</a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Raupai" title="Raupai – Lithuanian" lang="lt" hreflang="lt" data-title="Raupai" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target">Lietuvių</a></li><li class="interlanguage-link interwiki-ln mw-list-item"><a href="https://ln.wikipedia.org/wiki/Kokotu" title="Kokotu – Lingala" lang="ln" hreflang="ln" data-title="Kokotu" data-language-autonym="Lingála" data-language-local-name="Lingala" class="interlanguage-link-target">Lingála</a></li><li class="interlanguage-link interwiki-lmo mw-list-item"><a href="https://lmo.wikipedia.org/wiki/Varioeul" title="Varioeul – Lombard" lang="lmo" hreflang="lmo" data-title="Varioeul" data-language-autonym="Lombard" data-language-local-name="Lombard" class="interlanguage-link-target">Lombard</a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Fekete_himl%C5%91" title="Fekete himlő – Hungarian" lang="hu" hreflang="hu" data-title="Fekete himlő" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A1%D0%B8%D0%BF%D0%B0%D0%BD%D0%B8%D1%86%D0%B8" title="Сипаници – Macedonian" lang="mk" hreflang="mk" data-title="Сипаници" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target">Македонски</a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%B5%E0%B4%B8%E0%B5%82%E0%B4%B0%E0%B4%BF" title="വസൂരി – Malayalam" lang="ml" hreflang="ml" data-title="വസൂരി" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target">മലയാളം</a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%A6%E0%A5%87%E0%A4%B5%E0%A5%80_(%E0%A4%B0%E0%A5%8B%E0%A4%97)" title="देवी (रोग) – Marathi" lang="mr" hreflang="mr" data-title="देवी (रोग)" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target">मराठी</a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D8%AC%D8%AF%D8%B1%D9%89" title="جدرى – Egyptian Arabic" lang="arz" hreflang="arz" data-title="جدرى" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target">مصرى</a></li><li class="interlanguage-link interwiki-mzn mw-list-item"><a href="https://mzn.wikipedia.org/wiki/%D8%A2%D9%81%D9%84%D9%87" title="آفله – Mazanderani" lang="mzn" hreflang="mzn" data-title="آفله" data-language-autonym="مازِرونی" data-language-local-name="Mazanderani" class="interlanguage-link-target">مازِرونی</a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Cacar" title="Cacar – Malay" lang="ms" hreflang="ms" data-title="Cacar" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target">Bahasa Melayu</a></li><li class="interlanguage-link interwiki-cdo mw-list-item"><a href="https://cdo.wikipedia.org/wiki/Ti%C4%95ng-hu%C4%83" title="Tiĕng-huă – Mindong" lang="cdo" hreflang="cdo" data-title="Tiĕng-huă" data-language-autonym="閩東語 / Mìng-dĕ̤ng-ngṳ̄" data-language-local-name="Mindong" class="interlanguage-link-target">閩東語 / Mìng-dĕ̤ng-ngṳ̄</a></li><li class="interlanguage-link interwiki-my mw-list-item"><a href="https://my.wikipedia.org/wiki/%E1%80%80%E1%80%BB%E1%80%B1%E1%80%AC%E1%80%80%E1%80%BA%E1%80%80%E1%80%BC%E1%80%AE%E1%80%B8%E1%80%9B%E1%80%B1%E1%80%AC%E1%80%82%E1%80%AB" title="ကျောက်ကြီးရောဂါ – Burmese" lang="my" hreflang="my" data-title="ကျောက်ကြီးရောဂါ" data-language-autonym="မြန်မာဘာသာ" data-language-local-name="Burmese" class="interlanguage-link-target">မြန်မာဘာသာ</a></li><li class="interlanguage-link interwiki-nah mw-list-item"><a href="https://nah.wikipedia.org/wiki/Matlalzahuatl" title="Matlalzahuatl – Nahuatl" lang="nah" hreflang="nah" data-title="Matlalzahuatl" data-language-autonym="Nāhuatl" data-language-local-name="Nahuatl" class="interlanguage-link-target">Nāhuatl</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Pokken" title="Pokken – Dutch" lang="nl" hreflang="nl" data-title="Pokken" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ne mw-list-item"><a href="https://ne.wikipedia.org/wiki/%E0%A4%AC%E0%A4%BF%E0%A4%AB%E0%A4%B0" title="बिफर – Nepali" lang="ne" hreflang="ne" data-title="बिफर" data-language-autonym="नेपाली" data-language-local-name="Nepali" class="interlanguage-link-target">नेपाली</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%A4%A9%E7%84%B6%E7%97%98" title="天然痘 – Japanese" lang="ja" hreflang="ja" data-title="天然痘" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-frr mw-list-item"><a href="https://frr.wikipedia.org/wiki/Pooken" title="Pooken – Northern Frisian" lang="frr" hreflang="frr" data-title="Pooken" data-language-autonym="Nordfriisk" data-language-local-name="Northern Frisian" class="interlanguage-link-target">Nordfriisk</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Kopper_(sykdom)" title="Kopper (sykdom) – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Kopper (sykdom)" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Koppar" title="Koppar – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Koppar" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target">Norsk nynorsk</a></li><li class="interlanguage-link interwiki-oc mw-list-item"><a href="https://oc.wikipedia.org/wiki/Ver%C3%B2la" title="Veròla – Occitan" lang="oc" hreflang="oc" data-title="Veròla" data-language-autonym="Occitan" data-language-local-name="Occitan" class="interlanguage-link-target">Occitan</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%AC%E0%AC%B8%E0%AC%A8%E0%AD%8D%E0%AC%A4_%E0%AC%B0%E0%AD%8B%E0%AC%97" title="ବସନ୍ତ ରୋଗ – Odia" lang="or" hreflang="or" data-title="ବସନ୍ତ ରୋଗ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Chechak" title="Chechak – Uzbek" lang="uz" hreflang="uz" data-title="Chechak" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target">Oʻzbekcha / ўзбекча</a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%9A%E0%A9%87%E0%A8%9A%E0%A8%95" title="ਚੇਚਕ – Punjabi" lang="pa" hreflang="pa" data-title="ਚੇਚਕ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target">ਪੰਜਾਬੀ</a></li><li class="interlanguage-link interwiki-pnb mw-list-item"><a href="https://pnb.wikipedia.org/wiki/%DA%86%DB%8C%DA%86%DA%A9" title="چیچک – Western Punjabi" lang="pnb" hreflang="pnb" data-title="چیچک" data-language-autonym="پنجابی" data-language-local-name="Western Punjabi" class="interlanguage-link-target">پنجابی</a></li><li class="interlanguage-link interwiki-jam mw-list-item"><a href="https://jam.wikipedia.org/wiki/Sumaalpax" title="Sumaalpax – Jamaican Creole English" lang="jam" hreflang="jam" data-title="Sumaalpax" data-language-autonym="Patois" data-language-local-name="Jamaican Creole English" class="interlanguage-link-target">Patois</a></li><li class="interlanguage-link interwiki-pms mw-list-item"><a href="https://pms.wikipedia.org/wiki/Vair%C3%B2le" title="Vairòle – Piedmontese" lang="pms" hreflang="pms" data-title="Vairòle" data-language-autonym="Piemontèis" data-language-local-name="Piedmontese" class="interlanguage-link-target">Piemontèis</a></li><li class="interlanguage-link interwiki-nds mw-list-item"><a href="https://nds.wikipedia.org/wiki/Pocken" title="Pocken – Low German" lang="nds" hreflang="nds" data-title="Pocken" data-language-autonym="Plattdüütsch" data-language-local-name="Low German" class="interlanguage-link-target">Plattdüütsch</a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Ospa_prawdziwa" title="Ospa prawdziwa – Polish" lang="pl" hreflang="pl" data-title="Ospa prawdziwa" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Var%C3%ADola" title="Varíola – Portuguese" lang="pt" hreflang="pt" data-title="Varíola" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Variol%C4%83" title="Variolă – Romanian" lang="ro" hreflang="ro" data-title="Variolă" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-qu mw-list-item"><a href="https://qu.wikipedia.org/wiki/Muru_unquy" title="Muru unquy – Quechua" lang="qu" hreflang="qu" data-title="Muru unquy" data-language-autonym="Runa Simi" data-language-local-name="Quechua" class="interlanguage-link-target">Runa Simi</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9D%D0%B0%D1%82%D1%83%D1%80%D0%B0%D0%BB%D1%8C%D0%BD%D0%B0%D1%8F_%D0%BE%D1%81%D0%BF%D0%B0" title="Натуральная оспа – Russian" lang="ru" hreflang="ru" data-title="Натуральная оспа" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-sah mw-list-item"><a href="https://sah.wikipedia.org/wiki/%D0%A3%D0%BE%D1%81%D0%BF%D0%B0" title="Уоспа – Yakut" lang="sah" hreflang="sah" data-title="Уоспа" data-language-autonym="Саха тыла" data-language-local-name="Yakut" class="interlanguage-link-target">Саха тыла</a></li><li class="interlanguage-link interwiki-sa mw-list-item"><a href="https://sa.wikipedia.org/wiki/%E0%A4%AE%E0%A4%B8%E0%A5%82%E0%A4%B0%E0%A4%BF%E0%A4%95%E0%A4%BE" title="मसूरिका – Sanskrit" lang="sa" hreflang="sa" data-title="मसूरिका" data-language-autonym="संस्कृतम्" data-language-local-name="Sanskrit" class="interlanguage-link-target">संस्कृतम्</a></li><li class="interlanguage-link interwiki-sat mw-list-item"><a href="https://sat.wikipedia.org/wiki/%E1%B1%B5%E1%B1%9A%E1%B1%A5%E1%B1%9A%E1%B1%B1" title="ᱵᱚᱥᱚᱱ – Santali" lang="sat" hreflang="sat" data-title="ᱵᱚᱥᱚᱱ" data-language-autonym="ᱥᱟᱱᱛᱟᱲᱤ" data-language-local-name="Santali" class="interlanguage-link-target">ᱥᱟᱱᱛᱟᱲᱤ</a></li><li class="interlanguage-link interwiki-sc mw-list-item"><a href="https://sc.wikipedia.org/wiki/Pigota" title="Pigota – Sardinian" lang="sc" hreflang="sc" data-title="Pigota" data-language-autonym="Sardu" data-language-local-name="Sardinian" class="interlanguage-link-target">Sardu</a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Lia" title="Lia – Albanian" lang="sq" hreflang="sq" data-title="Lia" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target">Shqip</a></li><li class="interlanguage-link interwiki-scn mw-list-item"><a href="https://scn.wikipedia.org/wiki/Vaiolu" title="Vaiolu – Sicilian" lang="scn" hreflang="scn" data-title="Vaiolu" data-language-autonym="Sicilianu" data-language-local-name="Sicilian" class="interlanguage-link-target">Sicilianu</a></li><li class="interlanguage-link interwiki-si mw-list-item"><a href="https://si.wikipedia.org/wiki/%E0%B7%80%E0%B7%83%E0%B7%96%E0%B6%BB%E0%B7%92%E0%B6%BA" title="වසූරිය – Sinhala" lang="si" hreflang="si" data-title="වසූරිය" data-language-autonym="සිංහල" data-language-local-name="Sinhala" class="interlanguage-link-target">සිංහල</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Smallpox" title="Smallpox – Simple English" lang="en-simple" hreflang="en-simple" data-title="Smallpox" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-sd mw-list-item"><a href="https://sd.wikipedia.org/wiki/%D9%85%D8%A7%D8%AA%D8%A7_(%D8%A8%D9%8A%D9%85%D8%A7%D8%B1%D9%8A)" title="ماتا (بيماري) – Sindhi" lang="sd" hreflang="sd" data-title="ماتا (بيماري)" data-language-autonym="سنڌي" data-language-local-name="Sindhi" class="interlanguage-link-target">سنڌي</a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Kiahne" title="Kiahne – Slovak" lang="sk" hreflang="sk" data-title="Kiahne" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target">Slovenčina</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/%C4%8Crne_koze" title="Črne koze – Slovenian" lang="sl" hreflang="sl" data-title="Črne koze" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%DA%BE%D8%A7%D9%88%DA%B5%DB%95" title="ھاوڵە – Central Kurdish" lang="ckb" hreflang="ckb" data-title="ھاوڵە" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target">کوردی</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%92%D0%B5%D0%BB%D0%B8%D0%BA%D0%B5_%D0%B1%D0%BE%D0%B3%D0%B8%D1%9A%D0%B5" title="Велике богиње – Serbian" lang="sr" hreflang="sr" data-title="Велике богиње" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Boginje" title="Boginje – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Boginje" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target">Srpskohrvatski / српскохрватски</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Isorokko" title="Isorokko – Finnish" lang="fi" hreflang="fi" data-title="Isorokko" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Smittkoppor" title="Smittkoppor – Swedish" lang="sv" hreflang="sv" data-title="Smittkoppor" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-tl mw-list-item"><a href="https://tl.wikipedia.org/wiki/Bulutong" title="Bulutong – Tagalog" lang="tl" hreflang="tl" data-title="Bulutong" data-language-autonym="Tagalog" data-language-local-name="Tagalog" class="interlanguage-link-target">Tagalog</a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%AA%E0%AF%86%E0%AE%B0%E0%AE%BF%E0%AE%AF%E0%AE%AE%E0%AF%8D%E0%AE%AE%E0%AF%88" title="பெரியம்மை – Tamil" lang="ta" hreflang="ta" data-title="பெரியம்மை" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target">தமிழ்</a></li><li class="interlanguage-link interwiki-kab mw-list-item"><a href="https://kab.wikipedia.org/wiki/Tazerzayt" title="Tazerzayt – Kabyle" lang="kab" hreflang="kab" data-title="Tazerzayt" data-language-autonym="Taqbaylit" data-language-local-name="Kabyle" class="interlanguage-link-target">Taqbaylit</a></li><li class="interlanguage-link interwiki-tt mw-list-item"><a href="https://tt.wikipedia.org/wiki/%D0%A7%D3%99%D1%87%D3%99%D0%BA_(%D0%B0%D0%B2%D1%8B%D1%80%D1%83)" title="Чәчәк (авыру) – Tatar" lang="tt" hreflang="tt" data-title="Чәчәк (авыру)" data-language-autonym="Татарча / tatarça" data-language-local-name="Tatar" class="interlanguage-link-target">Татарча / tatarça</a></li><li class="interlanguage-link interwiki-te mw-list-item"><a href="https://te.wikipedia.org/wiki/%E0%B0%AE%E0%B0%B6%E0%B1%82%E0%B0%9A%E0%B0%BF" title="మశూచి – Telugu" lang="te" hreflang="te" data-title="మశూచి" data-language-autonym="తెలుగు" data-language-local-name="Telugu" class="interlanguage-link-target">తెలుగు</a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B8%9D%E0%B8%B5%E0%B8%94%E0%B8%B2%E0%B8%A9" title="โรคฝีดาษ – Thai" lang="th" hreflang="th" data-title="โรคฝีดาษ" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target">ไทย</a></li><li class="interlanguage-link interwiki-din mw-list-item"><a href="https://din.wikipedia.org/wiki/Male%C5%8Bd%C3%AFt" title="Maleŋdït – Dinka" lang="din" hreflang="din" data-title="Maleŋdït" data-language-autonym="Thuɔŋjäŋ" data-language-local-name="Dinka" class="interlanguage-link-target">Thuɔŋjäŋ</a></li><li class="interlanguage-link interwiki-chr mw-list-item"><a href="https://chr.wikipedia.org/wiki/%E1%8E%A4%E1%8F%83%E1%8F%94%E1%8F%A9%E1%8E%B8%E1%8F%AF%E1%8E%A9" title="ᎤᏃᏔᏩᎸᏯᎩ – Cherokee" lang="chr" hreflang="chr" data-title="ᎤᏃᏔᏩᎸᏯᎩ" data-language-autonym="ᏣᎳᎩ" data-language-local-name="Cherokee" class="interlanguage-link-target">ᏣᎳᎩ</a></li><li class="interlanguage-link interwiki-tcy mw-list-item"><a href="https://tcy.wikipedia.org/wiki/%E0%B2%8E%E0%B2%B2%E0%B3%8D%E0%B2%AF_%E0%B2%B8%E0%B2%BF%E0%B2%A1%E0%B3%8D%E0%B2%AC%E0%B3%81" title="ಎಲ್ಯ ಸಿಡ್ಬು – Tulu" lang="tcy" hreflang="tcy" data-title="ಎಲ್ಯ ಸಿಡ್ಬು" data-language-autonym="ತುಳು" data-language-local-name="Tulu" class="interlanguage-link-target">ತುಳು</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/%C3%87i%C3%A7ek_hastal%C4%B1%C4%9F%C4%B1" title="Çiçek hastalığı – Turkish" lang="tr" hreflang="tr" data-title="Çiçek hastalığı" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9D%D0%B0%D1%82%D1%83%D1%80%D0%B0%D0%BB%D1%8C%D0%BD%D0%B0_%D0%B2%D1%96%D1%81%D0%BF%D0%B0" title="Натуральна віспа – Ukrainian" lang="uk" hreflang="uk" data-title="Натуральна віспа" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target">Українська</a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%DA%86%DB%8C%DA%86%DA%A9" title="چیچک – Urdu" lang="ur" hreflang="ur" data-title="چیچک" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target">اردو</a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/%C4%90%E1%BA%ADu_m%C3%B9a" title="Đậu mùa – Vietnamese" lang="vi" hreflang="vi" data-title="Đậu mùa" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target">Tiếng Việt</a></li><li class="interlanguage-link interwiki-fiu-vro mw-list-item"><a href="https://fiu-vro.wikipedia.org/wiki/Hernet%C3%B5bi" title="Hernetõbi – Võro" lang="vro" hreflang="vro" data-title="Hernetõbi" data-language-autonym="Võro" data-language-local-name="Võro" class="interlanguage-link-target">Võro</a></li><li class="interlanguage-link interwiki-wa mw-list-item"><a href="https://wa.wikipedia.org/wiki/Noer%C3%A8s_plokes" title="Noerès plokes – Walloon" lang="wa" hreflang="wa" data-title="Noerès plokes" data-language-autonym="Walon" data-language-local-name="Walloon" class="interlanguage-link-target">Walon</a></li><li class="interlanguage-link interwiki-war mw-list-item"><a href="https://war.wikipedia.org/wiki/Pandok" title="Pandok – Waray" lang="war" hreflang="war" data-title="Pandok" data-language-autonym="Winaray" data-language-local-name="Waray" class="interlanguage-link-target">Winaray</a></li><li class="interlanguage-link interwiki-wuu mw-list-item"><a href="https://wuu.wikipedia.org/wiki/%E5%A4%A9%E8%8A%B1" title="天花 – Wu" lang="wuu" hreflang="wuu" data-title="天花" data-language-autonym="吴语" data-language-local-name="Wu" class="interlanguage-link-target">吴语</a></li><li class="interlanguage-link interwiki-yi mw-list-item"><a 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For other uses, see <a href="/wiki/Variola_(disambiguation)" class="mw-disambig" title="Variola (disambiguation)">Variola (disambiguation)</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Smallpox</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">variola,<a href="#cite_note-1">[1]</a> variola vera,<a href="#cite_note-2">[2]</a> pox,<a href="#cite_note-Fenner_1988-3">[3]</a> red plague<a href="#cite_note-Peg2017-4">[4]</a></td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><a href="/wiki/File:Child_with_Smallpox_Bangladesh.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/66/Child_with_Smallpox_Bangladesh.jpg/225px-Child_with_Smallpox_Bangladesh.jpg" decoding="async" width="225" height="343" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/66/Child_with_Smallpox_Bangladesh.jpg/338px-Child_with_Smallpox_Bangladesh.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/66/Child_with_Smallpox_Bangladesh.jpg/450px-Child_with_Smallpox_Bangladesh.jpg 2x" data-file-width="1995" data-file-height="3040" /></a></td></tr><tr><td colspan="2" class="infobox-full-data">A child with smallpox in <a href="/wiki/Bangladesh" title="Bangladesh">Bangladesh</a> in 1973. The bumps filled with thick fluid and a depression or dimple in the center are characteristic.</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Infectious_disease_(medical_specialty)" class="mw-redirect" title="Infectious disease (medical specialty)">Infectious disease</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style><div class="plainlist"> <ul><li>Early: Fever, vomiting, mouth sores<a href="#cite_note-CDC2016Sym-5">[5]</a></li> <li>Later: Fluid filled <a href="/wiki/Blisters" class="mw-redirect" title="Blisters">blisters</a> which <a href="/wiki/Wound_healing#Proliferative_phase" title="Wound healing">scab</a> over<a href="#cite_note-CDC2016Sym-5">[5]</a></li></ul> </div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data">Scarring of the skin, blindness<a href="#cite_note-CDC2016What-6">[6]</a></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">1 to 3 weeks following exposure<a href="#cite_note-CDC2016Sym-5">[5]</a></td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">About 4 weeks<a href="#cite_note-CDC2016Sym-5">[5]</a></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data">variola major virus, <a href="/wiki/Alastrim" class="mw-redirect" title="Alastrim">variola minor virus</a> (spread between people)<a href="#cite_note-CDC2016What-6">[6]</a><a href="#cite_note-She2004-7">[7]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Based on symptoms and confirmed by <a href="/wiki/Polymerase_chain_reaction" title="Polymerase chain reaction">PCR</a><a href="#cite_note-CDC2017Diag-8">[8]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Differential_diagnosis" title="Differential diagnosis">Differential diagnosis</a></th><td class="infobox-data"><a href="/wiki/Chickenpox" title="Chickenpox">Chickenpox</a>, <a href="/wiki/Impetigo" title="Impetigo">impetigo</a>, <a href="/wiki/Molluscum_contagiosum" title="Molluscum contagiosum">molluscum contagiosum</a>, <a href="/wiki/Mpox" title="Mpox">mpox</a><a href="#cite_note-CDC2017Diag-8">[8]</a></td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data"><a href="/wiki/Smallpox_vaccine" title="Smallpox vaccine">Smallpox vaccine</a><a href="#cite_note-CDC2017Tx-9">[9]</a></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Supportive_care" class="mw-redirect" title="Supportive care">Supportive care</a><a href="#cite_note-WHO2007Fact-10">[10]</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medication" title="Medication">Medication</a></th><td class="infobox-data"><a href="/wiki/Brincidofovir" title="Brincidofovir">Brincidofovir</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">30% risk of death<a href="#cite_note-CDC2016Sym-5">[5]</a></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data"><a href="/wiki/Eradication_of_infectious_diseases" title="Eradication of infectious diseases">Eradicated</a> (last naturally occuring case in 1977)</td></tr></tbody></table> Smallpox was an <a href="/wiki/Infectious_disease" class="mw-redirect" title="Infectious disease">infectious disease</a> caused by variola <a href="/wiki/Virus" title="Virus">virus</a> (often called smallpox virus), which belongs to the genus <a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">Orthopoxvirus</a>.<a href="#cite_note-She2004-7">[7]</a><a href="#cite_note-Viruses2015-11">[11]</a> The <a href="/wiki/Ali_Maow_Maalin#Maalin's_case" title="Ali Maow Maalin">last naturally occurring case</a> was diagnosed in October 1977, and the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> (WHO) certified the <a href="/wiki/Eradication_of_infectious_diseases" title="Eradication of infectious diseases">global eradication</a> of the disease in 1980,<a href="#cite_note-WHO2007Fact-10">[10]</a> making smallpox the only human disease to have been eradicated to date.<a href="#cite_note-12">[12]</a> The initial symptoms of the disease included <a href="/wiki/Fever" title="Fever">fever</a> and vomiting.<a href="#cite_note-CDC2016Sym-5">[5]</a> This was followed by formation of <a href="/wiki/Ulcer_(dermatology)" title="Ulcer (dermatology)">ulcers</a> in the mouth and a <a href="/wiki/Skin_rash" class="mw-redirect" title="Skin rash">skin rash</a>.<a href="#cite_note-CDC2016Sym-5">[5]</a> Over a number of days, the skin rash turned into the characteristic fluid-filled <a href="/wiki/Blister" title="Blister">blisters</a> with a dent in the center.<a href="#cite_note-CDC2016Sym-5">[5]</a> The bumps then <a href="/wiki/Wound_healing#Proliferative_phase" title="Wound healing">scabbed</a> over and fell off, leaving scars.<a href="#cite_note-CDC2016Sym-5">[5]</a> The disease was transmitted from one person to another primarily through prolonged face-to-face contact with an infected person or rarely via <a href="/wiki/Fomite" title="Fomite">contaminated objects</a>.<a href="#cite_note-CDC2016What-6">[6]</a><a href="#cite_note-Leb2013-13">[13]</a><a href="#cite_note-2012Spread-14">[14]</a> Prevention was achieved mainly through the <a href="/wiki/Smallpox_vaccine" title="Smallpox vaccine">smallpox vaccine</a>.<a href="#cite_note-CDC2017Tx-9">[9]</a> Once the disease had developed, certain <a href="/wiki/Antiviral_medication" class="mw-redirect" title="Antiviral medication">antiviral medications</a> could potentially have helped, but such medications did not become available until after the disease was eradicated.<a href="#cite_note-CDC2017Tx-9">[9]</a> The risk of death was about 30%, with higher rates among babies.<a href="#cite_note-CDC2016What-6">[6]</a><a href="#cite_note-Rie2005-15">[15]</a> Often, those who survived had extensive <a href="/wiki/Scarring" class="mw-redirect" title="Scarring">scarring</a> of their skin, and some were left blind.<a href="#cite_note-CDC2016What-6">[6]</a> The earliest evidence of the disease dates to around 1500 BC in Egyptian <a href="/wiki/Mummy" title="Mummy">mummies</a>.<a href="#cite_note-CDC2017His-16">[16]</a><a href="#cite_note-17">[17]</a> The disease historically occurred in <a href="/wiki/Disease_outbreak" title="Disease outbreak">outbreaks</a>.<a href="#cite_note-WHO2007Fact-10">[10]</a> It was one of several diseases introduced by the <a href="/wiki/Columbian_exchange" title="Columbian exchange">Columbian exchange</a> to the <a href="/wiki/New_World" title="New World">New World</a>, resulting in <a href="/wiki/Native_American_disease_and_epidemics#European_contact" title="Native American disease and epidemics">large swathes of Native Americans dying</a>. In 18th-century Europe, it is estimated that 400,000 people died from the disease per year, and that one-third of all cases of blindness were due to smallpox.<a href="#cite_note-WHO2007Fact-10">[10]</a><a href="#cite_note-Hays2005-18">[18]</a> Smallpox is estimated to have killed up to 300 million people in the 20th century<a href="#cite_note-19">[19]</a><a href="#cite_note-20">[20]</a> and around 500 million people in the last 100 years of its existence.<a href="#cite_note-21">[21]</a> Earlier deaths included six European <a href="/wiki/Monarch" title="Monarch">monarchs</a>, including <a href="/wiki/Louis_XV_of_France" class="mw-redirect" title="Louis XV of France">Louis XV of France</a> in 1774.<a href="#cite_note-WHO2007Fact-10">[10]</a><a href="#cite_note-Hays2005-18">[18]</a> As recently as 1967, 15 million cases occurred a year.<a href="#cite_note-WHO2007Fact-10">[10]</a> The final known fatal case <a href="/wiki/1978_smallpox_outbreak_in_the_United_Kingdom" title="1978 smallpox outbreak in the United Kingdom">occurred in the United Kingdom in 1978</a>. <a href="/wiki/Inoculation" title="Inoculation">Inoculation</a> for smallpox appears to have started in China around the 1500s.<a href="#cite_note-22">[22]</a><a href="#cite_note-23">[23]</a> Europe adopted this practice from Asia in the first half of the 18th century.<a href="#cite_note-strathern179-24">[24]</a> In 1796, <a href="/wiki/Edward_Jenner" title="Edward Jenner">Edward Jenner</a> introduced the modern smallpox vaccine.<a href="#cite_note-Wolfe2002-25">[25]</a><a href="#cite_note-26">[26]</a> In 1967, the WHO intensified efforts to eliminate the disease.<a href="#cite_note-WHO2007Fact-10">[10]</a> Smallpox is one of two infectious diseases to have been eradicated, the other being <a href="/wiki/Rinderpest" title="Rinderpest">rinderpest</a> (a disease of <a href="/wiki/Even-toed_ungulate" class="mw-redirect" title="Even-toed ungulate">even-toed ungulates</a>) in 2011.<a href="#cite_note-27">[27]</a><a href="#cite_note-28">[28]</a> The term "smallpox" was first used in England in the 16th century to distinguish the disease from <a href="/wiki/Syphilis" title="Syphilis">syphilis</a>, which was then known as the "great pox".<a href="#cite_note-29">[29]</a><a href="#cite_note-Bar1997-30">[30]</a> Other historical names for the disease include pox, speckled monster, and red plague.<a href="#cite_note-Fenner_1988-3">[3]</a><a href="#cite_note-Peg2017-4">[4]</a><a href="#cite_note-Bar1997-30">[30]</a> The United States and Russia retain samples of variola virus in laboratories, which has sparked <a href="/wiki/Smallpox_virus_retention_debate" title="Smallpox virus retention debate">debates over safety</a>. <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Classification">Classification</h2></div> <table class="wikitable" style="text-align:center"> <caption><a href="/wiki/Case_fatality_rate" title="Case fatality rate">Case fatality rate</a> and frequency of smallpox by type and vaccination status according to Rao case study<a href="#cite_note-31">[31]</a> </caption> <tbody><tr> <th rowspan="2">Type of disease </th> <th colspan="2">Case fatality rate (%)</th> <th colspan="2">Frequency (%) </th></tr> <tr> <th><abbr title="unvaccinated">Unvac.</abbr></th> <th><abbr title="vaccinated">Vac.</abbr></th> <th><abbr title="unvaccinated">Unvac.</abbr></th> <th><abbr title="vaccinated">Vac.</abbr> </th></tr> <tr> <td style="text-align:left"><a href="#Ordinary">Ordinary discrete</a> </td> <td>9.3</td> <td>0.7</td> <td>42.1</td> <td>58.4 </td></tr> <tr> <td style="text-align:left"><a href="#Confluent">Ordinary confluent</a> </td> <td>62</td> <td>26.3</td> <td>22.8</td> <td>4.6 </td></tr> <tr> <td style="text-align:left">Ordinary semiconfluent </td> <td>37</td> <td>8.4</td> <td>23.9</td> <td>7 </td></tr> <tr> <td style="text-align:left"><a href="#Modified">Modified</a> </td> <td>0</td> <td>0</td> <td>2.1</td> <td>25.3 </td></tr> <tr> <td style="text-align:left"><a href="#Malignant">Malignant aka Flat</a> </td> <td>96.5</td> <td>66.7</td> <td>6.7</td> <td>1.3 </td></tr> <tr> <td style="text-align:left"><a href="#Early">Early hemorrhagic</a> </td> <td>100</td> <td>100</td> <td>0.7</td> <td>1.4 </td></tr> <tr> <td style="text-align:left"><a href="#Late">Late hemorrhagic</a> </td> <td>96.8</td> <td>89.8</td> <td>1.7</td> <td>2.0 </td></tr></tbody></table> There are two forms of the smallpox. Variola major is the severe and most common form, with a more extensive rash and higher fever. <a href="/wiki/Alastrim" class="mw-redirect" title="Alastrim">Variola minor</a> is a less common presentation, causing less severe disease, typically discrete smallpox, with historical death rates of 1% or less.<a href="#cite_note-FactSheet-32">[32]</a> Subclinical (<a href="/wiki/Asymptomatic" title="Asymptomatic">asymptomatic</a>) infections with variola virus were noted but were not common.<a href="#cite_note-PinkBook-33">[33]</a> In addition, a form called variola sine eruptione (smallpox without rash) was seen generally in vaccinated persons. This form was marked by a fever that occurred after the usual <a href="/wiki/Incubation_period" title="Incubation period">incubation period</a> and could be confirmed only by <a href="/wiki/Antibody" title="Antibody">antibody</a> studies or, rarely, by <a href="/wiki/Viral_culture" title="Viral culture">viral culture</a>.<a href="#cite_note-PinkBook-33">[33]</a> In addition, there were two very rare and fulminating types of smallpox, the malignant (flat) and hemorrhagic forms, which were usually fatal. <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1257001546"><table class="infobox" style="clear: right; float:right;margin:0 0 1.5em 1.5em"><tbody><tr><th colspan="2" class="infobox-above" style="font-size:115%">External videos</th></tr><tr><td colspan="2" class="infobox-full-data" style="text-align: left"><img alt="video icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1b/Nuvola_apps_kaboodle.svg/16px-Nuvola_apps_kaboodle.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1b/Nuvola_apps_kaboodle.svg/24px-Nuvola_apps_kaboodle.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/1b/Nuvola_apps_kaboodle.svg/32px-Nuvola_apps_kaboodle.svg.png 2x" data-file-width="128" data-file-height="128" /> <a rel="nofollow" class="external text" href="https://www.youtube.com/watch?v=RF97QTvFMic">Smallpox (US Army, 1967)</a> on YouTube</td></tr></tbody></table> The initial symptoms were similar to other viral diseases that are still extant, such as <a href="/wiki/Influenza" title="Influenza">influenza</a> and the <a href="/wiki/Common_cold" title="Common cold">common cold</a>: fever of at least 38.3 °C (101 °F), <a href="/wiki/Myalgia" title="Myalgia">muscle pain</a>, <a href="/wiki/Malaise" title="Malaise">malaise</a>, headache and fatigue. As the <a href="/wiki/Gastrointestinal_tract" title="Gastrointestinal tract">digestive tract</a> was commonly involved, nausea, vomiting, and backache often occurred. The early <a href="/wiki/Prodromal" class="mw-redirect" title="Prodromal">prodromal</a> stage usually lasted 2–4 days. By days 12–15, the first visible lesions – small reddish spots called <a href="/wiki/Enanthem" title="Enanthem">enanthem</a> – appeared on mucous membranes of the mouth, tongue, <a href="/wiki/Palate" title="Palate">palate</a>, and throat, and the temperature fell to near-normal. These lesions rapidly enlarged and ruptured, releasing large amounts of virus into the saliva.<a href="#cite_note-AFIP-34">[34]</a> Variola virus tended to attack skin cells, causing the characteristic pimples, or <a href="/wiki/Macule" class="mw-redirect" title="Macule">macules</a>, associated with the disease. A rash developed on the skin 24 to 48 hours after lesions on the mucous membranes appeared. Typically the macules first appeared on the forehead, then rapidly spread to the whole face, <a href="/wiki/Proximal" class="mw-redirect" title="Proximal">proximal</a> portions of extremities, the trunk, and lastly to <a href="/wiki/Distal" class="mw-redirect" title="Distal">distal</a> portions of extremities. The process took no more than 24 to 36 hours, after which no new lesions appeared.<a href="#cite_note-AFIP-34">[34]</a> At this point, variola major disease could take several very different courses, which resulted in four types of smallpox disease based on the Rao classification:<a href="#cite_note-:0-35">[35]</a> ordinary, modified, malignant (or flat), and hemorrhagic smallpox. Historically, ordinary smallpox had an overall <a href="/wiki/Fatality_rate" class="mw-redirect" title="Fatality rate">fatality rate</a> of about 30%, and the malignant and hemorrhagic forms were usually fatal. The modified form was almost never fatal. In early hemorrhagic cases, hemorrhages occurred before any skin lesions developed.<a href="#cite_note-eMedicine_Smallpox-36">[36]</a> The <a href="/wiki/Incubation_period" title="Incubation period">incubation period</a> between contraction and the first obvious symptoms of the disease was 7–14 days.<a href="#cite_note-pmid25490691-37">[37]</a> <div class="mw-heading mw-heading3"><h3 id="Ordinary">Ordinary</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Smallpox_child.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Smallpox_child.jpg/170px-Smallpox_child.jpg" decoding="async" width="170" height="250" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Smallpox_child.jpg/255px-Smallpox_child.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Smallpox_child.jpg/340px-Smallpox_child.jpg 2x" data-file-width="1305" data-file-height="1919" /></a><figcaption>A child showing rash due to ordinary-type smallpox (variola major)</figcaption></figure> At least 90% of smallpox cases among unvaccinated persons were of the ordinary type.<a href="#cite_note-PinkBook-33">[33]</a> In this form of the disease, by the second day of the rash the macules had become raised <a href="/wiki/Papule" title="Papule">papules</a>. By the third or fourth day, the papules had filled with an opalescent fluid to become <a href="/wiki/Vesicle_(dermatology)" class="mw-redirect" title="Vesicle (dermatology)">vesicles</a>. This fluid became <a href="/wiki/Opacity_(optics)" class="mw-redirect" title="Opacity (optics)">opaque</a> and turbid within 24–48 hours, resulting in <a href="/wiki/Pustule" class="mw-redirect" title="Pustule">pustules</a>. By the sixth or seventh day, all the skin lesions had become pustules. Between seven and ten days the pustules had matured and reached their maximum size. The pustules were sharply raised, typically round, tense, and firm to the touch. The pustules were deeply embedded in the dermis, giving them the feel of a small bead in the skin. Fluid slowly leaked from the pustules, and by the end of the second week, the pustules had deflated and began to dry up, forming crusts or scabs. By day 16–20 scabs had formed over all of the lesions, which had started to flake off, leaving <a href="/wiki/Depigmentation" title="Depigmentation">depigmented</a> scars.<a href="#cite_note-training1-38">[38]</a> Ordinary smallpox generally produced a discrete rash, in which the pustules stood out on the skin separately. The distribution of the rash was most dense on the face, denser on the extremities than on the trunk, and denser on the distal parts of the extremities than on the proximal. The palms of the hands and soles of the feet were involved in most cases.<a href="#cite_note-PinkBook-33">[33]</a> <div class="mw-heading mw-heading4"><h4 id="Confluent">Confluent</h4></div> Sometimes, the blisters merged into sheets, forming a confluent rash, which began to detach the outer layers of skin from the underlying flesh. Patients with confluent smallpox often remained ill even after scabs had formed over all the lesions. In one case series, the case-fatality rate in confluent smallpox was 62%.<a href="#cite_note-PinkBook-33">[33]</a> <div class="mw-heading mw-heading3"><h3 id="Modified">Modified</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Modified_smallpox2.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/69/Modified_smallpox2.png/220px-Modified_smallpox2.png" decoding="async" width="220" height="162" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/69/Modified_smallpox2.png/330px-Modified_smallpox2.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/69/Modified_smallpox2.png/440px-Modified_smallpox2.png 2x" data-file-width="1637" data-file-height="1204" /></a><figcaption>Modified smallpox in a vaccinated 4 year old in <a href="/wiki/Cardiff" title="Cardiff">Cardiff</a>, <a href="/wiki/Wales" title="Wales">Wales</a>, 1962</figcaption></figure> Referring to the character of the eruption and the rapidity of its development, modified smallpox occurred mostly in previously vaccinated people. It was rare in unvaccinated people, with one case study showing 1–2% of modified cases compared to around 25% in vaccinated people. In this form, the prodromal illness still occurred but may have been less severe than in the ordinary type. There was usually no fever during the evolution of the rash. The skin lesions tended to be fewer and evolved more quickly, were more superficial, and may not have shown the uniform characteristic of more typical smallpox.<a href="#cite_note-training1-38">[38]</a> Modified smallpox was rarely, if ever, fatal. This form of variola major was more easily confused with <a href="/wiki/Chickenpox" title="Chickenpox">chickenpox</a>.<a href="#cite_note-PinkBook-33">[33]</a> <div class="mw-heading mw-heading3"><h3 id="Malignant">Malignant</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Malignant_smallpox_(cropped).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Malignant_smallpox_%28cropped%29.jpg/220px-Malignant_smallpox_%28cropped%29.jpg" decoding="async" width="220" height="200" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/91/Malignant_smallpox_%28cropped%29.jpg/330px-Malignant_smallpox_%28cropped%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/91/Malignant_smallpox_%28cropped%29.jpg/440px-Malignant_smallpox_%28cropped%29.jpg 2x" data-file-width="1647" data-file-height="1498" /></a><figcaption>Malignant hemorrhagic smallpox in a baker during an 1896 epidemic in <a href="/wiki/Gloucester" title="Gloucester">Gloucester</a>, <a href="/wiki/England" title="England">England</a>. Died 8 days after admission.</figcaption></figure> In malignant-type smallpox (also called flat smallpox) the lesions remained almost flush with the skin at the time when raised vesicles would have formed in the ordinary type. It is unknown why some people developed this type. Historically, it accounted for 5–10% of cases, and most (72%) were children.<a href="#cite_note-Fenner_1988-3">[3]</a> Malignant smallpox was accompanied by a severe <a href="/wiki/Prodrome" title="Prodrome">prodromal</a> phase that lasted 3–4 days, prolonged high fever, and severe symptoms of <a href="/wiki/Viremia" title="Viremia">viremia</a>. The prodromal symptoms continued even after the onset of the rash.<a href="#cite_note-Fenner_1988-3">[3]</a> The rash on the mucous membranes (<a href="/wiki/Enanthem" title="Enanthem">enanthem</a>) was extensive. Skin lesions matured slowly, were typically confluent or semi-confluent, and by the seventh or eighth day, they were flat and appeared to be buried in the skin. Unlike ordinary-type smallpox, the vesicles contained little fluid, were soft and velvety to the touch, and may have contained hemorrhages. Malignant smallpox was nearly always fatal and death usually occurred between the 8th and 12th day of illness. Often, a day or two before death, the lesions turned ashen gray, which, along with abdominal distension, was a bad prognostic sign.<a href="#cite_note-Fenner_1988-3">[3]</a> This form is thought to be caused by deficient <a href="/wiki/Cell-mediated_immunity" title="Cell-mediated immunity">cell-mediated immunity</a> to smallpox. If the person recovered, the lesions gradually faded and did not form scars or scabs.<a href="#cite_note-CDC-39">[39]</a> <div class="mw-heading mw-heading3"><h3 id="Hemorrhagic">Hemorrhagic</h3></div> <a href="/wiki/Viral_hemorrhagic_fever" title="Viral hemorrhagic fever">Hemorrhagic</a> smallpox is a severe form accompanied by extensive bleeding into the skin, mucous membranes, gastrointestinal tract, and <a href="/wiki/Organ_(anatomy)" class="mw-redirect" title="Organ (anatomy)">viscera</a>. This form develops in approximately 2% of infections and occurs mostly in adults.<a href="#cite_note-PinkBook-33">[33]</a> Pustules do not typically form in hemorrhagic smallpox. Instead, bleeding occurs under the skin, making it look charred and black,<a href="#cite_note-PinkBook-33">[33]</a> hence this form of the disease is also referred to as variola nigra or "black pox".<a href="#cite_note-PrestonNY-40">[40]</a> Hemorrhagic smallpox has very rarely been caused by variola minor virus.<a href="#cite_note-Downie_619–629-41">[41]</a> While bleeding may occur in mild cases and not affect outcomes,<a href="#cite_note-Dixon_1962-42">[42]</a> hemorrhagic smallpox is typically fatal.<a href="#cite_note-Lane_2011-43">[43]</a> Vaccination does not appear to provide any immunity to either form of hemorrhagic smallpox and some cases even occurred among people that were revaccinated shortly before. It has two forms.<a href="#cite_note-Fenner_1988-3">[3]</a> <div class="mw-heading mw-heading4"><h4 id="Early">Early</h4></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Hemorrhagic_smallpox_2_(cropped).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Hemorrhagic_smallpox_2_%28cropped%29.jpg/220px-Hemorrhagic_smallpox_2_%28cropped%29.jpg" decoding="async" width="220" height="179" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Hemorrhagic_smallpox_2_%28cropped%29.jpg/330px-Hemorrhagic_smallpox_2_%28cropped%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/9/9b/Hemorrhagic_smallpox_2_%28cropped%29.jpg 2x" data-file-width="362" data-file-height="295" /></a><figcaption>An unvaccinated person with probable hemorrhagic smallpox in a 1925 <a href="/wiki/Milwaukee,_Wisconsin" class="mw-redirect" title="Milwaukee, Wisconsin">Milwaukee, Wisconsin</a> epidemic. He later died of the disease.</figcaption></figure> The early or <a href="/wiki/Fulminant" title="Fulminant">fulminant</a> form of hemorrhagic smallpox (referred to as purpura variolosa) begins with a prodromal phase characterized by a high fever, severe headache, and abdominal pain.<a href="#cite_note-CDC-39">[39]</a> The skin becomes dusky and erythematous, and this is rapidly followed by the development of <a href="/wiki/Petechia" title="Petechia">petechiae</a> and bleeding in the skin, <a href="/wiki/Subconjunctival_bleeding" title="Subconjunctival bleeding">conjunctiva</a> and mucous membranes. Death often occurs suddenly between the fifth and seventh days of illness, when only a few insignificant skin lesions are present. Some people survive a few days longer, during which time the skin detaches and fluid accumulates under it, rupturing at the slightest injury. People are usually conscious until death or shortly before.<a href="#cite_note-Lane_2011-43">[43]</a> Autopsy reveals <a href="/wiki/Petechiae" class="mw-redirect" title="Petechiae">petechiae</a> and bleeding in the spleen, kidney, <a href="/wiki/Serous_membranes" class="mw-redirect" title="Serous membranes">serous membranes</a>, skeletal muscles, <a href="/wiki/Pericardium" title="Pericardium">pericardium</a>, liver, gonads and bladder.<a href="#cite_note-Downie_619–629-41">[41]</a> Historically, this condition was frequently misdiagnosed, with the correct diagnosis made only at autopsy.<a href="#cite_note-Downie_619–629-41">[41]</a> This form is more likely to occur in pregnant women than in the general population (approximately 16% of cases in unvaccinated pregnant women were early hemorrhagic smallpox, versus roughly 1% in nonpregnant women and adult males).<a href="#cite_note-Lane_2011-43">[43]</a> The case fatality rate of early hemorrhagic smallpox approaches 100%.<a href="#cite_note-Lane_2011-43">[43]</a> <div class="mw-heading mw-heading4"><h4 id="Late">Late</h4></div> There is also a later form of hemorrhagic smallpox (referred to late hemorrhagic smallpox, or variolosa pustula hemorrhagica). The prodrome is severe and similar to that observed in early hemorrhagic smallpox, and the fever persists throughout the course of the disease.<a href="#cite_note-Fenner_1988-3">[3]</a> Bleeding appears in the early eruptive period (but later than that seen in purpura variolosa), and the rash is often flat and does not progress beyond the vesicular stage. Hemorrhages in the mucous membranes appear to occur less often than in the early hemorrhagic form.<a href="#cite_note-PinkBook-33">[33]</a> Sometimes the rash forms pustules which bleed at the base and then undergo the same process as in ordinary smallpox. This form of the disease is characterized by a decrease in all of the elements of the <a href="/wiki/Coagulation" title="Coagulation">coagulation</a> cascade and an increase in circulating <a href="/wiki/Antithrombin" title="Antithrombin">antithrombin</a>.<a href="#cite_note-AFIP-34">[34]</a> This form of smallpox occurs anywhere from 3% to 25% of fatal cases, depending on the virulence of the smallpox strain.<a href="#cite_note-eMedicine_Smallpox-36">[36]</a> Most people with the late-stage form die within eight to 10 days of illness. Among the few who recover, the hemorrhagic lesions gradually disappear after a long period of convalescence.<a href="#cite_note-Fenner_1988-3">[3]</a> The case fatality rate for late hemorrhagic smallpox is around 90–95%.<a href="#cite_note-:0-35">[35]</a> Pregnant women are slightly more likely to experience this form of the disease, though not as much as early hemorrhagic smallpox.<a href="#cite_note-Fenner_1988-3">[3]</a> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2></div> <table class="infobox biota" style="text-align: left; width: 200px; font-size: 100%"> <tbody><tr> <th colspan="2" style="color:inherit; text-align: center; background-color: rgb(250,250,190)">Variola virus </th></tr> <tr> <td colspan="2" style="text-align: center"><a href="/wiki/File:Smallpox_virus_virions_TEM_PHIL_1849.JPG" class="mw-file-description"><img alt="This transmission electron micrograph depicts a number of smallpox virions. The "dumbbell-shaped" structure inside the virion is the viral core, which contains the viral DNA; Mag. = ~370,000×" src="//upload.wikimedia.org/wikipedia/commons/thumb/9/92/Smallpox_virus_virions_TEM_PHIL_1849.JPG/220px-Smallpox_virus_virions_TEM_PHIL_1849.JPG" decoding="async" width="220" height="239" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/92/Smallpox_virus_virions_TEM_PHIL_1849.JPG/330px-Smallpox_virus_virions_TEM_PHIL_1849.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/92/Smallpox_virus_virions_TEM_PHIL_1849.JPG/440px-Smallpox_virus_virions_TEM_PHIL_1849.JPG 2x" data-file-width="3424" data-file-height="3727" /></a> </td></tr> <tr> <td colspan="2" style="text-align: center; font-size: 88%">This <a href="/wiki/Transmission_electron_microscopy" title="Transmission electron microscopy">transmission electron micrograph</a> depicts a number of smallpox <a href="/wiki/Virion" class="mw-redirect" title="Virion">virions</a>. The "dumbbell-shaped" structure inside the virion is the viral core, which contains the viral DNA; Mag. = ~370,000× </td></tr> <tr> <th colspan="2" style="color:inherit; min-width:15em; text-align: center; background-color: rgb(250,250,190)"><a href="/wiki/Virus_classification" title="Virus classification">Virus classification</a> <a href="/wiki/Template:Taxonomy/Variola_virus" title="Edit this classification"><img alt="Edit this classification" src="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/OOjs_UI_icon_edit-ltr.svg/15px-OOjs_UI_icon_edit-ltr.svg.png" decoding="async" width="15" height="15" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/OOjs_UI_icon_edit-ltr.svg/23px-OOjs_UI_icon_edit-ltr.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/8a/OOjs_UI_icon_edit-ltr.svg/30px-OOjs_UI_icon_edit-ltr.svg.png 2x" data-file-width="20" data-file-height="20" /></a> </th></tr> <tr> <td>(unranked): </td> <td><a href="/wiki/Virus" title="Virus">Virus</a> </td></tr> <tr> <td>Realm: </td> <td><a href="/wiki/Varidnaviria" title="Varidnaviria">Varidnaviria</a> </td></tr> <tr> <td>Kingdom: </td> <td><a href="/wiki/Bamfordvirae" title="Bamfordvirae">Bamfordvirae</a> </td></tr> <tr> <td>Phylum: </td> <td><a href="/wiki/Nucleocytoviricota" title="Nucleocytoviricota">Nucleocytoviricota</a> </td></tr> <tr> <td>Class: </td> <td><a href="/wiki/Pokkesviricetes" title="Pokkesviricetes">Pokkesviricetes</a> </td></tr> <tr> <td>Order: </td> <td><a href="/wiki/Poxviridae" title="Poxviridae">Chitovirales</a> </td></tr> <tr> <td>Family: </td> <td><a href="/wiki/Poxviridae" title="Poxviridae">Poxviridae</a> </td></tr> <tr> <td>Genus: </td> <td><a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">Orthopoxvirus</a> </td></tr> <tr> <td>Species: </td> <td>†Variola virus </td></tr> </tbody></table><style data-mw-deduplicate="TemplateStyles:r1238732961">@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox.biota tr{background:transparent!important}html.skin-theme-clientpref-night .mw-parser-output .infobox.biota img{background:transparent}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox.biota tr{background:transparent!important}html.skin-theme-clientpref-os .mw-parser-output .infobox.biota img{background:white}}.mw-parser-output .infobox.biota .taxobox-edit-taxonomy img{background:transparent!important}body.skin-vector .mw-parser-output table.biota.infobox{margin-top:0.5em}body.skin--responsive .mw-parser-output table.biota.infobox tr.taxonrow td{padding:2px 10px}</style> Smallpox is caused by infection with variola virus, which belongs to the family <a href="/wiki/Poxviridae" title="Poxviridae">Poxviridae</a>, subfamily <a href="/wiki/Chordopoxvirinae" title="Chordopoxvirinae">Chordopoxvirinae</a>, genus <a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">Orthopoxvirus</a>. <div class="mw-heading mw-heading3"><h3 id="Evolution">Evolution</h3></div> The date of the appearance of smallpox is not settled. It most probably evolved from a terrestrial African rodent virus between 68,000 and 16,000 years ago.<a href="#cite_note-Esposito2006-44">[44]</a> The wide range of dates is due to the different records used to calibrate the <a href="/wiki/Molecular_clock" title="Molecular clock">molecular clock</a>. One <a href="/wiki/Clade" title="Clade">clade</a> was the variola major strains (the more clinically severe form of smallpox) which spread from Asia between 400 and 1,600 years ago. A second clade included both alastrim (a phenotypically mild smallpox) described from the American continents and isolates from West Africa which diverged from an ancestral strain between 1,400 and 6,300 years before present. This clade further diverged into two subclades at least 800 years ago.<a href="#cite_note-Li2007-45">[45]</a> A second estimate has placed the separation of variola virus from <a href="/w/index.php?title=Taterapox&action=edit&redlink=1" class="new" title="Taterapox (page does not exist)">Taterapox</a> (an <a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">Orthopoxvirus</a> of some African rodents including <a href="/wiki/Gerbillinae" title="Gerbillinae">gerbils</a>) at 3,000 to 4,000 years ago.<a href="#cite_note-Hughes2010-46">[46]</a> This is consistent with archaeological and historical evidence regarding the appearance of smallpox as a human disease which suggests a relatively recent origin. If the mutation rate is assumed to be similar to that of the <a href="/wiki/Herpesvirus" class="mw-redirect" title="Herpesvirus">herpesviruses</a>, the divergence date of variola virus from Taterapox has been estimated to be 50,000 years ago.<a href="#cite_note-Hughes2010-46">[46]</a> While this is consistent with the other published estimates, it suggests that the archaeological and historical evidence is very incomplete. Better estimates of mutation rates in these viruses are needed. Examination of a strain that dates from <abbr title="circa">c.</abbr> 1650 found that this strain was <a href="/wiki/Basal_(phylogenetics)" title="Basal (phylogenetics)">basal</a> to the other presently sequenced strains.<a href="#cite_note-Duggan2016-47">[47]</a> The mutation rate of this virus is well modeled by a molecular clock. Diversification of strains only occurred in the 18th and 19th centuries. <div class="mw-heading mw-heading3"><h3 id="Virology">Virology</h3></div> Variola virus is large and brick-shaped and is approximately 302 to 350 <a href="/wiki/Nanometer" class="mw-redirect" title="Nanometer">nanometers</a> by 244 to 270 nm,<a href="#cite_note-48">[48]</a> with a single linear <a href="/wiki/DsDNA" class="mw-redirect" title="DsDNA">double stranded DNA</a> <a href="/wiki/Genome" title="Genome">genome</a> 186 <a href="/wiki/Kilobase_pair" class="mw-redirect" title="Kilobase pair">kilobase pairs</a> (kbp) in size and containing a <a href="/wiki/Hairpin_loop" class="mw-redirect" title="Hairpin loop">hairpin loop</a> at each end.<a href="#cite_note-Moss-49">[49]</a><a href="#cite_note-Damon-50">[50]</a> Four orthopoxviruses cause infection in humans: variola, <a href="/wiki/Vaccinia" title="Vaccinia">vaccinia</a>, <a href="/wiki/Cowpox" title="Cowpox">cowpox</a>, and <a href="/wiki/Monkeypox_virus" title="Monkeypox virus">monkeypox</a>. Variola virus infects only humans in nature, although primates and other animals have been infected in an experimental setting. Vaccinia, cowpox, and monkeypox viruses can infect both humans and other animals in nature.<a href="#cite_note-PinkBook-33">[33]</a> The life cycle of poxviruses is complicated by having multiple infectious forms, with differing mechanisms of cell entry. Poxviruses are unique among human DNA viruses in that they replicate in the <a href="/wiki/Cytoplasm" title="Cytoplasm">cytoplasm</a> of the cell rather than in the <a href="/wiki/Cell_nucleus" title="Cell nucleus">nucleus</a>. To replicate, poxviruses produce a variety of specialized proteins not produced by other <a href="/wiki/DNA_viruses" class="mw-redirect" title="DNA viruses">DNA viruses</a>, the most important of which is a viral-associated <a href="/wiki/DNA-dependent_RNA_polymerase" class="mw-redirect" title="DNA-dependent RNA polymerase">DNA-dependent RNA polymerase</a>. Both <a href="/wiki/Viral_envelope" title="Viral envelope">enveloped</a> and unenveloped <a href="/wiki/Virions" class="mw-redirect" title="Virions">virions</a> are infectious. The viral envelope is made of modified <a href="/wiki/Golgi_apparatus" title="Golgi apparatus">Golgi</a> membranes containing viral-specific polypeptides, including <a href="/wiki/Hemagglutinin" title="Hemagglutinin">hemagglutinin</a>.<a href="#cite_note-Moss-49">[49]</a> Infection with either variola major virus or variola minor virus confers immunity against the other.<a href="#cite_note-AFIP-34">[34]</a> <div class="mw-heading mw-heading4"><h4 id="Variola_major">Variola major</h4></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Expand_section plainlinks metadata ambox mbox-small-left ambox-content" role="presentation"><tbody><tr><td class="mbox-image"><a href="/wiki/File:Wiki_letter_w_cropped.svg" class="mw-file-description"><img alt="[icon]" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/20px-Wiki_letter_w_cropped.svg.png" decoding="async" width="20" height="14" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/30px-Wiki_letter_w_cropped.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/40px-Wiki_letter_w_cropped.svg.png 2x" data-file-width="44" data-file-height="31" /></a></td><td class="mbox-text"><div class="mbox-text-span">This section needs expansion. You can help by <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Talk%3ASmallpox&preload=Template%3ASubmit+an+edit+request%2Fpreload&action=edit&section=new&editintro=Template%3AEdit+protected%2Feditintro&preloadtitle=Protected+edit+request+on+23+November+2024&preloadparams%5B%5D=edit+fully-protected&preloadparams%5B%5D=Smallpox">making an edit request</a><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Smallpox&action=edit&section=">adding to it</a> . (June 2023)</div></td></tr></tbody></table> The more common, infectious form of the disease was caused by the variola major virus strain, known for its significantly higher mortality rate compared to its counterpart, variola minor. Variola major had a fatality rate of around 30%, while variola minor’s mortality rate was about 1%. Throughout the 18th century, variola major was responsible for around 400,000 deaths annually in Europe alone. Survivors of the disease often faced lifelong consequences, such as blindness and severe scarring, which were nearly universal among those who recovered.<a href="#cite_note-51">[51]</a> In the first half of the 20th century, variola major was the primary cause of smallpox outbreaks across Asia and most of Africa. Meanwhile, variola minor was more commonly found in regions of Europe, North America, South America, and certain parts of Africa.<a href="#cite_note-52">[52]</a> <div class="mw-heading mw-heading4"><h4 id="Variola_minor">Variola minor</h4></div> Variola minor virus, also called alastrim, was a less common form of the virus, and much less deadly. Although variola minor had the same incubation period and pathogenetic stages as smallpox, it is believed to have had a mortality rate of less than 1%, as compared to variola major's 30%. Like variola major, variola minor was spread through inhalation of the virus in the air, which could occur through face-to-face contact or through fomites. Infection with variola minor virus conferred immunity against the more dangerous variola major virus. Because variola minor was a less debilitating disease than smallpox, people were more frequently ambulant and thus able to infect others more rapidly. As such, variola minor swept through the United States, Great Britain, and South Africa in the early 20th century, becoming the dominant form of the disease in those areas and thus rapidly decreasing mortality rates. Along with variola major, the minor form has now been totally eradicated from the globe. The last case of indigenous variola minor was reported in a Somali cook, Ali Maow Maalin, in October 1977, and smallpox was officially declared eradicated worldwide in May 1980.<a href="#cite_note-CDC2017His-16">[16]</a> Variola minor was also called white pox, kaffir pox, Cuban itch, West Indian pox, milk pox, and pseudovariola. <div class="mw-heading mw-heading4"><h4 id="Genome_composition">Genome composition</h4></div> The <a href="/wiki/Genome" title="Genome">genome</a> of variola major virus is about 186,000 base pairs in length.<a href="#cite_note-53">[53]</a> It is made from linear double stranded <a href="/wiki/DNA" title="DNA">DNA</a> and contains the <a href="/wiki/Coding_region" title="Coding region">coding sequence</a> for about 200 <a href="/wiki/Gene" title="Gene">genes</a>.<a href="#cite_note-:1-54">[54]</a> The genes are usually not overlapping and typically occur in blocks that point towards the closer terminal region of the genome.<a href="#cite_note-:2-55">[55]</a> The coding sequence of the central region of the genome is highly consistent across <a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">orthopoxviruses</a>, and the arrangement of genes is consistent across chordopoxviruses.<a href="#cite_note-:1-54">[54]</a><a href="#cite_note-:2-55">[55]</a> The center of the variola virus genome contains the majority of the essential viral genes, including the genes for structural <a href="/wiki/Protein" title="Protein">proteins</a>, <a href="/wiki/DNA_replication" title="DNA replication">DNA replication</a>, <a href="/wiki/Transcription_(biology)" title="Transcription (biology)">transcription</a>, and <a href="/wiki/Messenger_RNA" title="Messenger RNA">mRNA</a> synthesis.<a href="#cite_note-:1-54">[54]</a> The ends of the genome vary more across strains and species of <a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">orthopoxviruses</a>.<a href="#cite_note-:1-54">[54]</a> These regions contain proteins that <a href="/wiki/Immunomodulation" title="Immunomodulation">modulate</a> the hosts' immune systems, and are primarily responsible for the variability in <a href="/wiki/Virulence" title="Virulence">virulence</a> across the <a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">orthopoxvirus</a> family.<a href="#cite_note-:1-54">[54]</a> These terminal regions in poxviruses are <a href="/wiki/Inverted_repeat" title="Inverted repeat">inverted terminal repetitions</a> (ITR) sequences.<a href="#cite_note-:2-55">[55]</a> These sequences are identical but oppositely oriented on either end of the genome, leading to the genome being a continuous loop of DNA.<a href="#cite_note-:2-55">[55]</a> Components of the ITR sequences include an incompletely base paired A/T rich <a href="/wiki/Stem-loop" title="Stem-loop">hairpin loop</a>, a region of roughly 100 base pairs necessary for resolving <a href="/wiki/Concatemer" title="Concatemer">concatomeric</a> DNA (a stretch of DNA containing multiple copies of the same sequence), a few <a href="/wiki/Open_reading_frame" title="Open reading frame">open reading frames</a>, and <a href="/wiki/Microsatellite" title="Microsatellite">short tandemly repeating sequences</a> of varying number and length.<a href="#cite_note-:2-55">[55]</a> The ITRs of <a href="/wiki/Poxviridae" title="Poxviridae">poxviridae</a> vary in length across strains and species.<a href="#cite_note-:2-55">[55]</a> The coding sequence for most of the viral proteins in variola major virus have at least 90% similarity with the genome of <a href="/wiki/Vaccinia" title="Vaccinia">vaccinia</a>, a related virus used for <a href="/wiki/Vaccination" title="Vaccination">vaccination</a> against smallpox.<a href="#cite_note-:2-55">[55]</a> <div class="mw-heading mw-heading4"><h4 id="Gene_expression">Gene expression</h4></div> <a href="/wiki/Gene_expression" title="Gene expression">Gene expression</a> of variola virus occurs entirely within the <a href="/wiki/Cytoplasm" title="Cytoplasm">cytoplasm</a> of the host <a href="/wiki/Cell_(biology)" title="Cell (biology)">cell</a>, and follows a distinct progression during infection.<a href="#cite_note-:2-55">[55]</a> After entry of an infectious <a href="/wiki/Virus" title="Virus">virion</a> into a host cell, synthesis of viral <a href="/wiki/Messenger_RNA" title="Messenger RNA">mRNA</a> can be detected within 20 minutes.<a href="#cite_note-:2-55">[55]</a> About half of the viral genome is <a href="/wiki/Transcription_(biology)" title="Transcription (biology)">transcribed</a> prior to the <a href="/wiki/DNA_replication" title="DNA replication">replication</a> of viral DNA.<a href="#cite_note-:2-55">[55]</a> The first set of expressed genes are transcribed by pre-existing viral machinery packaged within the infecting virion.<a href="#cite_note-:2-55">[55]</a> These genes encode the factors necessary for viral DNA synthesis and for transcription of the next set of expressed genes.<a href="#cite_note-:2-55">[55]</a> Unlike most DNA viruses, <a href="/wiki/DNA_replication" title="DNA replication">DNA replication</a> in variola virus and other poxviruses takes place within the cytoplasm of the infected cell.<a href="#cite_note-:2-55">[55]</a> The exact timing of DNA replication after infection of a host cell varies across the <a href="/wiki/Poxviridae" title="Poxviridae">poxviridae</a>.<a href="#cite_note-:2-55">[55]</a> <a href="/wiki/Recombinant_DNA" title="Recombinant DNA">Recombination</a> of the genome occurs within actively infected cells.<a href="#cite_note-:2-55">[55]</a> Following the onset of viral DNA replication, an intermediate set of genes codes for <a href="/wiki/Transcription_factor" title="Transcription factor">transcription factors</a> of late gene expression.<a href="#cite_note-:2-55">[55]</a> The <a href="/wiki/Gene_product" title="Gene product">products</a> of the later genes include transcription factors necessary for transcribing the early genes for new virions, as well as viral <a href="/wiki/RNA_polymerase" title="RNA polymerase">RNA polymerase</a> and other essential enzymes for new viral particles.<a href="#cite_note-:2-55">[55]</a> These proteins are then packaged into new infectious virions capable of infecting other cells.<a href="#cite_note-:2-55">[55]</a> <div class="mw-heading mw-heading3"><h3 id="Research">Research</h3></div> Two live samples of variola major virus remain, one in the United States at the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">CDC</a> in Atlanta, and one at the <a href="/wiki/State_Research_Center_of_Virology_and_Biotechnology_VECTOR" title="State Research Center of Virology and Biotechnology VECTOR">Vector Institute</a> in Koltsovo, Russia.<a href="#cite_note-:3-56">[56]</a> Research with the remaining virus samples is tightly controlled, and each research proposal must be approved by the <a href="/wiki/World_Health_Organization" title="World Health Organization">WHO</a> and the <a href="/wiki/World_Health_Assembly" title="World Health Assembly">World Health Assembly</a> (WHA).<a href="#cite_note-:3-56">[56]</a> Most research on poxviruses is performed using the closely related <a href="/wiki/Vaccinia" title="Vaccinia">Vaccinia virus</a> as a model organism.<a href="#cite_note-:2-55">[55]</a> Vaccinia virus, which is used to vaccinate for smallpox, is also under research as a <a href="/wiki/Viral_vector_vaccine" title="Viral vector vaccine">viral vector</a> for <a href="/wiki/Vaccine" title="Vaccine">vaccines</a> for unrelated diseases.<a href="#cite_note-57">[57]</a> The genome of variola major virus was first <a href="/wiki/DNA_sequencing" title="DNA sequencing">sequenced</a> in its entirety in the 1990s.<a href="#cite_note-:1-54">[54]</a> The complete coding sequence is publicly available online. The current <a href="/wiki/Reference_genome" title="Reference genome">reference sequence</a> for variola major virus was sequenced from a strain that circulated in India in 1967. In addition, there are sequences for samples of other strains that were collected during the WHO eradication campaign.<a href="#cite_note-:1-54">[54]</a> A <a href="/wiki/Genome_browser" title="Genome browser">genome browser</a> for a complete database of annotated sequences of variola virus and other poxviruses is publicly available through the <a href="/wiki/Viral_Bioinformatics_Resource_Center" title="Viral Bioinformatics Resource Center">Viral Bioinformatics Resource Center</a>.<a href="#cite_note-58">[58]</a> <div class="mw-heading mw-heading4"><h4 id="Genetic_engineering">Genetic engineering</h4></div> The <a href="/wiki/World_Health_Organization" title="World Health Organization">WHO</a> currently bans <a href="/wiki/Genetic_engineering" title="Genetic engineering">genetic engineering</a> of the variola virus.<a href="#cite_note-:4-59">[59]</a> However, in 2004, a committee advisory to the WHO voted in favor of allowing editing of the genome of the two remaining samples of variola major virus to add a <a href="/wiki/Marker_gene" title="Marker gene">marker gene</a>.<a href="#cite_note-:4-59">[59]</a> This gene, called <a href="/wiki/Green_fluorescent_protein" title="Green fluorescent protein">GFP</a>, or green fluorescent protein, would cause live samples of the virus to glow green under fluorescent light.<a href="#cite_note-:5-60">[60]</a> The insertion of this gene, which would not influence the <a href="/wiki/Virulence" title="Virulence">virulence</a> of the virus, would be the only allowed modification of the genome.<a href="#cite_note-:5-60">[60]</a> The committee stated the proposed modification would aid in research of treatments by making it easier to assess whether a potential treatment was effective in killing viral samples.<a href="#cite_note-:5-60">[60]</a> The recommendation could only take effect if approved by the <a href="/wiki/World_Health_Assembly" title="World Health Assembly">WHA</a>.<a href="#cite_note-:5-60">[60]</a> When the WHA discussed the proposal in 2005, it refrained from taking a formal vote on the proposal, stating that it would review individual research proposals one at a time.<a href="#cite_note-61">[61]</a> Addition of the GFP gene to the <a href="/wiki/Vaccinia" title="Vaccinia">Vaccinia</a> genome is routinely performed during research on the closely related <a href="/wiki/Vaccinia" title="Vaccinia">Vaccinia virus</a>.<a href="#cite_note-62">[62]</a> <div class="mw-heading mw-heading4"><h4 id="Controversies">Controversies</h4></div> The public availability of the variola virus complete sequence has raised concerns about the possibility of illicit synthesis of infectious virus.<a href="#cite_note-:6-63">[63]</a> <a href="/wiki/Vaccinia" title="Vaccinia">Vaccinia</a>, a cousin of the variola virus, was artificially synthesized in 2002 by <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">NIH</a> scientists.<a href="#cite_note-:7-64">[64]</a> They used a previously established method that involved using a <a href="/wiki/Recombinant_DNA" title="Recombinant DNA">recombinant</a> viral genome to create a self-replicating bacterial <a href="/wiki/Plasmid" title="Plasmid">plasmid</a> that produced viral particles.<a href="#cite_note-:7-64">[64]</a> In 2016, another group synthesized the <a href="/wiki/Horsepox" class="mw-redirect" title="Horsepox">horsepox</a> virus using publicly available sequence data for horsepox.<a href="#cite_note-:8-65">[65]</a> The researchers argued that their work would be beneficial to creating a safer and more effective <a href="/wiki/Vaccine" title="Vaccine">vaccine</a> for smallpox, although an effective vaccine is already available.<a href="#cite_note-:8-65">[65]</a> The horsepox virus had previously seemed to have gone extinct, raising concern about potential revival of variola major and causing other scientists to question their motives.<a href="#cite_note-:6-63">[63]</a> Critics found it especially concerning that the group was able to recreate viable virus in a short time frame with relatively little cost or effort.<a href="#cite_note-:8-65">[65]</a> Although the WHO bans individual laboratories from <a href="/wiki/Artificial_gene_synthesis" title="Artificial gene synthesis">synthesizing</a> more than 20% of the genome at a time, and purchases of smallpox genome fragments are monitored and regulated, a group with <a href="/wiki/Bioterrorism" title="Bioterrorism">malicious intentions</a> could compile, from multiple sources, the full synthetic genome necessary to produce viable virus.<a href="#cite_note-:8-65">[65]</a> <div class="mw-heading mw-heading3"><h3 id="Transmission">Transmission</h3></div> Smallpox was highly contagious, but generally spread more slowly and less widely than some other viral diseases, perhaps because transmission required close contact and occurred after the onset of the rash. The overall rate of infection was also affected by the short duration of the infectious stage. In <a href="/wiki/Temperate" class="mw-redirect" title="Temperate">temperate</a> areas, the number of smallpox infections was highest during the winter and spring. In tropical areas, seasonal variation was less evident and the disease was present throughout the year.<a href="#cite_note-PinkBook-33">[33]</a> Age distribution of smallpox infections depended on <a href="/wiki/Acquired_immunity" class="mw-redirect" title="Acquired immunity">acquired immunity</a>. <a href="/wiki/Vaccination" title="Vaccination">Vaccination</a> <a href="/wiki/Immunity_(medical)" class="mw-redirect" title="Immunity (medical)">immunity</a> declined over time and was probably lost within thirty years.<a href="#cite_note-AFIP-34">[34]</a> Smallpox was not known to be transmitted by insects or animals and there was no <a href="/wiki/Asymptomatic_carrier" title="Asymptomatic carrier">asymptomatic carrier</a> state.<a href="#cite_note-PinkBook-33">[33]</a> Transmission occurred through inhalation of <a href="/wiki/Airborne_disease" class="mw-redirect" title="Airborne disease">airborne</a> variola virus, usually droplets expressed from the oral, nasal, or <a href="/wiki/Pharynx" title="Pharynx">pharyngeal</a> <a href="/wiki/Mucosa" class="mw-redirect" title="Mucosa">mucosa</a> of an infected person. It was transmitted from one person to another primarily through prolonged face-to-face contact with an infected person.<a href="#cite_note-2012Spread-14">[14]</a> Some infections of laundry workers with smallpox after handling contaminated bedding suggested that smallpox could be spread through direct contact with contaminated objects (<a href="/wiki/Fomite" title="Fomite">fomites</a>), but this was found to be rare.<a href="#cite_note-2012Spread-14">[14]</a><a href="#cite_note-:0-35">[35]</a> Also rarely, smallpox was spread by virus carried in the air in enclosed settings such as buildings, buses, and trains.<a href="#cite_note-FactSheet-32">[32]</a> The virus can cross the <a href="/wiki/Placenta" title="Placenta">placenta</a>, but the incidence of <a href="/wiki/Congenital" class="mw-redirect" title="Congenital">congenital</a> smallpox was relatively low.<a href="#cite_note-AFIP-34">[34]</a> Smallpox was not notably infectious in the <a href="/wiki/Prodrome" title="Prodrome">prodromal</a> period and viral shedding was usually delayed until the appearance of the rash, which was often accompanied by <a href="/wiki/Lesion" title="Lesion">lesions</a> in the mouth and pharynx. The virus can be transmitted throughout the course of the illness, but this happened most frequently during the first week of the rash when most of the skin lesions were intact.<a href="#cite_note-PinkBook-33">[33]</a> Infectivity waned in 7 to 10 days when scabs formed over the lesions, but the infected person was contagious until the last smallpox scab fell off.<a href="#cite_note-pmid10367824-66">[66]</a> Concern about possible use of smallpox for biological warfare led in 2002 to Donald K. Milton's detailed review of existing research on its transmission and of then-current recommendations for controlling its spread. He agreed, citing Rao, <a href="/wiki/Frank_Fenner" title="Frank Fenner">Fenner</a> and others, that “careful epidemiologic investigation rarely implicated fomites as a source of infection”; noted that “Current recommendations for control of secondary smallpox infections emphasize transmission ‘by expelled droplets to close contacts (those within 6–7 feet)’”; but warned that the “emphasis on spread via large droplets may reduce the vigilance with which more difficult airborne precautions [i.e. against finer droplets capable of traveling longer distances and penetrating deeply into the lower respiratory tract] are maintained”.<a href="#cite_note-67">[67]</a> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2></div> Once inhaled, the variola virus invaded the mucous membranes of the mouth, throat, and respiratory tract. From there, it migrated to regional <a href="/wiki/Lymph_nodes" class="mw-redirect" title="Lymph nodes">lymph nodes</a> and began to multiply. In the initial growth phase, the virus seemed to move from cell to cell, but by around the 12th day, widespread <a href="/wiki/Lysis" title="Lysis">lysis</a> of infected cells occurred and the virus could be found in the bloodstream in large numbers, a condition known as <a href="/wiki/Viremia" title="Viremia">viremia</a>. This resulted in the second wave of multiplication in the <a href="/wiki/Spleen" title="Spleen">spleen</a>, <a href="/wiki/Bone_marrow" title="Bone marrow">bone marrow</a>, and lymph nodes. <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2></div> The clinical definition of ordinary smallpox is an illness with acute onset of fever equal to or greater than 38.3 °C (101 °F) followed by a rash characterized by firm, deep-seated vesicles or pustules in the same stage of development without other apparent cause.<a href="#cite_note-PinkBook-33">[33]</a> When a clinical case was observed, smallpox was confirmed using laboratory tests. <a href="/wiki/Microscope" title="Microscope">Microscopically</a>, poxviruses produce characteristic <a href="/wiki/Cytoplasmic" class="mw-redirect" title="Cytoplasmic">cytoplasmic</a> <a href="/wiki/Inclusion_bodies" title="Inclusion bodies">inclusion bodies</a>, the most important of which are known as <a href="/wiki/Guarnieri_bodies" class="mw-redirect" title="Guarnieri bodies">Guarnieri bodies</a>, and are the sites of <a href="/wiki/Viral_replication" title="Viral replication">viral replication</a>. Guarnieri bodies are readily identified in skin biopsies stained with hematoxylin and eosin, and appear as pink blobs. They are found in virtually all poxvirus infections but the absence of Guarnieri bodies could not be used to rule out smallpox.<a href="#cite_note-68">[68]</a> The diagnosis of an orthopoxvirus infection can also be made rapidly by <a href="/wiki/Electron_microscopy" class="mw-redirect" title="Electron microscopy">electron microscopic</a> examination of pustular fluid or scabs. All orthopoxviruses exhibit identical brick-shaped <a href="/wiki/Virions" class="mw-redirect" title="Virions">virions</a> by electron microscopy.<a href="#cite_note-AFIP-34">[34]</a> If particles with the characteristic morphology of <a href="/wiki/Herpesvirus" class="mw-redirect" title="Herpesvirus">herpesviruses</a> are seen this will eliminate smallpox and other orthopoxvirus infections. Definitive laboratory identification of variola virus involved growing the virus on <a href="/wiki/Chorioallantoic_membrane" title="Chorioallantoic membrane">chorioallantoic membrane</a> (part of a chicken <a href="/wiki/Embryo" title="Embryo">embryo</a>) and examining the resulting pock lesions under defined temperature conditions.<a href="#cite_note-69">[69]</a> Strains were characterized by <a href="/wiki/Polymerase_chain_reaction" title="Polymerase chain reaction">polymerase chain reaction</a> (PCR) and <a href="/wiki/Restriction_fragment_length_polymorphism" title="Restriction fragment length polymorphism">restriction fragment length polymorphism</a> (RFLP) analysis. <a href="/wiki/Serologic" class="mw-redirect" title="Serologic">Serologic</a> tests and <a href="/wiki/Enzyme_linked_immunosorbent_assay" class="mw-redirect" title="Enzyme linked immunosorbent assay">enzyme linked immunosorbent assays</a> (ELISA), which measured variola virus-specific immunoglobulin and antigen were also developed to assist in the diagnosis of infection.<a href="#cite_note-70">[70]</a> <a href="/wiki/Chickenpox" title="Chickenpox">Chickenpox</a> was commonly confused with smallpox in the immediate post-eradication era. Chickenpox and smallpox could be distinguished by several methods. Unlike smallpox, chickenpox does not usually affect the palms and soles. Additionally, chickenpox pustules are of varying size due to variations in the timing of pustule eruption: smallpox pustules are all very nearly the same size since the viral effect progresses more uniformly. A variety of laboratory methods were available for detecting chickenpox in the evaluation of suspected smallpox cases.<a href="#cite_note-PinkBook-33">[33]</a> <ul class="gallery mw-gallery-traditional"> <li class="gallerybox" style="width: 235px"> <div class="thumb" style="width: 230px; height: 230px;"><a href="/wiki/File:Smallpox_CAM.png" class="mw-file-description" title="Smallpox virus lesions on the chorioallantoic membrane of a developing chick"><img alt="Smallpox virus lesions on the chorioallantoic membrane of a developing chick" src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f8/Smallpox_CAM.png/200px-Smallpox_CAM.png" decoding="async" width="200" height="146" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f8/Smallpox_CAM.png/300px-Smallpox_CAM.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f8/Smallpox_CAM.png/400px-Smallpox_CAM.png 2x" data-file-width="2934" data-file-height="2144" /></a></div> <div class="gallerytext">Smallpox virus lesions on the <a href="/wiki/Chorioallantoic_membrane" title="Chorioallantoic membrane">chorioallantoic membrane</a> of a developing chick</div> </li> <li class="gallerybox" style="width: 235px"> <div class="thumb" style="width: 230px; height: 230px;"><a href="/wiki/File:Smallpox_versus_chickenpox_english_plain.svg" class="mw-file-description" title="In contrast to the rash in smallpox, the rash in chickenpox occurs mostly on the torso, spreading less to the limbs."><img alt="In contrast to the rash in smallpox, the rash in chickenpox occurs mostly on the torso, spreading less to the limbs." src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Smallpox_versus_chickenpox_english_plain.svg/143px-Smallpox_versus_chickenpox_english_plain.svg.png" decoding="async" width="143" height="200" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Smallpox_versus_chickenpox_english_plain.svg/214px-Smallpox_versus_chickenpox_english_plain.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5e/Smallpox_versus_chickenpox_english_plain.svg/285px-Smallpox_versus_chickenpox_english_plain.svg.png 2x" data-file-width="920" data-file-height="1289" /></a></div> <div class="gallerytext">In contrast to the rash in smallpox, the rash in <a href="/wiki/Chickenpox" title="Chickenpox">chickenpox</a> occurs mostly on the torso, spreading less to the limbs.</div> </li> <li class="gallerybox" style="width: 235px"> <div class="thumb" style="width: 230px; height: 230px;"><a href="/wiki/File:Female_smallpox_patient_--_late-stage_confluent_maculopapular_scarring.jpg" class="mw-file-description" title="An Italian female smallpox patient whose skin displayed the characteristics of late-stage confluent maculopapular scarring, 1965"><img alt="An Italian female smallpox patient whose skin displayed the characteristics of late-stage confluent maculopapular scarring, 1965" src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Female_smallpox_patient_--_late-stage_confluent_maculopapular_scarring.jpg/126px-Female_smallpox_patient_--_late-stage_confluent_maculopapular_scarring.jpg" decoding="async" width="126" height="200" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Female_smallpox_patient_--_late-stage_confluent_maculopapular_scarring.jpg/189px-Female_smallpox_patient_--_late-stage_confluent_maculopapular_scarring.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Female_smallpox_patient_--_late-stage_confluent_maculopapular_scarring.jpg/252px-Female_smallpox_patient_--_late-stage_confluent_maculopapular_scarring.jpg 2x" data-file-width="1141" data-file-height="1810" /></a></div> <div class="gallerytext">An Italian female smallpox patient whose skin displayed the characteristics of late-stage confluent maculopapular scarring, 1965</div> </li> </ul> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Smallpox_vaccine" title="Smallpox vaccine">Smallpox vaccine</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Smallpox_vaccine_(cropped).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/de/Smallpox_vaccine_%28cropped%29.jpg/220px-Smallpox_vaccine_%28cropped%29.jpg" decoding="async" width="220" height="131" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/de/Smallpox_vaccine_%28cropped%29.jpg/330px-Smallpox_vaccine_%28cropped%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/de/Smallpox_vaccine_%28cropped%29.jpg/440px-Smallpox_vaccine_%28cropped%29.jpg 2x" data-file-width="2647" data-file-height="1577" /></a><figcaption>Components of a modern smallpox <a href="/wiki/Vaccination" title="Vaccination">vaccination</a> kit including the <a href="/wiki/Diluent" title="Diluent">diluent</a>, a vial of Dryvax vaccinia vaccine, and a <a href="/wiki/Bifurcated_needle" title="Bifurcated needle">bifurcated needle</a></figcaption></figure> The earliest procedure used to prevent smallpox was <a href="/wiki/Inoculation" title="Inoculation">inoculation</a> with variola minor virus (a method later known as <a href="/wiki/Variolation" title="Variolation">variolation</a> after the introduction of <a href="/wiki/Smallpox_vaccine" title="Smallpox vaccine">smallpox vaccine</a> to avoid possible confusion), which likely occurred in India, Africa, and China well before the practice arrived in Europe.<a href="#cite_note-Rie2005-15">[15]</a> The idea that inoculation originated in India has been challenged, as few of the ancient <a href="/wiki/Sanskrit" title="Sanskrit">Sanskrit</a> medical texts described the process of inoculation.<a href="#cite_note-71">[71]</a> Accounts of inoculation against smallpox in China can be found as early as the late 10th century, and the procedure was widely practiced by the 16th century, during the <a href="/wiki/Ming_dynasty" title="Ming dynasty">Ming dynasty</a>.<a href="#cite_note-Temple-72">[72]</a> If successful, inoculation produced lasting <a href="/wiki/Immunity_(medical)" class="mw-redirect" title="Immunity (medical)">immunity</a> to smallpox. Because the person was infected with variola virus, a severe infection could result, and the person could transmit smallpox to others. Variolation had a 0.5–2 percent mortality rate, considerably less than the 20–30 percent mortality rate of smallpox.<a href="#cite_note-PinkBook-33">[33]</a> Two reports on the Chinese practice of <a href="/wiki/Inoculation" title="Inoculation">inoculation</a> were received by the <a href="/wiki/Royal_Society" title="Royal Society">Royal Society</a> in London in 1700; one by Dr. <a href="/wiki/Martin_Lister" title="Martin Lister">Martin Lister</a> who received a report by an employee of the <a href="/wiki/East_India_Company" title="East India Company">East India Company</a> stationed in China and another by <a href="/wiki/Clopton_Havers" title="Clopton Havers">Clopton Havers</a>.<a href="#cite_note-73">[73]</a> <a href="/wiki/Lady_Mary_Wortley_Montagu" title="Lady Mary Wortley Montagu">Lady Mary Wortley Montagu</a> observed smallpox inoculation during her stay in the <a href="/wiki/Ottoman_Empire" title="Ottoman Empire">Ottoman Empire</a>, writing detailed accounts of the practice in her letters, and enthusiastically promoted the procedure in England upon her return in 1718.<a href="#cite_note-74">[74]</a> According to <a href="/wiki/Voltaire" title="Voltaire">Voltaire</a> (1742), the Turks derived their use of inoculation from neighbouring <a href="/wiki/Circassia" title="Circassia">Circassia</a>. Voltaire does not speculate on where the Circassians derived their technique from, though he reports that the Chinese have practiced it "these hundred years".<a href="#cite_note-Voltaire_1742-75">[75]</a> In 1721, <a href="/wiki/Cotton_Mather#Advocacy_for_smallpox_inoculation" title="Cotton Mather">Cotton Mather</a> and colleagues provoked controversy in Boston by inoculating hundreds. After publishing The present method of inoculating for the small-pox in 1767, <a href="/wiki/Thomas_Dimsdale#Careers" title="Thomas Dimsdale">Dr Thomas Dimsdale</a> was invited to Russia to variolate the Empress <a href="/wiki/Catherine_the_Great" title="Catherine the Great">Catherine the Great</a> of Russia and her son, <a href="/wiki/Paul_I_of_Russia" title="Paul I of Russia">Grand Duke Paul</a>, which he successfully did in 1768. In 1796, <a href="/wiki/Edward_Jenner" title="Edward Jenner">Edward Jenner</a>, a doctor in <a href="/wiki/Berkeley,_Gloucestershire" title="Berkeley, Gloucestershire">Berkeley, Gloucestershire</a>, rural England, discovered that immunity to smallpox could be produced by inoculating a person with material from a cowpox lesion. Cowpox is a poxvirus in the same family as variola. Jenner called the material used for inoculation vaccine from the <a href="/wiki/Root_(linguistics)" title="Root (linguistics)">root word</a> vacca, which is Latin for cow. The procedure was much safer than variolation and did not involve a risk of smallpox transmission. Vaccination to prevent smallpox was soon practiced all over the world. During the 19th century, the cowpox virus used for smallpox vaccination was replaced by the vaccinia virus. Vaccinia is in the same family as cowpox and variola virus but is genetically distinct from both. The origin of the vaccinia virus and how it came to be in the vaccine are not known.<a href="#cite_note-PinkBook-33">[33]</a> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:The_cow_pock.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/The_cow_pock.jpg/310px-The_cow_pock.jpg" decoding="async" width="310" height="222" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/The_cow_pock.jpg/465px-The_cow_pock.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d6/The_cow_pock.jpg/620px-The_cow_pock.jpg 2x" data-file-width="1279" data-file-height="915" /></a><figcaption>An 1802 cartoon by <a href="/wiki/James_Gillray" title="James Gillray">James Gillray</a> of the early controversy surrounding <a href="/wiki/Edward_Jenner" title="Edward Jenner">Edward Jenner</a>'s vaccination procedure, showing using his cowpox-derived <a href="/wiki/Smallpox_vaccine" title="Smallpox vaccine">smallpox vaccine</a> causing cattle to emerge from patients</figcaption></figure> The current formulation of the smallpox vaccine is a live virus preparation of the infectious vaccinia virus. The vaccine is given using a <a href="/wiki/Bifurcated_needle" title="Bifurcated needle">bifurcated (two-pronged) needle</a> that is dipped into the vaccine solution. The needle is used to prick the skin (usually the upper arm) several times in a few seconds. If successful, a red and itchy bump develops at the vaccine site in three or four days. In the first week, the bump becomes a large blister (called a "Jennerian vesicle") which fills with pus and begins to drain. During the second week, the blister begins to dry up, and a scab forms. The scab falls off in the third week, leaving a small scar.<a href="#cite_note-76">[76]</a> The <a href="/wiki/Antibodies" class="mw-redirect" title="Antibodies">antibodies</a> induced by the vaccinia vaccine are cross-protective for other orthopoxviruses, such as monkeypox, cowpox, and variola (smallpox) viruses. Neutralizing antibodies are detectable 10 days after first-time vaccination and seven days after revaccination. Historically, the vaccine has been effective in preventing smallpox infection in 95 percent of those vaccinated.<a href="#cite_note-CDCvac-77">[77]</a> Smallpox vaccination provides a high level of immunity for three to five years and decreasing immunity thereafter. If a person is vaccinated again later, the immunity lasts even longer. Studies of smallpox cases in Europe in the 1950s and 1960s demonstrated that the fatality rate among persons vaccinated less than 10 years before exposure was 1.3 percent; it was 7 percent among those vaccinated 11 to 20 years prior, and 11 percent among those vaccinated 20 or more years before infection. By contrast, 52 percent of unvaccinated persons died.<a href="#cite_note-78">[78]</a> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Smallpox_vaccine_injection.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Smallpox_vaccine_injection.jpg/220px-Smallpox_vaccine_injection.jpg" decoding="async" width="220" height="143" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Smallpox_vaccine_injection.jpg/330px-Smallpox_vaccine_injection.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b8/Smallpox_vaccine_injection.jpg/440px-Smallpox_vaccine_injection.jpg 2x" data-file-width="3008" data-file-height="1960" /></a><figcaption>A demonstration by medical personnel on use of a bifurcated needle to deliver the smallpox vaccine, 2002</figcaption></figure> There are side effects and risks associated with the smallpox vaccine. In the past, about 1 out of 1,000 people vaccinated for the first time experienced serious, but non-life-threatening, reactions, including toxic or <a href="/wiki/Allergic_reaction" class="mw-redirect" title="Allergic reaction">allergic reaction</a> at the site of the vaccination (<a href="/wiki/Erythema_multiforme" title="Erythema multiforme">erythema multiforme</a>), spread of the vaccinia virus to other parts of the body, and spread to other individuals. Potentially life-threatening reactions occurred in 14 to 500 people out of every 1 million people vaccinated for the first time. Based on past experience, it is estimated that 1 or 2 people in 1 million (0.000198 percent) who receive the vaccine may die as a result, most often the result of postvaccinial <a href="/wiki/Encephalitis" title="Encephalitis">encephalitis</a> or severe <a href="/wiki/Necrosis" title="Necrosis">necrosis</a> in the area of vaccination (called <a href="/wiki/Progressive_vaccinia" title="Progressive vaccinia">progressive vaccinia</a>).<a href="#cite_note-CDCvac-77">[77]</a> Given these risks, as smallpox became effectively eradicated and the number of naturally occurring cases fell below the number of vaccine-induced illnesses and deaths, routine childhood vaccination was discontinued in the United States in 1972 and was abandoned in most European countries in the early 1970s.<a href="#cite_note-WHO2007Fact-10">[10]</a><a href="#cite_note-79">[79]</a> Routine vaccination of health care workers was discontinued in the U.S. in 1976, and among military recruits in 1990 (although military personnel deploying to the Middle East and Korea still receive the vaccination<a href="#cite_note-80">[80]</a>). By 1986, routine vaccination had ceased in all countries.<a href="#cite_note-WHO2007Fact-10">[10]</a> It is now primarily recommended for laboratory workers at risk for occupational exposure.<a href="#cite_note-PinkBook-33">[33]</a> However, the possibility of variola virus being used as a biological weapon has rekindled interest in the development of newer vaccines.<a href="#cite_note-Metzger_2007-81">[81]</a> The smallpox vaccine is also effective in, and therefore administered for, the prevention of <a href="/wiki/Mpox" title="Mpox">mpox</a>.<a href="#cite_note-pmid36179973-82">[82]</a> <a href="/wiki/ACAM2000" title="ACAM2000">ACAM2000</a> is a <a href="/wiki/Smallpox_vaccine" title="Smallpox vaccine">smallpox vaccine</a> developed by Acambis, approved for use in the United States by the <a href="/wiki/Food_and_Drug_Administration_(United_States)" class="mw-redirect" title="Food and Drug Administration (United States)">U.S. FDA</a> on August 31, 2007. It contains live <a href="/wiki/Vaccinia" title="Vaccinia">vaccinia</a> virus, cloned from the same strain used in an earlier <a href="/wiki/Vaccine" title="Vaccine">vaccine</a>, <a href="/wiki/Dryvax" class="mw-redirect" title="Dryvax">Dryvax</a>. While the Dryvax virus was cultured in the skin of calves and freeze-dried, ACAM2000s virus is cultured in kidney epithelial cells (<a href="/wiki/Vero_cell" title="Vero cell">Vero cells</a>) from an <a href="/wiki/African_green_monkey" class="mw-redirect" title="African green monkey">African green monkey</a>. Efficacy and adverse reaction incidence are similar to Dryvax.<a href="#cite_note-Metzger_2007-81">[81]</a> The vaccine is not routinely available to the US public; it is, however, used in the military and maintained in the <a href="/wiki/Strategic_National_Stockpile" title="Strategic National Stockpile">Strategic National Stockpile</a>.<a href="#cite_note-83">[83]</a> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2></div> Smallpox vaccination within three days of exposure will prevent or significantly lessen the severity of smallpox symptoms in the vast majority of people. Vaccination four to seven days after exposure can offer some protection from disease or may modify the severity of the disease.<a href="#cite_note-CDCvac-77">[77]</a> Other than vaccination, treatment of smallpox is primarily supportive, such as wound care and infection control, fluid therapy, and possible <a href="/wiki/Ventilator" title="Ventilator">ventilator</a> assistance. Flat and hemorrhagic types of smallpox are treated with the same therapies used to treat <a href="/wiki/Shock_(circulatory)" title="Shock (circulatory)">shock</a>, such as <a href="/wiki/Fluid_replacement" title="Fluid replacement">fluid resuscitation</a>. People with semi-confluent and confluent types of smallpox may have therapeutic issues similar to patients with extensive skin <a href="/wiki/Burn" title="Burn">burns</a>.<a href="#cite_note-Fenner4-84">[84]</a> <a href="/wiki/Antiviral_drug" title="Antiviral drug">Antiviral</a> treatments have improved since the last large smallpox epidemics, and as of 2004, studies suggested that the antiviral drug <a href="/wiki/Cidofovir" title="Cidofovir">cidofovir</a> might be useful as a therapeutic agent. The drug must be administered <a href="/wiki/Intravenously" class="mw-redirect" title="Intravenously">intravenously</a>, and may cause serious <a href="/wiki/Renal" class="mw-redirect" title="Renal">kidney</a> toxicity.<a href="#cite_note-85">[85]</a> In July 2018, the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> approved <a href="/wiki/Tecovirimat" title="Tecovirimat">tecovirimat</a>, the first drug approved for treatment of smallpox.<a href="#cite_note-86">[86]</a> However, during treatment viral mutations causing resistance have been known to occur, especially since its use in the <a href="/wiki/2022%E2%80%932023_mpox_outbreak" title="2022–2023 mpox outbreak">2022–2023 mpox outbreak</a> which jeopardize its effectiveness for smallpox biothreat preparedness.<a href="#cite_note-cdc-87">[87]</a> In June 2021, <a href="/wiki/Brincidofovir" title="Brincidofovir">brincidofovir</a> was approved for medical use in the United States for the treatment of human smallpox disease caused by variola virus.<a href="#cite_note-FDA_Tembexa-88">[88]</a><a href="#cite_note-FDA_appeoval_letter-89">[89]</a> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Man_with_facial_scarring_and_blindness_due_to_smallpox,_1972_(cropped).jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b7/Man_with_facial_scarring_and_blindness_due_to_smallpox%2C_1972_%28cropped%29.jpg/170px-Man_with_facial_scarring_and_blindness_due_to_smallpox%2C_1972_%28cropped%29.jpg" decoding="async" width="170" height="223" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b7/Man_with_facial_scarring_and_blindness_due_to_smallpox%2C_1972_%28cropped%29.jpg/255px-Man_with_facial_scarring_and_blindness_due_to_smallpox%2C_1972_%28cropped%29.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b7/Man_with_facial_scarring_and_blindness_due_to_smallpox%2C_1972_%28cropped%29.jpg/340px-Man_with_facial_scarring_and_blindness_due_to_smallpox%2C_1972_%28cropped%29.jpg 2x" data-file-width="1681" data-file-height="2204" /></a><figcaption>Smallpox survivor with facial scarring, blindness and white <a href="/wiki/Corneal_opacity" title="Corneal opacity">corneal scar</a> in his left eye, 1972</figcaption></figure> The mortality rate from variola minor is approximately 1%, while the mortality rate from variola major is approximately 30%.<a href="#cite_note-WHOSmallpox-90">[90]</a> Ordinary type-confluent is fatal about 50–75% of the time, ordinary-type semi-confluent about 25–50% of the time, in cases where the rash is discrete the case-fatality rate is less than 10%. The overall fatality rate for children younger than 1 year of age is 40–50%. Hemorrhagic and flat types have the highest fatality rates. The fatality rate for flat or late hemorrhagic type smallpox is 90% or greater and nearly 100% is observed in cases of early hemorrhagic smallpox.<a href="#cite_note-Lane_2011-43">[43]</a> The case-fatality rate for variola minor is 1% or less.<a href="#cite_note-training1-38">[38]</a> There is no evidence of chronic or recurrent infection with variola virus.<a href="#cite_note-training1-38">[38]</a> In cases of flat smallpox in vaccinated people, the condition was extremely rare but less lethal, with one case series showing a 67% death rate.<a href="#cite_note-Fenner_1988-3">[3]</a> In fatal cases of ordinary smallpox, death usually occurs between days 10–16 of the illness. The cause of death from smallpox is not clear, but the infection is now known to involve multiple organs. Circulating <a href="/wiki/Immune_complex" title="Immune complex">immune complexes</a>, overwhelming viremia, or an uncontrolled <a href="/wiki/Immune_response" title="Immune response">immune response</a> may be contributing factors.<a href="#cite_note-PinkBook-33">[33]</a> In early hemorrhagic smallpox, death occurs suddenly about six days after the fever develops. The cause of death in early hemorrhagic cases is commonly due to heart failure and <a href="/wiki/Pulmonary_edema" title="Pulmonary edema">pulmonary edema</a>. In late hemorrhagic cases, high and sustained viremia, severe <a href="/wiki/Thrombocytopenia" title="Thrombocytopenia">platelet loss</a> and poor immune response were often cited as causes of death.<a href="#cite_note-Fenner_1988-3">[3]</a> In flat smallpox modes of death are similar to those in burns, with <a href="/wiki/Hypovolemic_shock" title="Hypovolemic shock">loss of fluid</a>, protein and <a href="/wiki/Electrolyte" title="Electrolyte">electrolytes</a>, and fulminating <a href="/wiki/Sepsis" title="Sepsis">sepsis</a>.<a href="#cite_note-Fenner4-84">[84]</a> <div class="mw-heading mw-heading3"><h3 id="Complications">Complications</h3></div> Complications of smallpox arise most commonly in the respiratory system and range from simple <a href="/wiki/Bronchitis" title="Bronchitis">bronchitis</a> to fatal <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a>. Respiratory complications tend to develop on about the eighth day of the illness and can be either viral or bacterial in origin. Secondary bacterial infection of the skin is a relatively uncommon complication of smallpox. When this occurs, the fever usually remains elevated.<a href="#cite_note-PinkBook-33">[33]</a> Other complications include <a href="/wiki/Encephalitis" title="Encephalitis">encephalitis</a> (1 in 500 patients), which is more common in adults and may cause temporary disability; permanent pitted scars, most notably on the face; and complications involving the eyes (2% of all cases). Pustules can form on the eyelid, <a href="/wiki/Conjunctiva" title="Conjunctiva">conjunctiva</a>, and <a href="/wiki/Cornea" title="Cornea">cornea</a>, leading to complications such as <a href="/wiki/Conjunctivitis" title="Conjunctivitis">conjunctivitis</a>, <a href="/wiki/Keratitis" title="Keratitis">keratitis</a>, <a href="/wiki/Corneal_ulcer" title="Corneal ulcer">corneal ulcer</a>, <a href="/wiki/Iritis" class="mw-redirect" title="Iritis">iritis</a>, <a href="/wiki/Iridocyclitis" class="mw-redirect" title="Iridocyclitis">iridocyclitis</a>, and atrophy of the optic nerve. Blindness results in approximately 35–40% of eyes affected with keratitis and corneal ulcer. Hemorrhagic smallpox can cause subconjunctival and <a href="/wiki/Retina" title="Retina">retinal</a> hemorrhages. In 2–5% of young children with smallpox, virions reach the joints and bone, causing <a href="/wiki/Osteomyelitis" title="Osteomyelitis">osteomyelitis</a> variolosa. Bony lesions are symmetrical, most common in the elbows, legs, and characteristically cause separation of the <a href="/wiki/Epiphysis" title="Epiphysis">epiphysis</a> and marked <a href="/wiki/Periosteum" title="Periosteum">periosteal</a> reactions. Swollen joints limit movement, and arthritis may lead to limb deformities, <a href="/wiki/Ankylosis" title="Ankylosis">ankylosis</a>, malformed bones, flail joints, and stubby fingers.<a href="#cite_note-AFIP-34">[34]</a> Between 65 and 80% of survivors are marked with deep pitted scars (pockmarks), most prominent on the face. <div class="mw-heading mw-heading2"><h2 id="History">History</h2></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/History_of_smallpox" title="History of smallpox">History of smallpox</a></div> <div class="mw-heading mw-heading3"><h3 id="Disease_emergence">Disease emergence</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Native_American_disease_and_epidemics" title="Native American disease and epidemics">Native American disease and epidemics</a>, <a href="/wiki/History_of_smallpox_in_Mexico" title="History of smallpox in Mexico">History of smallpox in Mexico</a>, and <a href="/wiki/List_of_epidemics_and_pandemics" title="List of epidemics and pandemics">List of epidemics and pandemics</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Sopona.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/00/Sopona.jpg/170px-Sopona.jpg" decoding="async" width="170" height="257" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/00/Sopona.jpg/255px-Sopona.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/00/Sopona.jpg/340px-Sopona.jpg 2x" data-file-width="1190" data-file-height="1800" /></a><figcaption>Statue of <a href="/wiki/Sopona" title="Sopona">Sopona</a>, the <a href="/wiki/Yoruba_religion" title="Yoruba religion">Yoruba</a> god thought to cause the disease</figcaption></figure> The earliest credible clinical evidence of smallpox is found in the descriptions of smallpox-like disease in medical writings from ancient India (as early as 1500 BCE),<a href="#cite_note-Shchelkunov2011-91">[91]</a><a href="#cite_note-Serum_Evils_p._5-92">[92]</a> and China (1122 BCE),<a href="#cite_note-Hopkins_2002-93">[93]</a> as well as a study of the <a href="/wiki/Ancient_Egypt" title="Ancient Egypt">Egyptian</a> <a href="/wiki/Mummy" title="Mummy">mummy</a> of <a href="/wiki/Ramses_V" class="mw-redirect" title="Ramses V">Ramses V</a> (died 1145 BCE).<a href="#cite_note-Serum_Evils_p._5-92">[92]</a><a href="#cite_note-Ramses-94">[94]</a> It has been speculated that Egyptian traders brought smallpox to India during the 1st millennium BCE, where it remained as an <a href="/wiki/Endemic_(epidemiology)" title="Endemic (epidemiology)">endemic</a> human disease for at least 2000 years. Smallpox was probably introduced into China during the 1st century CE from the southwest, and in the 6th century was carried from China to Japan.<a href="#cite_note-Fenner_1988-3">[3]</a> In Japan, the <a href="/wiki/735%E2%80%93737_Japanese_smallpox_epidemic" title="735–737 Japanese smallpox epidemic">epidemic of 735–737</a> is believed to have killed as much as one-third of the population.<a href="#cite_note-Hays2005-18">[18]</a><a href="#cite_note-95">[95]</a> At least seven religious deities have been specifically dedicated to smallpox, such as the god <a href="/wiki/Sopona" title="Sopona">Sopona</a> in the <a href="/wiki/Yoruba_religion" title="Yoruba religion">Yoruba religion</a> in West Africa. In India, the Hindu goddess of smallpox, <a href="/wiki/Shitala" title="Shitala">Shitala</a>, was worshipped in temples throughout the country.<a href="#cite_note-96">[96]</a> A different viewpoint is that smallpox emerged 1588 CE and the earlier reported cases were incorrectly identified as smallpox.<a href="#cite_note-97">[97]</a><a href="#cite_note-Duggan2016-47">[47]</a> The timing of the arrival of smallpox in Europe and south-western Asia is less clear. Smallpox is not clearly described in either the <a href="/wiki/Old_Testament" title="Old Testament">Old</a> or <a href="/wiki/New_Testament" title="New Testament">New Testaments</a> of the Bible or in the literature of the Greeks or Romans. While some have identified the <a href="/wiki/Plague_of_Athens" title="Plague of Athens">Plague of Athens</a> – which was said to have originated in "<a href="/wiki/Aethiopia_(Classical_Greek_term)" class="mw-redirect" title="Aethiopia (Classical Greek term)">Ethiopia</a>" and Egypt – or the plague that lifted Carthage's 396 BCE <a href="/wiki/Siege_of_Syracuse_(397_BC)" title="Siege of Syracuse (397 BC)">siege of Syracuse</a> – with smallpox,<a href="#cite_note-Fenner_1988-3">[3]</a> many scholars agree it is very unlikely such a serious disease as variola major would have escaped being described by <a href="/wiki/Hippocrates" title="Hippocrates">Hippocrates</a> if it had existed in the Mediterranean region during his lifetime.<a href="#cite_note-Dixon_1962-42">[42]</a> While the <a href="/wiki/Antonine_Plague" title="Antonine Plague">Antonine Plague</a> that swept through the <a href="/wiki/Roman_Empire" title="Roman Empire">Roman Empire</a> in 165–180 CE may have been caused by smallpox,<a href="#cite_note-98">[98]</a> Saint <a href="/wiki/Nicasius_of_Rheims" title="Nicasius of Rheims">Nicasius of Rheims</a> became the patron saint of smallpox victims for having supposedly survived a bout in 450,<a href="#cite_note-Fenner_1988-3">[3]</a> and Saint <a href="/wiki/Gregory_of_Tours" title="Gregory of Tours">Gregory of Tours</a> recorded a similar outbreak in France and Italy in 580, the first use of the term variola.<a href="#cite_note-Fenner_1988-3">[3]</a> Other historians speculate that <a href="/wiki/Arab" class="mw-redirect" title="Arab">Arab</a> armies first carried smallpox from Africa into Southwestern Europe during the 7th and 8th centuries.<a href="#cite_note-Fenner_1988-3">[3]</a> In the 9th century the <a href="/wiki/Islamic_medicine" class="mw-redirect" title="Islamic medicine">Persian physician</a>, <a href="/wiki/Muhammad_ibn_Zakariya_ar-Razi" class="mw-redirect" title="Muhammad ibn Zakariya ar-Razi">Rhazes</a>, provided one of the most definitive descriptions of smallpox and was the first to differentiate smallpox from <a href="/wiki/Measles" title="Measles">measles</a> and <a href="/wiki/Chickenpox" title="Chickenpox">chickenpox</a> in his Kitab fi al-jadari wa-al-hasbah (The Book of Smallpox and Measles).<a href="#cite_note-99">[99]</a> During the <a href="/wiki/Middle_Ages" title="Middle Ages">Middle Ages</a> several smallpox outbreaks occurred in Europe. However, smallpox had not become established there until the population growth and mobility marked by the <a href="/wiki/Crusades" title="Crusades">Crusades</a> allowed it to do so. By the 16th century, smallpox had become entrenched across most of Europe,<a href="#cite_note-Fenner_1988-3">[3]</a> where it had a mortality rate as high as 30 percent. This endemic occurrence of smallpox in Europe is of particular historical importance, as successive exploration and colonization by Europeans tended to spread the disease to other nations. By the 16th century, smallpox had become a predominant cause of morbidity and mortality throughout much of the world.<a href="#cite_note-Fenner_1988-3">[3]</a> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:FlorentineCodex_BK12_F54_smallpox.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/FlorentineCodex_BK12_F54_smallpox.jpg/220px-FlorentineCodex_BK12_F54_smallpox.jpg" decoding="async" width="220" height="170" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/FlorentineCodex_BK12_F54_smallpox.jpg/330px-FlorentineCodex_BK12_F54_smallpox.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7d/FlorentineCodex_BK12_F54_smallpox.jpg/440px-FlorentineCodex_BK12_F54_smallpox.jpg 2x" data-file-width="640" data-file-height="494" /></a><figcaption>Drawing accompanying text in Book XII of the 16th-century <a href="/wiki/Florentine_Codex" title="Florentine Codex">Florentine Codex</a> (compiled 1555–1576), showing <a href="/wiki/Nahua_peoples" class="mw-redirect" title="Nahua peoples">Nahuas</a> of conquest-era central Mexico with smallpox</figcaption></figure> There were no credible descriptions of smallpox-like disease in the <a href="/wiki/Americas" title="Americas">Americas</a> before the westward exploration by Europeans in the 15th century CE.<a href="#cite_note-Li2007-45">[45]</a> Smallpox was introduced into the Caribbean island of <a href="/wiki/Hispaniola" title="Hispaniola">Hispaniola</a> in 1507, and into the mainland in 1520, when Spanish settlers from Hispaniola arrived in Mexico, inadvertently carrying smallpox with them. Because the native <a href="/wiki/Amerindian" class="mw-redirect" title="Amerindian">Amerindian</a> population had no acquired immunity to this new disease, their peoples were decimated by epidemics. Such disruption and population losses were an important factor in the Spanish achieving conquest of the <a href="/wiki/Aztec" class="mw-redirect" title="Aztec">Aztecs</a> and the <a href="/wiki/Inca" class="mw-redirect" title="Inca">Incas</a>.<a href="#cite_note-Fenner_1988-3">[3]</a> Similarly, English settlement of the east coast of North America in 1633 in <a href="/wiki/Plymouth,_Massachusetts" title="Plymouth, Massachusetts">Plymouth, Massachusetts</a> was accompanied by devastating outbreaks of smallpox among Native American populations,<a href="#cite_note-100">[100]</a> and subsequently among the native-born colonists.<a href="#cite_note-101">[101]</a> Case fatality rates during outbreaks in Native American populations were as high as 90%.<a href="#cite_note-102">[102]</a> Smallpox was introduced into <a href="/wiki/Australia" title="Australia">Australia</a> in 1789 and again in 1829,<a href="#cite_note-Fenner_1988-3">[3]</a> though colonial surgeons, who by 1829 were attempting to distinguish between smallpox and <a href="/wiki/Chickenpox" title="Chickenpox">chickenpox</a> (which could be almost equally fatal to Aborigines), were divided as to whether the 1829–1830 epidemic was chickenpox or smallpox.<a href="#cite_note-103">[103]</a> Although smallpox was never endemic on the continent,<a href="#cite_note-Fenner_1988-3">[3]</a> it has been described as the principal cause of death in <a href="/wiki/Indigenous_Australians" title="Indigenous Australians">Aboriginal</a> populations between 1780 and 1870.<a href="#cite_note-Glynn_2004-104">[104]</a> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Global_number_of_reported_smallpox_cases_(1920-2016).svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/39/Global_number_of_reported_smallpox_cases_%281920-2016%29.svg/220px-Global_number_of_reported_smallpox_cases_%281920-2016%29.svg.png" decoding="async" width="220" height="155" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/39/Global_number_of_reported_smallpox_cases_%281920-2016%29.svg/330px-Global_number_of_reported_smallpox_cases_%281920-2016%29.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/39/Global_number_of_reported_smallpox_cases_%281920-2016%29.svg/440px-Global_number_of_reported_smallpox_cases_%281920-2016%29.svg.png 2x" data-file-width="850" data-file-height="600" /></a><figcaption>Global number of reported smallpox cases from 1920 to 2016</figcaption></figure> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Friedhof_Rastede_-_Kindergrab_von_1711.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9c/Friedhof_Rastede_-_Kindergrab_von_1711.jpg/220px-Friedhof_Rastede_-_Kindergrab_von_1711.jpg" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9c/Friedhof_Rastede_-_Kindergrab_von_1711.jpg/330px-Friedhof_Rastede_-_Kindergrab_von_1711.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9c/Friedhof_Rastede_-_Kindergrab_von_1711.jpg/440px-Friedhof_Rastede_-_Kindergrab_von_1711.jpg 2x" data-file-width="3888" data-file-height="5184" /></a><figcaption>Gravestone from 1711 for 4 children who died of smallpox (Rastede, Germany)</figcaption></figure> By the mid-18th century, smallpox was a major <a href="/wiki/Endemic_(epidemiology)" title="Endemic (epidemiology)">endemic disease</a> everywhere in the world except in Australia and small islands untouched by outside exploration. In 18th century Europe, smallpox was a leading cause of death, killing an estimated 400,000 Europeans each year.<a href="#cite_note-105">[105]</a> Up to 10 percent of <a href="/wiki/Sweden" title="Sweden">Swedish</a> infants died of smallpox each year,<a href="#cite_note-Hays2005-18">[18]</a> and the death rate of infants in <a href="/wiki/Russia" title="Russia">Russia</a> might have been even higher.<a href="#cite_note-Hopkins_2002-93">[93]</a> The widespread use of <a href="/wiki/Variolation" title="Variolation">variolation</a> in a few countries, notably Great Britain, its North American colonies, and China, somewhat reduced the impact of smallpox among the wealthy classes during the latter part of the 18th century, but a real reduction in its incidence did not occur until vaccination became a common practice toward the end of the 19th century. Improved vaccines and the practice of re-vaccination led to a substantial reduction in cases in Europe and North America, but smallpox remained almost unchecked everywhere else in the world. By the mid-20th century, variola minor occurred along with variola major, in varying proportions, in many parts of Africa. Patients with variola minor experience only a mild systemic illness, are often <a href="/wiki/Walk" class="mw-redirect" title="Walk">ambulant</a> throughout the course of the disease, and are therefore able to more easily spread disease. Infection with variola minor virus induces immunity against the more deadly variola major form. Thus, as variola minor spread all over the US, into Canada, the South American countries, and Great Britain, it became the dominant form of smallpox, further reducing mortality rates.<a href="#cite_note-Fenner_1988-3">[3]</a> <div class="mw-heading mw-heading3"><h3 id="Eradication">Eradication</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Smallpox_vaccine" title="Smallpox vaccine">Smallpox vaccine</a> and <a href="/wiki/Inoculation" title="Inoculation">Inoculation</a></div> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Decade-in-which-smallpox-ceased-to-be-endemic-by-country.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/71/Decade-in-which-smallpox-ceased-to-be-endemic-by-country.svg/350px-Decade-in-which-smallpox-ceased-to-be-endemic-by-country.svg.png" decoding="async" width="350" height="247" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/71/Decade-in-which-smallpox-ceased-to-be-endemic-by-country.svg/525px-Decade-in-which-smallpox-ceased-to-be-endemic-by-country.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/71/Decade-in-which-smallpox-ceased-to-be-endemic-by-country.svg/700px-Decade-in-which-smallpox-ceased-to-be-endemic-by-country.svg.png 2x" data-file-width="850" data-file-height="600" /></a><figcaption>Decade in which smallpox ceased to be <a href="/wiki/Endemic_(epidemiology)" title="Endemic (epidemiology)">endemic</a> by country</figcaption></figure> The first clear reference to smallpox inoculation was made by the Chinese author <a href="/wiki/Wan_Quan" title="Wan Quan">Wan Quan</a> (1499–1582) in his Dòuzhěn xīnfǎ (痘疹心法, "Pox Rash Teachings") published in 1549,<a href="#cite_note-106">[106]</a> with earliest hints of the practice in China during the 10th century.<a href="#cite_note-needham_volume_6_part_6_154-107">[107]</a> In China, powdered smallpox scabs were blown up the noses of the healthy. People would then develop a mild case of the disease and from then on were immune to it. The technique did have a 0.5–2.0% mortality rate, but that was considerably less than the 20–30% mortality rate of the disease itself. Two reports on the Chinese practice of <a href="/wiki/Inoculation" title="Inoculation">inoculation</a> were received by the <a href="/wiki/Royal_Society" title="Royal Society">Royal Society</a> in London in 1700: one by Dr. <a href="/wiki/Martin_Lister" title="Martin Lister">Martin Lister</a> who received a report by an employee of the <a href="/wiki/East_India_Company" title="East India Company">East India Company</a> stationed in China and another by <a href="/wiki/Clopton_Havers" title="Clopton Havers">Clopton Havers</a>.<a href="#cite_note-108">[108]</a> <a href="/wiki/Voltaire" title="Voltaire">Voltaire</a> (1742) reports that the Chinese had practiced smallpox inoculation "these hundred years".<a href="#cite_note-Voltaire_1742-75">[75]</a> <a href="/wiki/Variolation" title="Variolation">Variolation</a> had also been witnessed in <a href="/wiki/Ottoman_Empire" title="Ottoman Empire">Turkey</a> by <a href="/wiki/Lady_Mary_Wortley_Montagu" title="Lady Mary Wortley Montagu">Lady Mary Wortley Montagu</a>, who later introduced it in the UK.<a href="#cite_note-109">[109]</a> An early mention of the possibility of smallpox's eradication was made in reference to the work of <a href="/wiki/Johnnie_Notions" title="Johnnie Notions">Johnnie Notions</a>, a self-taught inoculator from <a href="/wiki/Shetland" title="Shetland">Shetland</a>, Scotland. Notions found success in treating people from at least the late 1780s through a method devised by himself despite having no formal medical background.<a href="#cite_note-Smith1998-110">[110]</a><a href="#cite_note-Conacher2001-111">[111]</a> His method involved exposing smallpox pus to <a href="/wiki/Peat" title="Peat">peat</a> smoke, burying it in the ground with <a href="/wiki/Camphor" title="Camphor">camphor</a> for up to 8 years, and then inserting the matter into a person's skin using a knife, and covering the incision with a cabbage leaf.<a href="#cite_note-Dishington1999-112">[112]</a> He was reputed not to have lost a single patient.<a href="#cite_note-Dishington1999-112">[112]</a> <a href="/wiki/Arthur_Edmondston" title="Arthur Edmondston">Arthur Edmondston</a>, in writings on Notions' technique that were published in 1809, stated, "Had every practitioner been as uniformly successful in the disease as he was, the small-pox might have been banished from the face of the earth, without injuring the system, or leaving any doubt as to the fact."<a href="#cite_note-Edmondston1809-113">[113]</a> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Fighting_smallpox_in_Niger,_1969.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/28/Fighting_smallpox_in_Niger%2C_1969.jpg/220px-Fighting_smallpox_in_Niger%2C_1969.jpg" decoding="async" width="220" height="285" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/28/Fighting_smallpox_in_Niger%2C_1969.jpg/330px-Fighting_smallpox_in_Niger%2C_1969.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/28/Fighting_smallpox_in_Niger%2C_1969.jpg/440px-Fighting_smallpox_in_Niger%2C_1969.jpg 2x" data-file-width="2124" data-file-height="2750" /></a><figcaption>Vaccination during the Smallpox Eradication and Measles Control Program in <a href="/wiki/Niger" title="Niger">Niger</a>, 1969</figcaption></figure> The English physician <a href="/wiki/Edward_Jenner" title="Edward Jenner">Edward Jenner</a> demonstrated the effectiveness of cowpox to protect humans from smallpox in 1796, after which various attempts were made to eliminate smallpox on a regional scale. In Russia in 1796, the first child to receive this treatment was bestowed the name "Vaccinov" by <a href="/wiki/Catherine_the_Great" title="Catherine the Great">Catherine the Great</a>, and was educated at the expense of the nation.<a href="#cite_note-114">[114]</a> The introduction of the vaccine to the New World took place in <a href="/wiki/Trinity,_Newfoundland_and_Labrador" title="Trinity, Newfoundland and Labrador">Trinity, Newfoundland</a> in 1800 by <a href="/wiki/John_Clinch" title="John Clinch">Dr. John Clinch</a>, boyhood friend and medical colleague of Jenner.<a href="#cite_note-115">[115]</a> As early as 1803, the Spanish Crown organized the <a href="/wiki/Balmis_expedition" class="mw-redirect" title="Balmis expedition">Balmis expedition</a> to transport the vaccine to the <a href="/wiki/Spanish_Empire" title="Spanish Empire">Spanish colonies</a> in the Americas and the Philippines, and establish mass vaccination programs there.<a href="#cite_note-116">[116]</a> The <a href="/wiki/United_States_Congress" title="United States Congress">U.S. Congress</a> passed the <a href="/wiki/Vaccine_Act_of_1813" title="Vaccine Act of 1813">Vaccine Act of 1813</a> to ensure that safe smallpox vaccine would be available to the American public. By about 1817, a robust state vaccination program existed in the <a href="/wiki/Dutch_East_Indies" title="Dutch East Indies">Dutch East Indies</a>.<a href="#cite_note-117">[117]</a> On August 26, 1807, <a href="/wiki/Kingdom_of_Bavaria" title="Kingdom of Bavaria">Bavaria</a> became the first country in the world to introduce compulsory vaccinations. <a href="/wiki/Grand_Duchy_of_Baden" title="Grand Duchy of Baden">Baden</a> followed in 1809, <a href="/wiki/Kingdom_of_Prussia" title="Kingdom of Prussia">Prussia</a> in 1815, <a href="/wiki/Kingdom_of_W%C3%BCrttemberg" title="Kingdom of Württemberg">Württemberg</a> in 1818, <a href="/wiki/Union_between_Sweden_and_Norway" title="Union between Sweden and Norway">Sweden</a> in 1816 and the <a href="/wiki/German_Empire" title="German Empire">German Empire</a> in 1874 through the Reichs Vaccination Act.<a href="#cite_note-MeyerReiter-118">[118]</a><a href="#cite_note-Klein-119">[119]</a> In Lutheran Sweden, the Protestant clergy played a pioneering role in voluntary smallpox vaccination as early as 1800.<a href="#cite_note-120">[120]</a> The first vaccination was carried out in Liechtenstein in 1801, and from 1812 it was mandatory to vaccinate.<a href="#cite_note-121">[121]</a> In <a href="/wiki/British_India" class="mw-redirect" title="British India">British India</a> a program was launched to propagate smallpox vaccination, through Indian vaccinators, under the supervision of European officials.<a href="#cite_note-122">[122]</a> Nevertheless, British vaccination efforts in India, and in <a href="/wiki/British_rule_in_Burma" title="British rule in Burma">Burma</a> in particular, were hampered by indigenous preference for inoculation and distrust of vaccination, despite tough legislation, improvements in the local efficacy of the vaccine and vaccine preservative, and education efforts.<a href="#cite_note-123">[123]</a> By 1832, the federal government of the United States established a smallpox vaccination program for <a href="/wiki/Native_Americans_in_the_United_States" title="Native Americans in the United States">Native Americans</a>.<a href="#cite_note-124">[124]</a> In 1842, the United Kingdom banned inoculation, later progressing to <a href="/wiki/Vaccination_Act" title="Vaccination Act">mandatory vaccination</a>. The British government introduced compulsory smallpox vaccination by an Act of Parliament in 1853.<a href="#cite_note-125">[125]</a> In the United States, from 1843 to 1855, first <a href="/wiki/Massachusetts" title="Massachusetts">Massachusetts</a> and then other states required smallpox vaccination. Although some disliked these measures,<a href="#cite_note-Hopkins_2002-93">[93]</a> coordinated efforts against smallpox went on, and the disease continued to diminish in the wealthy countries. In Northern Europe a number of countries had eliminated smallpox by 1900, and by 1914, the incidence in most industrialized countries had decreased to comparatively low levels. Vaccination continued in industrialized countries as protection against reintroduction until the mid to late 1970s. <a href="/wiki/Australia" title="Australia">Australia</a> and <a href="/wiki/New_Zealand" title="New Zealand">New Zealand</a> are two notable exceptions; neither experienced endemic smallpox and never vaccinated widely, relying instead on protection by distance and strict quarantines.<a href="#cite_note-Plotkin_1999-126">[126]</a> <figure class="mw-default-size mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Smallpox_keep_out_of_this_house..JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/92/Smallpox_keep_out_of_this_house..JPG/220px-Smallpox_keep_out_of_this_house..JPG" decoding="async" width="220" height="79" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/92/Smallpox_keep_out_of_this_house..JPG/330px-Smallpox_keep_out_of_this_house..JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/92/Smallpox_keep_out_of_this_house..JPG/440px-Smallpox_keep_out_of_this_house..JPG 2x" data-file-width="914" data-file-height="329" /></a><figcaption>Smallpox quarantine order, California, <abbr title="circa">c.</abbr> 1910</figcaption></figure> The first <a href="/wiki/Western_Hemisphere" title="Western Hemisphere">hemisphere</a>-wide effort to eradicate smallpox was made in 1950 by the <a href="/wiki/Pan_American_Health_Organization" title="Pan American Health Organization">Pan American Health Organization</a>.<a href="#cite_note-127">[127]</a> The campaign was successful in eliminating smallpox from all countries of the Americas except Argentina, Brazil, Colombia, and Ecuador.<a href="#cite_note-Plotkin_1999-126">[126]</a> In 1958 Professor <a href="/wiki/Viktor_Zhdanov" title="Viktor Zhdanov">Viktor Zhdanov</a>, Deputy Minister of Health for the <a href="/wiki/Soviet_Union" title="Soviet Union">USSR</a>, called on the <a href="/wiki/World_Health_Assembly" title="World Health Assembly">World Health Assembly</a> to undertake a global initiative to <a href="/wiki/Eradication_of_infectious_diseases" title="Eradication of infectious diseases">eradicate</a> smallpox.<a href="#cite_note-Fenner2-128">[128]</a> The proposal (Resolution WHA11.54) was accepted in 1959.<a href="#cite_note-Fenner2-128">[128]</a> At this point, 2 million people were dying from smallpox every year. Overall, the progress towards eradication was disappointing, especially in Africa and in the <a href="/wiki/Indian_subcontinent" title="Indian subcontinent">Indian subcontinent</a>. In 1966 an international team, the Smallpox Eradication Unit, was formed under the leadership of an American, <a href="/wiki/Donald_Henderson" title="Donald Henderson">Donald Henderson</a>.<a href="#cite_note-Fenner2-128">[128]</a> In 1967, the World Health Organization intensified the global smallpox eradication by contributing $2.4 million annually to the effort, and adopted the new <a href="/wiki/Disease_surveillance" title="Disease surveillance">disease surveillance</a> method promoted by Czech epidemiologist <a href="/wiki/Karel_Ra%C5%A1ka" title="Karel Raška">Karel Raška</a>.<a href="#cite_note-pmid20586232-129">[129]</a> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Rahima_Banu.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9d/Rahima_Banu.jpg/170px-Rahima_Banu.jpg" decoding="async" width="170" height="262" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9d/Rahima_Banu.jpg/255px-Rahima_Banu.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9d/Rahima_Banu.jpg/340px-Rahima_Banu.jpg 2x" data-file-width="1382" data-file-height="2130" /></a><figcaption>Three-year-old <a href="/wiki/Rahima_Banu" title="Rahima Banu">Rahima Banu</a> of Bangladesh (pictured) was the last person infected with naturally occurring variola major, in 1975.</figcaption></figure> In the early 1950s, an estimated 50 million cases of smallpox occurred in the world each year.<a href="#cite_note-WHO2007Fact-10">[10]</a> To eradicate smallpox, each outbreak had to be stopped from spreading, by isolation of cases and vaccination of everyone who lived close by.<a href="#cite_note-130">[130]</a> This process is known as "ring vaccination". The key to this strategy was the monitoring of cases in a community (known as surveillance) and containment. The initial problem the WHO team faced was inadequate reporting of smallpox cases, as many cases did not come to the attention of the authorities. The fact that humans are the only reservoir for smallpox infection (the virus only infected humans and not other animals) and that <a href="/wiki/Asymptomatic_carrier" title="Asymptomatic carrier">carriers</a> did not exist played a significant role in the eradication of smallpox. The WHO established a network of consultants who assisted countries in setting up surveillance and containment activities. Early on, donations of vaccine were provided primarily by the Soviet Union and the United States, but by 1973, more than 80 percent of all vaccine was produced in developing countries.<a href="#cite_note-Plotkin_1999-126">[126]</a> The Soviet Union provided one and a half billion doses between 1958 and 1979, as well as the medical staff.<a href="#cite_note-131">[131]</a> The last major European outbreak of smallpox was in <a href="/wiki/1972_Yugoslav_smallpox_outbreak" title="1972 Yugoslav smallpox outbreak">1972 in Yugoslavia</a>, after a pilgrim from <a href="/wiki/Kosovo" title="Kosovo">Kosovo</a> returned from the Middle East, where he had contracted the virus. The epidemic infected 175 people, causing 35 deaths. Authorities declared <a href="/wiki/Martial_law" title="Martial law">martial law</a>, enforced quarantine, and undertook widespread re-vaccination of the population, enlisting the help of the WHO. In two months, the outbreak was over.<a href="#cite_note-132">[132]</a> Prior to this, there had been a smallpox outbreak in May–July 1963 in <a href="/wiki/Stockholm" title="Stockholm">Stockholm</a>, Sweden, brought from the <a href="/wiki/Far_East" title="Far East">Far East</a> by a Swedish sailor; this had been dealt with by quarantine measures and vaccination of the local population.<a href="#cite_note-133">[133]</a> <figure class="mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Bifurcated_vaccinating_needle_for_smallpox.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Bifurcated_vaccinating_needle_for_smallpox.jpg/75px-Bifurcated_vaccinating_needle_for_smallpox.jpg" decoding="async" width="75" height="384" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Bifurcated_vaccinating_needle_for_smallpox.jpg/113px-Bifurcated_vaccinating_needle_for_smallpox.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/f/fa/Bifurcated_vaccinating_needle_for_smallpox.jpg 2x" data-file-width="118" data-file-height="600" /></a><figcaption>Bifurcated needle used in the WHO's smallpox eradication program<a href="#cite_note-134">[134]</a></figcaption></figure> By the end of 1975, smallpox persisted only in the <a href="/wiki/Horn_of_Africa" title="Horn of Africa">Horn of Africa</a>. Conditions were very difficult in <a href="/wiki/Derg" title="Derg">Ethiopia</a> and <a href="/wiki/Somali_Democratic_Republic" title="Somali Democratic Republic">Somalia</a>, where there were few roads. Civil war, famine, and refugees made the task even more difficult. An intensive surveillance, containment, and vaccination program was undertaken in these countries in early and mid-1977, under the direction of Australian microbiologist <a href="/wiki/Frank_Fenner" title="Frank Fenner">Frank Fenner</a>. As the campaign neared its goal, Fenner and his team played an important role in verifying eradication.<a href="#cite_note-135">[135]</a> The last naturally occurring case of indigenous smallpox (Variola minor) was diagnosed in <a href="/wiki/Ali_Maow_Maalin" title="Ali Maow Maalin">Ali Maow Maalin</a>, a hospital cook in Merca, <a href="/wiki/Somalia" title="Somalia">Somalia</a>, on 26 October 1977.<a href="#cite_note-PinkBook-33">[33]</a> The last naturally occurring case of the more deadly Variola major had been detected in October 1975 in a three-year-old <a href="/wiki/Bangladesh" title="Bangladesh">Bangladeshi</a> girl, <a href="/wiki/Rahima_Banu" title="Rahima Banu">Rahima Banu</a>.<a href="#cite_note-PrestonNY-40">[40]</a> The global eradication of smallpox was certified, based on intense verification activities, by a commission of eminent scientists on 9 December 1979 and subsequently endorsed by the World Health Assembly on 8 May 1980.<a href="#cite_note-WHO2007Fact-10">[10]</a><a href="#cite_note-Fenner_2006-136">[136]</a> The first two sentences of the resolution read: <style data-mw-deduplicate="TemplateStyles:r1244412712">.mw-parser-output .templatequote{overflow:hidden;margin:1em 0;padding:0 32px}.mw-parser-output .templatequotecite{line-height:1.5em;text-align:left;margin-top:0}@media(min-width:500px){.mw-parser-output .templatequotecite{padding-left:1.6em}}</style><blockquote class="templatequote">Having considered the development and results of the global program on smallpox eradication initiated by WHO in 1958 and intensified since 1967 … Declares solemnly that the world and its peoples have won freedom from smallpox, which was a most devastating disease sweeping in epidemic form through many countries since earliest time, leaving death, blindness and disfigurement in its wake and which only a decade ago was rampant in Africa, Asia and South America.<a href="#cite_note-Pennington-137">[137]</a></blockquote> <div class="mw-heading mw-heading4"><h4 id="Costs_and_benefits">Costs and benefits</h4></div> The cost of the eradication effort, from 1967 to 1979, was roughly US$300 million. Roughly a third came from the developed world, which had largely eradicated smallpox decades earlier. The United States, the largest contributor to the program, has reportedly recouped that investment every 26 days since in money not spent on vaccinations and the costs of incidence.<a href="#cite_note-138">[138]</a> <div class="mw-heading mw-heading3"><h3 id="Since_eradication">Since eradication</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Smallpox_virus_retention_debate" title="Smallpox virus retention debate">Smallpox virus retention debate</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Directors_of_Global_Smallpox_Eradication_Program.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/77/Directors_of_Global_Smallpox_Eradication_Program.jpg/220px-Directors_of_Global_Smallpox_Eradication_Program.jpg" decoding="async" width="220" height="173" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/77/Directors_of_Global_Smallpox_Eradication_Program.jpg/330px-Directors_of_Global_Smallpox_Eradication_Program.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/77/Directors_of_Global_Smallpox_Eradication_Program.jpg/440px-Directors_of_Global_Smallpox_Eradication_Program.jpg 2x" data-file-width="2816" data-file-height="2220" /></a><figcaption>Three former directors of the Global Smallpox Eradication Program read the news that smallpox had been globally eradicated, 1980.</figcaption></figure> The last case of smallpox in the world occurred in <a href="/wiki/1978_smallpox_outbreak_in_the_United_Kingdom" title="1978 smallpox outbreak in the United Kingdom">an outbreak in the United Kingdom in 1978</a>.<a href="#cite_note-Pallen-139">[139]</a> A medical photographer, Janet Parker, contracted the disease at the <a href="/wiki/University_of_Birmingham_Medical_School" title="University of Birmingham Medical School">University of Birmingham Medical School</a> and died on 11 September 1978. Although it has remained unclear how Parker became infected, the source of the infection was established to be the variola virus grown for research purposes at the Medical School laboratory.<a href="#cite_note-140">[140]</a><a href="#cite_note-141">[141]</a> All known stocks of smallpox worldwide were subsequently destroyed or transferred to two WHO-designated reference laboratories with <a href="/wiki/BSL-4" class="mw-redirect" title="BSL-4">BSL-4</a> facilities – the United States' <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a> (CDC) and the Soviet Union's (now Russia's) <a href="/wiki/State_Research_Center_of_Virology_and_Biotechnology_VECTOR" title="State Research Center of Virology and Biotechnology VECTOR">State Research Center of Virology and Biotechnology VECTOR</a>.<a href="#cite_note-142">[142]</a> WHO first recommended destruction of the virus in 1986 and later set the date of destruction to be 30 December 1993. This was postponed to 30 June 1999.<a href="#cite_note-143">[143]</a> Due to resistance from the U.S. and Russia, in 2002 the World Health Assembly agreed to permit the temporary retention of the virus stocks for specific research purposes.<a href="#cite_note-144">[144]</a> Destroying existing stocks would reduce the risk involved with ongoing smallpox research; the stocks are not needed to respond to a smallpox outbreak.<a href="#cite_note-145">[145]</a> Some scientists have argued that the stocks may be useful in developing new vaccines, antiviral drugs, and diagnostic tests;<a href="#cite_note-pmid17431262-146">[146]</a> a 2010 review by a team of public health experts appointed by WHO concluded that no essential public health purpose is served by the U.S. and Russia continuing to retain virus stocks.<a href="#cite_note-AGIES-147">[147]</a> The latter view is frequently supported in the scientific community, particularly among veterans of the WHO Smallpox Eradication Program.<a href="#cite_note-eradedit-148">[148]</a> On March 31, 2003, smallpox <a href="/wiki/Coagulation" title="Coagulation">scabs</a> were found inside an envelope in an 1888 book on <a href="/wiki/American_Civil_War" title="American Civil War">Civil War</a> medicine in <a href="/wiki/Santa_Fe,_New_Mexico" title="Santa Fe, New Mexico">Santa Fe, New Mexico</a>.<a href="#cite_note-USA_Today_20031226-149">[149]</a> The envelope was labeled as containing scabs from a vaccination and gave scientists at the CDC an opportunity to study the history of smallpox vaccination in the United States. On July 1, 2014, six sealed glass vials of smallpox dated 1954, along with sample vials of other pathogens, were discovered in a cold storage room in an FDA laboratory at the <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a> location in <a href="/wiki/Bethesda,_Maryland" title="Bethesda, Maryland">Bethesda, Maryland</a>. The smallpox vials were subsequently transferred to the custody of the CDC in Atlanta, where virus taken from at least two vials proved viable in culture.<a href="#cite_note-150">[150]</a><a href="#cite_note-151">[151]</a> After studies were conducted, the CDC destroyed the virus under WHO observation on February 24, 2015.<a href="#cite_note-152">[152]</a> In 2017, scientists at the <a href="/wiki/University_of_Alberta" title="University of Alberta">University of Alberta</a> recreated an extinct <a href="/wiki/Horse_pox" class="mw-redirect" title="Horse pox">horse pox</a> virus to demonstrate that the variola virus can be recreated in a small lab at a cost of about $100,000, by a team of scientists without specialist knowledge.<a href="#cite_note-153">[153]</a> This makes the retention controversy irrelevant since the virus can be easily recreated even if all samples are destroyed. Although the scientists performed the research to help development of new vaccines as well as trace smallpox's history, the possibility of the techniques being used for nefarious purposes was immediately recognized, raising questions on <a href="/wiki/Dual-use_technology#Biological" title="Dual-use technology">dual use research</a> and regulations.<a href="#cite_note-154">[154]</a><a href="#cite_note-155">[155]</a> In September 2019, the Russian lab housing smallpox samples experienced a gas explosion that injured one worker. It did not occur near the virus storage area, and no samples were compromised, but the incident prompted a review of risks to containment.<a href="#cite_note-156">[156]</a> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2></div> <div class="mw-heading mw-heading3"><h3 id="Biological_warfare">Biological warfare</h3></div> In 1763, <a href="/wiki/Pontiac%27s_War" title="Pontiac's War">Pontiac's War</a> broke out as a <a href="/wiki/Native_Americans_in_the_United_States" title="Native Americans in the United States">Native American</a> confederacy led by <a href="/wiki/Pontiac_(Ottawa_leader)" class="mw-redirect" title="Pontiac (Ottawa leader)">Pontiac</a> attempted to counter British control over the <a href="/wiki/Great_Lakes" title="Great Lakes">Great Lakes</a> region.<a href="#cite_note-Jennings_1988-157">[157]</a><a href="#cite_note-158">[158]</a><a href="#cite_note-159">[159]</a> A group of Native American warriors <a href="/wiki/Siege_of_Fort_Pitt" title="Siege of Fort Pitt">laid siege</a> to British-held <a href="/wiki/Fort_Pitt_(Pennsylvania)" title="Fort Pitt (Pennsylvania)">Fort Pitt</a> on June 22.<a href="#cite_note-160">[160]</a> In response, <a href="/wiki/Henry_Bouquet" title="Henry Bouquet">Henry Bouquet</a>, the commander of the fort, ordered his subordinate Simeon Ecuyer to give smallpox-infested blankets from the infirmary to a <a href="/wiki/Lenape" title="Lenape">Delaware</a> delegation outside the fort. Bouquet had discussed this with his superior, <a href="/wiki/Jeffery_Amherst,_1st_Baron_Amherst" title="Jeffery Amherst, 1st Baron Amherst">Sir Jeffrey Amherst</a>, who wrote to Bouquet stating: "Could it not be contrived to send the small pox among the disaffected tribes of Indians? We must on this occasion use every stratagem in our power to reduce them." Bouquet agreed with the proposal, writing back that "I will try to inocculate [<a href="/wiki/Sic" title="Sic">sic</a>] the Indians by means of Blankets that may fall in their hands".<a href="#cite_note-Dixon-161">[161]</a> On 24 June 1763, William Trent, a local trader and commander of the Fort Pitt militia, wrote, "Out of our regard for them, we gave them two Blankets and an Handkerchief out of the Small Pox Hospital. I hope it will have the desired effect."<a href="#cite_note-162">[162]</a><a href="#cite_note-Jennings_1988-157">[157]</a> The effectiveness of this effort to broadcast the disease is unknown. There are also accounts that smallpox was used as a weapon during the <a href="/wiki/American_Revolutionary_War" title="American Revolutionary War">American Revolutionary War</a> (1775–1783).<a href="#cite_note-BBC_pox_weapon_01-163">[163]</a><a href="#cite_note-164">[164]</a> According to a theory put forward in Journal of Australian Studies (JAS) by independent researcher Christopher Warren, <a href="/wiki/Royal_Marines" title="Royal Marines">Royal Marines</a> used smallpox in 1789 against indigenous tribes in <a href="/wiki/New_South_Wales" title="New South Wales">New South Wales</a>.<a href="#cite_note-165">[165]</a> This theory was also considered earlier in Bulletin of the History of Medicine<a href="#cite_note-Bennett_2009-166">[166]</a> and by David Day.<a href="#cite_note-167">[167]</a> However it is disputed by some medical academics, including Professor Jack Carmody, who in 2010 claimed that the rapid spread of the outbreak in question was more likely indicative of <a href="/wiki/Chickenpox" title="Chickenpox">chickenpox</a> – a more infectious disease which, at the time, was often confused, even by surgeons, with smallpox, and may have been comparably deadly to Aborigines and other peoples without natural immunity to it.<a href="#cite_note-168">[168]</a> Carmody noted that in the 8-month voyage of the <a href="/wiki/First_Fleet" title="First Fleet">First Fleet</a> and the following 14 months there were no reports of smallpox amongst the colonists and that, since smallpox has an incubation period of 10–12 days, it is unlikely it was present in the First Fleet; however, Warren argued in the JAS article that the likely source was bottles of variola virus possessed by <a href="/wiki/First_Fleet#Smallpox" title="First Fleet">First Fleet surgeons</a>. Ian and Jennifer Glynn, in The life and death of smallpox, confirm that bottles of "variolous matter" were carried to Australia for use as a vaccine, but think it unlikely the virus could have survived till 1789.<a href="#cite_note-Glynn_2004-104">[104]</a> In 2007, Christopher Warren offered evidence that the British smallpox may have been still viable.<a href="#cite_note-169">[169]</a> However, the only non-Aborigine reported to have died in this outbreak was a seaman called Joseph Jeffries, who was recorded as being of "American Indian" origin.<a href="#cite_note-170">[170]</a> W. S. Carus, an expert in biological weapons, has written that there is circumstantial evidence that smallpox was deliberately introduced to the Aboriginal population.<a href="#cite_note-171">[171]</a> However Carmody and the Australian National University's Boyd Hunter continue to support the chickenpox hypothesis.<a href="#cite_note-172">[172]</a> In a 2013 lecture at the Australian National University,<a href="#cite_note-173">[173]</a> Carmody pointed out that chickenpox, unlike smallpox, was known to be present in the Sydney Cove colony. He also suggested that all <abbr title="circa">c.</abbr> 18th century (and earlier) identifications of smallpox outbreaks were dubious because: "surgeons … would have been unaware of the distinction between smallpox and chickenpox – the latter having traditionally been considered a milder form of smallpox."<a href="#cite_note-174">[174]</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Smallpox_in_Australia" title="Smallpox in Australia">Smallpox in Australia</a></div> During <a href="/wiki/World_War_II" title="World War II">World War II</a>, scientists from the United Kingdom, United States, and Japan (<a href="/wiki/Unit_731" title="Unit 731">Unit 731</a> of the <a href="/wiki/Imperial_Japanese_Army" title="Imperial Japanese Army">Imperial Japanese Army</a>) were involved in research into producing a biological weapon from smallpox.<a href="#cite_note-175">[175]</a> Plans of large scale production were never carried through as they considered that the weapon would not be very effective due to the wide-scale availability of a <a href="/wiki/Vaccine" title="Vaccine">vaccine</a>.<a href="#cite_note-BBC_pox_weapon_01-163">[163]</a> In 1947, the <a href="/wiki/Soviet_Union" title="Soviet Union">Soviet Union</a> established a smallpox weapons factory in the city of <a href="/wiki/Zagorsk" class="mw-redirect" title="Zagorsk">Zagorsk</a>, 75 km to the northeast of Moscow.<a href="#cite_note-Alibek-176">[176]</a> An <a href="/wiki/Aral_smallpox_incident" class="mw-redirect" title="Aral smallpox incident">outbreak of weaponized smallpox</a> occurred during testing at a facility on an island in the <a href="/wiki/Aral_Sea" title="Aral Sea">Aral Sea</a> in 1971. General Prof. Peter Burgasov, former Chief Sanitary Physician of the <a href="/wiki/Soviet_Army" title="Soviet Army">Soviet Army</a> and a senior researcher within the <a href="/wiki/Soviet_program_of_biological_weapons" class="mw-redirect" title="Soviet program of biological weapons">Soviet program of biological weapons</a>, described the incident: <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1244412712"><blockquote class="templatequote">On <a href="/wiki/Vozrozhdeniya_Island" title="Vozrozhdeniya Island">Vozrozhdeniya Island</a> in the <a href="/wiki/Aral_Sea" title="Aral Sea">Aral Sea</a>, the strongest recipes of smallpox were tested. Suddenly I was informed that there were mysterious cases of mortalities in <a href="/wiki/Aral,_Kazakhstan" title="Aral, Kazakhstan">Aralsk</a>. A research ship of the Aral fleet came to within 15 km of the island (it was forbidden to come any closer than 40 km). The lab technician of this ship took samples of plankton twice a day from the top deck. The smallpox formulation – 400 gr. of which was exploded on the island – "got her" and she became infected. After returning home to Aralsk, she infected several people including children. All of them died. I suspected the reason for this and called the Chief of General Staff of the Ministry of Defense and requested to forbid the stop of the <a href="/wiki/Alma-Ata" class="mw-redirect" title="Alma-Ata">Alma-Ata</a>–Moscow train in Aralsk. As a result, the epidemic around the country was prevented. I called <a href="/wiki/Yuri_Andropov" title="Yuri Andropov">Andropov</a>, who at that time was Chief of KGB, and informed him of the exclusive recipe of smallpox obtained on Vozrazhdenie Island.<a href="#cite_note-Shoham-177">[177]</a><a href="#cite_note-178">[178]</a></blockquote> Others contend that the first patient may have contracted the disease while visiting Uyaly or <a href="/w/index.php?title=Komsomolsk-on-Ustyurt&action=edit&redlink=1" class="new" title="Komsomolsk-on-Ustyurt (page does not exist)">Komsomolsk-on-Ustyurt</a>, two cities where the boat docked.<a href="#cite_note-179">[179]</a><a href="#cite_note-180">[180]</a> Responding to international pressures, in 1991 the Soviet government allowed a joint U.S.–British inspection team to tour four of its main weapons facilities at <a href="/wiki/Biopreparat" title="Biopreparat">Biopreparat</a>. The inspectors were met with evasion and denials from the Soviet scientists and were eventually ordered out of the facility.<a href="#cite_note-Preston-181">[181]</a> In 1992, Soviet defector <a href="/wiki/Ken_Alibek" title="Ken Alibek">Ken Alibek</a> alleged that the Soviet bioweapons program at Zagorsk had produced a large stockpile – as much as twenty tons – of weaponized smallpox (possibly engineered to resist vaccines, Alibek further alleged), along with refrigerated <a href="/wiki/Warhead" title="Warhead">warheads</a> to deliver it. Alibek's stories about the former Soviet program's smallpox activities have never been independently verified. In 1997, the Russian government announced that all of its remaining smallpox samples would be moved to the <a href="/wiki/State_Research_Center_of_Virology_and_Biotechnology_VECTOR" title="State Research Center of Virology and Biotechnology VECTOR">Vector Institute</a> in <a href="/wiki/Koltsovo,_Novosibirsk_Oblast" title="Koltsovo, Novosibirsk Oblast">Koltsovo</a>.<a href="#cite_note-Preston-181">[181]</a> With the breakup of the Soviet Union and unemployment of many of the weapons program's scientists, U.S. government officials have expressed concern that smallpox and the expertise to weaponize it may have become available to other governments or terrorist groups who might wish to use virus as means of biological warfare.<a href="#cite_note-CDCcourse-182">[182]</a> Specific allegations made against Iraq in this respect proved to be false.<a href="#cite_note-USfalseallegation-183">[183]</a> <div class="mw-heading mw-heading3"><h3 id="Notable_cases">Notable cases</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Martini_bologna_mozart_1777.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Martini_bologna_mozart_1777.jpg/220px-Martini_bologna_mozart_1777.jpg" decoding="async" width="220" height="259" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Martini_bologna_mozart_1777.jpg/330px-Martini_bologna_mozart_1777.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/aa/Martini_bologna_mozart_1777.jpg/440px-Martini_bologna_mozart_1777.jpg 2x" data-file-width="510" data-file-height="600" /></a><figcaption>In 1767, the 11-year-old composer <a href="/wiki/Wolfgang_Amadeus_Mozart" title="Wolfgang Amadeus Mozart">Wolfgang Amadeus Mozart</a> survived a smallpox outbreak in <a href="/wiki/Austria" title="Austria">Austria</a> that killed Holy Roman Empress <a href="/wiki/Maria_Josepha_of_Bavaria" title="Maria Josepha of Bavaria">Maria Josepha</a>, who became the second consecutive wife of <a href="/wiki/Joseph_II,_Holy_Roman_Emperor" title="Joseph II, Holy Roman Emperor">Holy Roman Emperor Joseph II</a> to die of the disease, as well as <a href="/wiki/Archduchess_Maria_Josepha_of_Austria" title="Archduchess Maria Josepha of Austria">Archduchess Maria Josepha</a>. (See <a href="/wiki/Mozart_and_smallpox" title="Mozart and smallpox">Mozart and smallpox</a>.)</figcaption></figure> Famous historical figures who contracted smallpox include Lakota Chief <a href="/wiki/Sitting_Bull" title="Sitting Bull">Sitting Bull</a>, <a href="/wiki/Ramses_V" class="mw-redirect" title="Ramses V">Ramses V</a>,<a href="#cite_note-Koplow_2003-184">[184]</a> the <a href="/wiki/Kangxi_Emperor" title="Kangxi Emperor">Kangxi Emperor</a> (survived), <a href="/wiki/Shunzhi_Emperor" title="Shunzhi Emperor">Shunzhi Emperor</a> and <a href="/wiki/Tongzhi_Emperor" title="Tongzhi Emperor">Tongzhi Emperor</a> of China, <a href="/wiki/Emperor_Komei" class="mw-redirect" title="Emperor Komei">Emperor Komei</a> of Japan (died of smallpox in 1867), and <a href="/wiki/Date_Masamune" title="Date Masamune">Date Masamune</a> of Japan (who lost an eye to the disease). <a href="/wiki/Cuitl%C3%A1huac" title="Cuitláhuac">Cuitláhuac</a>, the 10th <a href="/wiki/Tlatoani" title="Tlatoani">tlatoani</a> (ruler) of the <a href="/wiki/Aztec" class="mw-redirect" title="Aztec">Aztec</a> city of <a href="/wiki/Tenochtitlan" title="Tenochtitlan">Tenochtitlan</a>, died of smallpox in 1520, shortly after its introduction to the <a href="/wiki/Americas" title="Americas">Americas</a>, and the Incan emperor <a href="/wiki/Huayna_Capac" title="Huayna Capac">Huayna Capac</a> died of it in 1527 (causing a civil war of succession in the Inca empire and the eventual conquest by the Spaniards). More recent public figures include <a href="/wiki/Guru_Har_Krishan" title="Guru Har Krishan">Guru Har Krishan</a>, 8th Guru of the Sikhs, in 1664, <a href="/wiki/Louis_I_of_Spain" title="Louis I of Spain">Louis I of Spain</a> in 1724 (died), <a href="/wiki/Peter_II_of_Russia" title="Peter II of Russia">Peter II of Russia</a> in 1730 (died),<a href="#cite_note-doctorzebra.com-185">[185]</a> <a href="/wiki/George_Washington" title="George Washington">George Washington</a> (survived), <a href="/wiki/Louis_XV_of_France" class="mw-redirect" title="Louis XV of France">Louis XV of France</a> in 1774 (died) and <a href="/wiki/Maximilian_III_Joseph_of_Bavaria" class="mw-redirect" title="Maximilian III Joseph of Bavaria">Maximilian III Joseph of Bavaria</a> in 1777 (died). Prominent families throughout the world often had several people infected by and/or perish from the disease. For example, several relatives of <a href="/wiki/Henry_VIII_of_England" class="mw-redirect" title="Henry VIII of England">Henry VIII of England</a> survived the disease but were scarred by it. These include his sister <a href="/wiki/Margaret_Tudor" title="Margaret Tudor">Margaret</a>, his wife <a href="/wiki/Anne_of_Cleves" title="Anne of Cleves">Anne of Cleves</a>, and his two daughters: <a href="/wiki/Mary_I" class="mw-redirect" title="Mary I">Mary I</a> in 1527 and <a href="/wiki/Elizabeth_I" title="Elizabeth I">Elizabeth I</a> in 1562. Elizabeth tried to disguise the pockmarks with heavy makeup. <a href="/wiki/Mary,_Queen_of_Scots" title="Mary, Queen of Scots">Mary, Queen of Scots</a>, contracted the disease as a child but had no visible scarring. In Europe, deaths from smallpox often changed dynastic succession. <a href="/wiki/Louis_XV_of_France" class="mw-redirect" title="Louis XV of France">Louis XV of France</a> succeeded his great-grandfather <a href="/wiki/Louis_XIV" title="Louis XIV">Louis XIV</a> through a series of deaths of smallpox or measles among those higher in the succession line. He himself died of the disease in 1774. <a href="/wiki/Peter_II_of_Russia" title="Peter II of Russia">Peter II of Russia</a> died of the disease at 14 years of age. Also, before becoming emperor, <a href="/wiki/Peter_III_of_Russia" title="Peter III of Russia">Peter III of Russia</a> caught the virus and suffered greatly from it.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] He was left scarred and disfigured. His wife, <a href="/wiki/Catherine_the_Great" title="Catherine the Great">Catherine the Great</a>, was spared but fear of the virus clearly had its effects on her. She feared for the safety of her son, <a href="/wiki/Paul_I_of_Russia" title="Paul I of Russia">Paul</a>, so much that she made sure that large crowds were kept at bay and sought to isolate him. Eventually, she decided to have herself inoculated by a <a href="/wiki/Great_Britain" title="Great Britain">British</a> doctor, <a href="/wiki/Thomas_Dimsdale" title="Thomas Dimsdale">Thomas Dimsdale</a>. While this was considered a controversial method at the time, she succeeded. Paul was later inoculated as well. Catherine then sought to have inoculations throughout her empire stating: "My objective was, through my example, to save from death the multitude of my subjects who, not knowing the value of this technique, and frightened of it, were left in danger." By 1800, approximately two million inoculations had been administered in the Russian Empire.<a href="#cite_note-186">[186]</a> In China, the <a href="/wiki/Qing_dynasty" title="Qing dynasty">Qing dynasty</a> had extensive protocols to protect <a href="/wiki/Manchu" class="mw-redirect" title="Manchu">Manchus</a> from <a href="/wiki/Peking" class="mw-redirect" title="Peking">Peking</a>'s endemic smallpox. U.S. Presidents <a href="/wiki/George_Washington" title="George Washington">George Washington</a>, <a href="/wiki/Andrew_Jackson" title="Andrew Jackson">Andrew Jackson</a>, and <a href="/wiki/Abraham_Lincoln" title="Abraham Lincoln">Abraham Lincoln</a> all contracted and recovered from the disease. Washington became infected with smallpox on a visit to <a href="/wiki/Barbados" title="Barbados">Barbados</a> in 1751.<a href="#cite_note-Michael_B._A._Oldstone-187">[187]</a> Jackson developed the illness after being taken prisoner by the British during the American Revolution, and though he recovered, his brother Robert did not.<a href="#cite_note-Michael_B._A._Oldstone-187">[187]</a> Lincoln contracted the disease during his presidency, possibly from his son Tad, and was quarantined shortly after giving the Gettysburg address in 1863.<a href="#cite_note-Michael_B._A._Oldstone-187">[187]</a> The famous theologian <a href="/wiki/Jonathan_Edwards_(theologian)" title="Jonathan Edwards (theologian)">Jonathan Edwards</a> died of smallpox in 1758 following an inoculation.<a href="#cite_note-Edwards_bio-188">[188]</a> <a href="/wiki/Soviet_Union" title="Soviet Union">Soviet</a> leader <a href="/wiki/Joseph_Stalin" title="Joseph Stalin">Joseph Stalin</a> fell ill with smallpox at the age of seven. His face was badly scarred by the disease. He later had photographs retouched to make his pockmarks less apparent.<a href="#cite_note-189">[189]</a> Hungarian poet <a href="/wiki/Ferenc_K%C3%B6lcsey" title="Ferenc Kölcsey">Ferenc Kölcsey</a>, who wrote the Hungarian national anthem, lost his right eye to smallpox.<a href="#cite_note-190">[190]</a> <div class="mw-heading mw-heading3"><h3 id="Tradition_and_religion">Tradition and religion</h3></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Kalighat_Shitala.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/62/Kalighat_Shitala.jpg/220px-Kalighat_Shitala.jpg" decoding="async" width="220" height="261" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/62/Kalighat_Shitala.jpg/330px-Kalighat_Shitala.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/6/62/Kalighat_Shitala.jpg 2x" data-file-width="411" data-file-height="487" /></a><figcaption>The Hindu goddess <a href="/wiki/Shitala" title="Shitala">Shitala</a> was worshipped to prevent or cure smallpox.</figcaption></figure> In the face of the devastation of smallpox, various smallpox gods and goddesses have been worshipped throughout parts of the <a href="/wiki/Old_World" title="Old World">Old World</a>, for example in China and India. In China, the smallpox goddess was referred to as T'ou-Shen Niang-Niang (<a href="/wiki/Chinese_language" title="Chinese language">Chinese</a>: 痘疹娘娘).<a href="#cite_note-HopkinsDonald-191">[191]</a> Chinese believers actively worked to appease the goddess and pray for her mercy, by such measures as referring to smallpox pustules as "beautiful flowers" as a <a href="/wiki/Euphemism" title="Euphemism">euphemism</a> intended to avert offending the goddess, for example (the Chinese word for smallpox is <a href="https://en.wiktionary.org/wiki/%E5%A4%A9%E8%8A%B1#Chinese" class="extiw" title="wikt:天花">天花</a>, literally "heaven flower").<a href="#cite_note-GiblinJames-192">[192]</a> In a related New Year's Eve custom it was prescribed that the children of the house wear ugly masks while sleeping, so as to conceal any beauty and thereby avoid attracting the goddess, who would be passing through sometime that night.<a href="#cite_note-GiblinJames-192">[192]</a> If a case of smallpox did occur, shrines would be set up in the homes of the victims, to be worshipped and offered to as the disease ran its course. If the victim recovered, the shrines were removed and carried away in a special paper chair or boat for burning. If the patient did not recover, the shrine was destroyed and cursed, to expel the goddess from the house.<a href="#cite_note-HopkinsDonald-191">[191]</a> In the <a href="/wiki/Yoruba_language" title="Yoruba language">Yoruba language</a> smallpox is known as ṣọpọná, but it was also written as shakpanna, shopona, ṣhapana, and ṣọpọnọ. The word is a combination of 3 words, the verb ṣán, meaning to cover or plaster (referring to the pustules characteristic of smallpox), kpa or pa, meaning to kill, and enia, meaning human. Roughly translated, it means One who kills a person by covering them with pustules.<a href="#cite_note-193">[193]</a> Among the <a href="/wiki/Yoruba_people" title="Yoruba people">Yorùbá people</a> of West Africa, and also in <a href="/wiki/Dahomean_religion" title="Dahomean religion">Dahomean religion</a>, Trinidad, and <a href="/wiki/Candombl%C3%A9" title="Candomblé">in Brazil</a>, The deity <a href="/wiki/Sopona" title="Sopona">Sopona</a>, also known as <a href="/wiki/Babal%C3%BA-Ay%C3%A9" title="Babalú-Ayé">Obaluaye</a>, is the deity of smallpox and other deadly diseases (like leprosy, HIV/AIDS, and fevers). One of the most feared deities of the <a href="/wiki/Orisha" title="Orisha">orisha</a> pantheon, smallpox was seen as a form of punishment from Shopona.<a href="#cite_note-cdc.gov-194">[194]</a> Worship of Shopona was highly controlled by his priests, and it was believed that priests could also spread smallpox when angered.<a href="#cite_note-cdc.gov-194">[194]</a> However, Shopona was also seen as a healer who could cure the diseases he inflicted, and he was often called upon by his victims to heal them.<a href="#cite_note-africanart.nl-195">[195]</a> The British government banned the worship of the god because it was believed his priests were purposely spreading smallpox to their opponents.<a href="#cite_note-africanart.nl-195">[195]</a><a href="#cite_note-cdc.gov-194">[194]</a> India's first records of smallpox can be found in a medical book that dates back to 400 CE. This book describes a disease that sounds exceptionally like smallpox.<a href="#cite_note-GiblinJames-192">[192]</a> India, like China and the Yorùbá, created a goddess in response to its exposure to smallpox. The Hindu goddess <a href="/wiki/Shitala" title="Shitala">Shitala</a> was both worshipped and feared during her reign. It was believed that this goddess was both evil and kind and had the ability to inflict victims when angered, as well as calm the fevers of the already affected.<a href="#cite_note-196">[196]</a><a href="#cite_note-Hopkins_2002-93">[93]</a> Portraits of the goddess show her holding a broom in her right hand to continue to move the disease and a pot of cool water in the other hand in an attempt to soothe patients.<a href="#cite_note-GiblinJames-192">[192]</a> Shrines were created where many Indian natives, both healthy and not, went to worship and attempt to protect themselves from this disease. Some Indian women, in an attempt to ward off Shitala, placed plates of cooling foods and pots of water on the roofs of their homes.<a href="#cite_note-197">[197]</a> In cultures that did not recognize a smallpox deity, there was often nonetheless a belief in <a href="/wiki/Smallpox_demon" title="Smallpox demon">smallpox demons</a>, who were accordingly blamed for the disease. Such beliefs were prominent in Japan, Europe, Africa, and other parts of the world. Nearly all cultures who believed in the demon also believed that it was afraid of the color red. This led to the invention of the so-called red treatment, where patients and their rooms would be decorated in red. The practice spread to Europe in the 12th century and was practiced by (among others) <a href="/wiki/Charles_V_of_France" title="Charles V of France">Charles V of France</a> and <a href="/wiki/Elizabeth_I_of_England" class="mw-redirect" title="Elizabeth I of England">Elizabeth I of England</a>.<a href="#cite_note-Fenner_1988-3">[3]</a> Afforded scientific credibility through the studies by <a href="/wiki/Niels_Ryberg_Finsen" title="Niels Ryberg Finsen">Niels Ryberg Finsen</a> showing that red light reduced scarring,<a href="#cite_note-Fenner_1988-3">[3]</a> this belief persisted even until the 1930s. <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2></div> <ul><li><a href="/wiki/List_of_epidemics" class="mw-redirect" title="List of epidemics">List of epidemics</a></li> <li><a href="/wiki/List_of_epidemics_and_pandemics#Chronology" title="List of epidemics and pandemics">List of epidemics and pandemics § Chronology</a></li> <li><a href="/wiki/Population_history_of_indigenous_peoples_of_the_Americas#Depopulation_by_Old_World_diseases" class="mw-redirect" title="Population history of indigenous peoples of the Americas">Population history of indigenous peoples of the Americas § Depopulation by Old World diseases</a></li> <li><a href="/wiki/1971_Aral_smallpox_incident" title="1971 Aral smallpox incident">1971 Aral smallpox incident</a></li> <li><a href="/wiki/Jacobson_v._Massachusetts" title="Jacobson v. Massachusetts">Jacobson v. Massachusetts</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><a href="#cite_ref-1">^</a> <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFBartonFriedman2008" class="citation book cs1">Barton LL, Friedman NR (2008). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=GaIyKkRBqIQC&pg=PA151">The Neurological Manifestations of Pediatric Infectious Diseases and Immunodeficiency Syndromes</a>. Springer Science & Business Media. p. 151. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-59745-391-2" title="Special:BookSources/978-1-59745-391-2"><bdi>978-1-59745-391-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Neurological+Manifestations+of+Pediatric+Infectious+Diseases+and+Immunodeficiency+Syndromes&rft.pages=151&rft.pub=Springer+Science+%26+Business+Media&rft.date=2008&rft.isbn=978-1-59745-391-2&rft.aulast=Barton&rft.aufirst=Leslie+L.&rft.au=Friedman%2C+Neil+R.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DGaIyKkRBqIQC%26pg%3DPA151&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-2"><a href="#cite_ref-2">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSchaller2012" class="citation book cs1">Schaller KF (2012). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=Bw8yBwAAQBAJ&pg=PP21">Colour Atlas of Tropical Dermatology and Venerology</a>. Springer Science & Business Media. p. Chapter 1. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-3-642-76200-0" title="Special:BookSources/978-3-642-76200-0"><bdi>978-3-642-76200-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Colour+Atlas+of+Tropical+Dermatology+and+Venerology&rft.pages=Chapter+1&rft.pub=Springer+Science+%26+Business+Media&rft.date=2012&rft.isbn=978-3-642-76200-0&rft.aulast=Schaller&rft.aufirst=Karl+F.&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DBw8yBwAAQBAJ%26pg%3DPP21&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-Fenner_1988-3">^ <a href="#cite_ref-Fenner_1988_3-0">a</a> <a href="#cite_ref-Fenner_1988_3-1">b</a> <a href="#cite_ref-Fenner_1988_3-2">c</a> <a href="#cite_ref-Fenner_1988_3-3">d</a> <a href="#cite_ref-Fenner_1988_3-4">e</a> <a href="#cite_ref-Fenner_1988_3-5">f</a> <a href="#cite_ref-Fenner_1988_3-6">g</a> <a href="#cite_ref-Fenner_1988_3-7">h</a> <a href="#cite_ref-Fenner_1988_3-8">i</a> <a href="#cite_ref-Fenner_1988_3-9">j</a> <a href="#cite_ref-Fenner_1988_3-10">k</a> <a href="#cite_ref-Fenner_1988_3-11">l</a> <a href="#cite_ref-Fenner_1988_3-12">m</a> <a href="#cite_ref-Fenner_1988_3-13">n</a> <a href="#cite_ref-Fenner_1988_3-14">o</a> <a href="#cite_ref-Fenner_1988_3-15">p</a> <a href="#cite_ref-Fenner_1988_3-16">q</a> <a href="#cite_ref-Fenner_1988_3-17">r</a> <a href="#cite_ref-Fenner_1988_3-18">s</a> <a href="#cite_ref-Fenner_1988_3-19">t</a> <a href="#cite_ref-Fenner_1988_3-20">u</a> <a href="#cite_ref-Fenner_1988_3-21">v</a> <a href="#cite_ref-Fenner_1988_3-22">w</a> <a href="#cite_ref-Fenner_1988_3-23">x</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFennerHendersonAritaJežek1988" class="citation book cs1">Fenner F, Henderson DA, Arita I, Ježek Z, Ladnyi ID (1988). <a rel="nofollow" class="external text" href="https://biotech.law.lsu.edu/blaw/bt/smallpox/who/red-book/9241561106_chp5.pdf">"The History of Smallpox and its Spread Around the World"</a> (PDF). 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Retrieved 24 February 2017.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Washington+Post&rft.atitle=FDA+found+more+than+smallpox+vials+in+storage+room&rft.date=2014-07-16&rft_id=https%3A%2F%2Fwww.washingtonpost.com%2Fnational%2Fhealth-science%2Ffda-found-more-than-smallpox-vials-in-storage-room%2F2014%2F07%2F16%2F850d4b12-0d22-11e4-8341-b8072b1e7348_story.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-152"><a href="#cite_ref-152">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://osp.od.nih.gov/wp-content/uploads/Final_Report_of_the_Variola_BRP.pdf">"Report of the Blue Ribbon Panel to Review the 2014 Smallpox (variola) Virus Incident on the NIH Campus"</a> (PDF). 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PLOS Pathogens. 14 (10): e1007025. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1371%2Fjournal.ppat.1007025">10.1371/journal.ppat.1007025</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171955">6171955</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30286190">30286190</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLOS+Pathogens&rft.atitle=Synthetic+horsepox+viruses+and+the+continuing+debate+about+dual+use+research&rft.volume=14&rft.issue=10&rft.pages=e1007025&rft.date=2018-10&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6171955%23id-name%3DPMC&rft_id=info%3Apmid%2F30286190&rft_id=info%3Adoi%2F10.1371%2Fjournal.ppat.1007025&rft.aulast=Noyce&rft.aufirst=RS&rft.au=Evans%2C+DH&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6171955&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-156"><a href="#cite_ref-156">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKritz2019" class="citation news cs1">Kritz F (19 September 2019). <a rel="nofollow" class="external text" href="https://www.npr.org/sections/goatsandsoda/2019/09/19/762013515/russian-lab-explosion-raises-question-should-smallpox-virus-be-kept-or-destroyed">"Russian Lab Explosion Raises Question: Should Smallpox Virus Be Kept Or Destroyed?"</a>. <a href="/wiki/NPR" title="NPR">NPR</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200723010532/https://www.npr.org/sections/goatsandsoda/2019/09/19/762013515/russian-lab-explosion-raises-question-should-smallpox-virus-be-kept-or-destroyed">Archived</a> from the original on 23 July 2020. 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Bulletin of the History of Medicine. 83 (1): 37–62. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1353%2Fbhm.0.0167">10.1353/bhm.0.0167</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19329841">19329841</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:24057488">24057488</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Bulletin+of+the+History+of+Medicine&rft.atitle=Smallpox+and+cowpox+under+the+Southern+Cross%3A+the+smallpox+epidemic+of+1789+and+the+advent+of+vaccination+in+colonial+Australia&rft.volume=83&rft.issue=1&rft.pages=37-62&rft.date=2009&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A24057488%23id-name%3DS2CID&rft_id=info%3Apmid%2F19329841&rft_id=info%3Adoi%2F10.1353%2Fbhm.0.0167&rft.aulast=Bennett&rft.aufirst=MJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-167"><a href="#cite_ref-167">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDay2001" class="citation book cs1">Day D (2001). Claiming a Continent: A New History of Australia. Sydney: Harper Collins Publishers PTY Limited. p. 42. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7322-6976-0" title="Special:BookSources/978-0-7322-6976-0"><bdi>978-0-7322-6976-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Claiming+a+Continent%3A+A+New+History+of+Australia&rft.place=Sydney&rft.pages=42&rft.pub=Harper+Collins+Publishers+PTY+Limited&rft.date=2001&rft.isbn=978-0-7322-6976-0&rft.aulast=Day&rft.aufirst=David&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-168"><a href="#cite_ref-168">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.abc.net.au/radionational/programs/ockhamsrazor/chicken-pox-or-smallpox-in-the-colony-at-sydney/2972652#transcript">"Chicken pox or smallpox in the colony at Sydney Cove in April, 1789"</a>. Radio National. 17 September 2010. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150925213836/http://www.abc.net.au/radionational/programs/ockhamsrazor/chicken-pox-or-smallpox-in-the-colony-at-sydney/2972652#transcript">Archived</a> from the original on 25 September 2015. Retrieved 7 July 2014.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Radio+National&rft.atitle=Chicken+pox+or+smallpox+in+the+colony+at+Sydney+Cove+in+April%2C+1789&rft.date=2010-09-17&rft_id=http%3A%2F%2Fwww.abc.net.au%2Fradionational%2Fprograms%2Fockhamsrazor%2Fchicken-pox-or-smallpox-in-the-colony-at-sydney%2F2972652%23transcript&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988">]. </li> <li id="cite_note-169"><a href="#cite_ref-169">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWarren" class="citation journal cs1">Warren C. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20160305174741/https://www.scribd.com/doc/49665744/Warren-AbHist31-2007">"Could First Fleet smallpox infect Aborigines? – A note"</a>. Aboriginal History. 31: 152–64. Archived from <a rel="nofollow" class="external text" href="https://www.scribd.com/doc/49665744/Warren-AbHist31-2007">the original</a> on 5 March 2016. Retrieved 31 March 2019.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Aboriginal+History&rft.atitle=Could+First+Fleet+smallpox+infect+Aborigines%3F+%E2%80%93+A+note&rft.volume=31&rft.pages=152-64&rft.aulast=Warren&rft.aufirst=C&rft_id=https%3A%2F%2Fwww.scribd.com%2Fdoc%2F49665744%2FWarren-AbHist31-2007&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-170"><a href="#cite_ref-170">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.geni.com/people/Joseph-Jeffries-Crew-Supply-1788/6000000073111673102">"Joseph Jeffries [Crew "Supply" 1788]"</a>. www.geni.com. 1767. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200807055930/https://www.geni.com/people/Joseph-Jeffries-Crew-Supply-1788/6000000073111673102">Archived</a> from the original on 7 August 2020. Retrieved 29 March 2019.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.geni.com&rft.atitle=Joseph+Jeffries+%5BCrew+%22Supply%22+1788%5D&rft.date=1767&rft_id=https%3A%2F%2Fwww.geni.com%2Fpeople%2FJoseph-Jeffries-Crew-Supply-1788%2F6000000073111673102&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20200807054007/http://www.ffghs.org.au/page8.php">"Friends of the First Government House Site Inc – Smallpox Epidemic"</a>. www.ffghs.org.au. Archived from <a rel="nofollow" class="external text" href="http://www.ffghs.org.au/page8.php">the original</a> on 7 August 2020. Retrieved 29 March 2019.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.ffghs.org.au&rft.atitle=Friends+of+the+First+Government+House+Site+Inc+%E2%80%93+Smallpox+Epidemic&rft_id=http%3A%2F%2Fwww.ffghs.org.au%2Fpage8.php&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-171"><a href="#cite_ref-171">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCarus2015" class="citation journal cs1">Carus WS (2015). "The History of Biological Weapons Use: What We Know and What We Don't". Health Security. 13 (4): 219–55. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1089%2Fhs.2014.0092">10.1089/hs.2014.0092</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26221997">26221997</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Health+Security&rft.atitle=The+History+of+Biological+Weapons+Use%3A+What+We+Know+and+What+We+Don%27t&rft.volume=13&rft.issue=4&rft.pages=219-55&rft.date=2015&rft_id=info%3Adoi%2F10.1089%2Fhs.2014.0092&rft_id=info%3Apmid%2F26221997&rft.aulast=Carus&rft.aufirst=WS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-172"><a href="#cite_ref-172">^</a> See a fuller discussion of their views and those of Dr. G. E. Ford in <a href="/wiki/Australian_history_wars" title="Australian history wars">"The History Wars: Smallpox Debates"</a>. </li> <li id="cite_note-173"><a href="#cite_ref-173">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://caepr.cass.anu.edu.au/events/myth-smallpox-sydney-cove-april-1789">"The 'myth' of smallpox at Sydney Cove in April 1789"</a>. 3 August 2013. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200629052308/https://caepr.cass.anu.edu.au/events/myth-smallpox-sydney-cove-april-1789">Archived</a> from the original on 29 June 2020. Retrieved 28 June 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=The+%27myth%27+of+smallpox+at+Sydney+Cove+in+April+1789&rft.date=2013-08-03&rft_id=https%3A%2F%2Fcaepr.cass.anu.edu.au%2Fevents%2Fmyth-smallpox-sydney-cove-april-1789&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-174"><a href="#cite_ref-174">^</a> See also <a rel="nofollow" class="external text" href="https://www.watoday.com.au/national/act/chickenpox-blamed-for-aboriginal-deaths-20130807-2rh3m.html">Chickenpox blamed for Aboriginal deaths</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200630081058/https://www.watoday.com.au/national/act/chickenpox-blamed-for-aboriginal-deaths-20130807-2rh3m.html">Archived</a> 30 June 2020 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a>, by Tom McIlroy, WA Today, 8 August 2013. </li> <li id="cite_note-175"><a href="#cite_ref-175">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20150812210729/http://www.dhhr.wv.gov/oeps/disease/Documents/USAMRIID_BlueBook.pdf">"USAMRIID's Medical Management of Biological Casualties Handbook"</a> (PDF). Archived from <a rel="nofollow" class="external text" href="http://www.dhhr.wv.gov/oeps/disease/documents/usamriid_bluebook.pdf">the original</a> (PDF) on 12 August 2015. Retrieved 18 July 2015.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=USAMRIID%27s+Medical+Management+of+Biological+Casualties+Handbook&rft_id=http%3A%2F%2Fwww.dhhr.wv.gov%2Foeps%2Fdisease%2Fdocuments%2Fusamriid_bluebook.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-Alibek-176"><a href="#cite_ref-Alibek_176-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAlibekHandelman1999" class="citation book cs1"><a href="/wiki/Kenneth_Alibek" class="mw-redirect" title="Kenneth Alibek">Alibek K</a>, Handelman S (1999). <a rel="nofollow" class="external text" href="https://archive.org/details/biohazardchillin00alib_0">Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World – Told from Inside by the Man Who Ran It</a>. New York: Delta. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-385-33496-9" title="Special:BookSources/978-0-385-33496-9"><bdi>978-0-385-33496-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Biohazard%3A+The+Chilling+True+Story+of+the+Largest+Covert+Biological+Weapons+Program+in+the+World+%E2%80%93+Told+from+Inside+by+the+Man+Who+Ran+It&rft.place=New+York&rft.pub=Delta&rft.date=1999&rft.isbn=978-0-385-33496-9&rft.aulast=Alibek&rft.aufirst=K&rft.au=Handelman%2C+S&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fbiohazardchillin00alib_0&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-Shoham-177"><a href="#cite_ref-Shoham_177-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFShohamWolfson2004" class="citation journal cs1">Shoham D, Wolfson Z (2004). "The Russian biological weapons program: vanished or disappeared?". Critical Reviews in Microbiology. 30 (4): 241–61. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1080%2F10408410490468812">10.1080/10408410490468812</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15646399">15646399</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:30487628">30487628</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Critical+Reviews+in+Microbiology&rft.atitle=The+Russian+biological+weapons+program%3A+vanished+or+disappeared%3F&rft.volume=30&rft.issue=4&rft.pages=241-61&rft.date=2004&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A30487628%23id-name%3DS2CID&rft_id=info%3Apmid%2F15646399&rft_id=info%3Adoi%2F10.1080%2F10408410490468812&rft.aulast=Shoham&rft.aufirst=D&rft.au=Wolfson%2C+Z&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-178"><a href="#cite_ref-178">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1 cs1-prop-foreign-lang-source"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20071014200222/http://mn.ru/issue.php?2001-46-48">"Smallpox – not a bad weapon"</a>. Interview with General Burgasov (in Russian). <a href="/wiki/Moscow_News" class="mw-redirect" title="Moscow News">Moscow News</a>. Archived from <a rel="nofollow" class="external text" href="http://mn.ru/issue.php?2001-46-48">the original</a> on 14 October 2007. Retrieved 18 June 2007.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Interview+with+General+Burgasov&rft.atitle=Smallpox+%E2%80%93+not+a+bad+weapon&rft_id=http%3A%2F%2Fmn.ru%2Fissue.php%3F2001-46-48&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-179"><a href="#cite_ref-179">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFEnserink2002" class="citation journal cs1">Enserink M (June 2002). "Biowarfare. Did bioweapons test cause a deadly smallpox outbreak?". Science. 296 (5576): 2116–17. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1126%2Fscience.296.5576.2116">10.1126/science.296.5576.2116</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12077372">12077372</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:27029430">27029430</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Science&rft.atitle=Biowarfare.+Did+bioweapons+test+cause+a+deadly+smallpox+outbreak%3F&rft.volume=296&rft.issue=5576&rft.pages=2116-17&rft.date=2002-06&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A27029430%23id-name%3DS2CID&rft_id=info%3Apmid%2F12077372&rft_id=info%3Adoi%2F10.1126%2Fscience.296.5576.2116&rft.aulast=Enserink&rft.aufirst=M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-180"><a href="#cite_ref-180">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBellomoZelicoff2005" class="citation book cs1">Bellomo M, Zelicoff AP (2005). <a rel="nofollow" class="external text" href="https://archive.org/details/microbeareweread00alan/page/101">Microbe: are we ready for the next plague?</a>. New York: American Management Association. p. <a rel="nofollow" class="external text" href="https://archive.org/details/microbeareweread00alan/page/101">101</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-8144-0865-0" title="Special:BookSources/978-0-8144-0865-0"><bdi>978-0-8144-0865-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Microbe%3A+are+we+ready+for+the+next+plague%3F&rft.place=New+York&rft.pages=101&rft.pub=American+Management+Association&rft.date=2005&rft.isbn=978-0-8144-0865-0&rft.aulast=Bellomo&rft.aufirst=Michael&rft.au=Zelicoff%2C+Alan+P.&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fmicrobeareweread00alan%2Fpage%2F101&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-Preston-181">^ <a href="#cite_ref-Preston_181-0">a</a> <a href="#cite_ref-Preston_181-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPreston2003" class="citation book cs1">Preston R (2003). The Demon in the Freezer. Fawcett. pp. 105–15. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-345-46663-1" title="Special:BookSources/978-0-345-46663-1"><bdi>978-0-345-46663-1</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Demon+in+the+Freezer&rft.pages=105-15&rft.pub=Fawcett&rft.date=2003&rft.isbn=978-0-345-46663-1&rft.aulast=Preston&rft.aufirst=Richard&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-CDCcourse-182"><a href="#cite_ref-CDCcourse_182-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20070715234749/http://www.bt.cdc.gov/agent/smallpox/training/overview/pdf/eradicationhistory.pdf">"History and Epidemiology of Global Smallpox Eradication"</a> (PDF). Smallpox: Disease, Prevention, and Intervention. CDC and the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a>. Archived from <a rel="nofollow" class="external text" href="https://www.bt.cdc.gov/agent/smallpox/training/overview/pdf/eradicationhistory.pdf">the original</a> (PDF) on 15 July 2007. <q>Slide 16–17</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=History+and+Epidemiology+of+Global+Smallpox+Eradication&rft.series=Smallpox%3A+Disease%2C+Prevention%2C+and+Intervention&rft.pub=CDC+and+the+World+Health+Organization&rft_id=http%3A%2F%2Fwww.bt.cdc.gov%2Fagent%2Fsmallpox%2Ftraining%2Foverview%2Fpdf%2Feradicationhistory.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-USfalseallegation-183"><a href="#cite_ref-USfalseallegation_183-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBurkeman2003" class="citation web cs1">Burkeman O (19 September 2003). <a rel="nofollow" class="external text" href="https://www.theguardian.com/world/2003/sep/20/iraq.oliverburkeman">"No evidence of smallpox"</a>. <a href="/wiki/The_Guardian" title="The Guardian">The Guardian</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20130827133911/http://www.theguardian.com/world/2003/sep/20/iraq.oliverburkeman">Archived</a> from the original on 27 August 2013. Retrieved 10 May 2012.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+Guardian&rft.atitle=No+evidence+of+smallpox&rft.date=2003-09-19&rft.aulast=Burkeman&rft.aufirst=Oliver&rft_id=https%3A%2F%2Fwww.theguardian.com%2Fworld%2F2003%2Fsep%2F20%2Firaq.oliverburkeman&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-Koplow_2003-184"><a href="#cite_ref-Koplow_2003_184-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKoplow2003" class="citation book cs1">Koplow D (2003). <a rel="nofollow" class="external text" href="https://archive.org/details/smallpoxfighttoe00kopl">Smallpox: The Fight to Eradicate a Global Scourge</a>. Berkeley and Los Angeles: University of California Press. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-520-23732-2" title="Special:BookSources/978-0-520-23732-2"><bdi>978-0-520-23732-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Smallpox%3A+The+Fight+to+Eradicate+a+Global+Scourge&rft.place=Berkeley+and+Los+Angeles&rft.pub=University+of+California+Press&rft.date=2003&rft.isbn=978-0-520-23732-2&rft.aulast=Koplow&rft.aufirst=David&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fsmallpoxfighttoe00kopl&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-doctorzebra.com-185"><a href="#cite_ref-doctorzebra.com_185-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.doctorzebra.com/prez/g16.htm#25">"President Abraham Lincoln: Health & Medical History"</a>. 24 March 2007. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150710025155/http://www.doctorzebra.com/prez/g16.htm#25">Archived</a> from the original on 10 July 2015. 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New York: Random House. pp. 387–88. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-679-45672-8" title="Special:BookSources/978-0-679-45672-8"><bdi>978-0-679-45672-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Catherine+the+Great%3A+Portrait+of+as+Woman&rft.place=New+York&rft.pages=387-88&rft.pub=Random+House&rft.date=2011&rft.isbn=978-0-679-45672-8&rft.aulast=Massie&rft.aufirst=Robert+K.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-Michael_B._A._Oldstone-187">^ <a href="#cite_ref-Michael_B._A._Oldstone_187-0">a</a> <a href="#cite_ref-Michael_B._A._Oldstone_187-1">b</a> <a href="#cite_ref-Michael_B._A._Oldstone_187-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFOldstone2010" class="citation book cs1">Oldstone M (2010). Viruses, Plagues, and History. Oxford University Press. pp. 65–71. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-19-532731-1" title="Special:BookSources/978-0-19-532731-1"><bdi>978-0-19-532731-1</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Viruses%2C+Plagues%2C+and+History&rft.pages=65-71&rft.pub=Oxford+University+Press&rft.date=2010&rft.isbn=978-0-19-532731-1&rft.aulast=Oldstone&rft.aufirst=Michael&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-Edwards_bio-188"><a href="#cite_ref-Edwards_bio_188-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://edwards.yale.edu/research/about-edwards/biography">"Biography at the Edwards Center at Yale University"</a>. 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Phoenix. p. 61. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4072-2145-8" title="Special:BookSources/978-1-4072-2145-8"><bdi>978-1-4072-2145-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Young+Stalin&rft.pages=61&rft.pub=Phoenix&rft.date=2008&rft.isbn=978-1-4072-2145-8&rft.aulast=Montefiore&rft.aufirst=Simon+Sebag&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-190"><a href="#cite_ref-190">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSzinnyei2000" class="citation book cs1">Szinnyei J (2000). <a rel="nofollow" class="external text" href="http://mek.niif.hu/03600/03630/html/k/k12495.htm">Magyar írók élete és munkái</a>. 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Cambridge: University Press.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Man%2C+past+and+present&rft.place=Cambridge&rft.pub=University+Press&rft.date=1920&rft.aulast=Keane&rft.aufirst=Augustus+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-cdc.gov-194">^ <a href="#cite_ref-cdc.gov_194-0">a</a> <a href="#cite_ref-cdc.gov_194-1">b</a> <a href="#cite_ref-cdc.gov_194-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/museum/history/shapona.html">"Shapona, the Yoruba god of smallpox | David J. Sencer CDC Museum"</a>. 30 April 2021. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200721183322/https://www.cdc.gov/museum/history/shapona.html">Archived</a> from the original on 21 July 2020. Retrieved 11 July 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Shapona%2C+the+Yoruba+god+of+smallpox+%26%23124%3B+David+J.+Sencer+CDC+Museum&rft.date=2021-04-30&rft_id=https%3A%2F%2Fwww.cdc.gov%2Fmuseum%2Fhistory%2Fshapona.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-africanart.nl-195">^ <a href="#cite_ref-africanart.nl_195-0">a</a> <a href="#cite_ref-africanart.nl_195-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.africanart.nl/en/pokken-in-afrika-amerika-en-terug-in-afrika/">"Smallpox controlfrom Africa to America and back again | African Art"</a>. 3 July 2017. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200807080630/http://www.africanart.nl/en/pokken-in-afrika-amerika-en-terug-in-afrika/">Archived</a> from the original on 7 August 2020. Retrieved 11 July 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Smallpox+controlfrom+Africa+to+America+and+back+again+%26%23124%3B+African+Art&rft.date=2017-07-03&rft_id=http%3A%2F%2Fwww.africanart.nl%2Fen%2Fpokken-in-afrika-amerika-en-terug-in-afrika%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-196"><a href="#cite_ref-196">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWileyAllen2009" class="citation book cs1">Wiley AS, Allen JS (2009). Medical Anthropology: A Biocultural Approach. New York: Oxford University Press.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Medical+Anthropology%3A+A+Biocultural+Approach&rft.place=New+York&rft.pub=Oxford+University+Press&rft.date=2009&rft.aulast=Wiley&rft.aufirst=AS&rft.au=Allen%2C+JS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> <li id="cite_note-197"><a href="#cite_ref-197">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTucker2001" class="citation book cs1">Tucker JB (2001). Scourge: The Once and Future Threat of Smallpox. New York: Atlantic Monthly Press.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Scourge%3A+The+Once+and+Future+Threat+of+Smallpox&rft.place=New+York&rft.pub=Atlantic+Monthly+Press&rft.date=2001&rft.aulast=Tucker&rft.aufirst=Jonathan+B.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2></div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin refbegin-columns references-column-width" style="column-width: 60em"> <ul><li>Fenn, Elizabeth A. Pox Americana: the great smallpox epidemic of 1775–82 (Macmillan, 2001) <a rel="nofollow" class="external text" href="https://books.google.com/books?id=eSFfxz6mJhQC&dq=fenn++pox&pg=PR7">online</a>.</li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFenner1988" class="citation book cs1">Fenner F (1988). <a rel="nofollow" class="external text" href="http://whqlibdoc.who.int/smallpox/9241561106.pdf">Smallpox and Its Eradication (History of International Public Health, No. 6)</a> (PDF). Geneva: World Health Organization. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-92-4-156110-5" title="Special:BookSources/978-92-4-156110-5"><bdi>978-92-4-156110-5</bdi></a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150219005302/http://whqlibdoc.who.int/smallpox/9241561106.pdf">Archived</a> (PDF) from the original on 19 February 2015. Retrieved 7 September 2007.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Smallpox+and+Its+Eradication+%28History+of+International+Public+Health%2C+No.+6%29&rft.place=Geneva&rft.pub=World+Health+Organization&rft.date=1988&rft.isbn=978-92-4-156110-5&rft.aulast=Fenner&rft.aufirst=Frank&rft_id=http%3A%2F%2Fwhqlibdoc.who.int%2Fsmallpox%2F9241561106.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"></li> <li>Henderson, Donald Ainslie. Smallpox: the death of a disease: the inside story of eradicating a worldwide killer. (Prometheus Books, 2009).</li></ul> <ul><li>Hopkins, Donald R. The greatest killer: smallpox in history (U of Chicago press, 2002) <a rel="nofollow" class="external text" href="https://books.google.com/books?id=z2zMKsc1Sn0C&dq=Hopkins++smallpox&pg=PR11">online</a>, a major scholarly history</li> <li>Koplow, David A. Smallpox: The Fight to Eradicate a Global Scourge (U of California Press, 2003)</li> <li>Kotar, S.L. and J.E. Gessler. Smallpox: A History (McFarland, 2013) <a rel="nofollow" class="external text" href="https://archive.org/details/smallpoxhistory0000kota">online</a> anecdotal accounts from letters and editorials in local newspapers.</li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPallen2018" class="citation book cs1">Pallen M (2018). The Last Days of Smallpox: Tragedy in Birmingham. UK: Amazon KDP. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-9804-5522-6" title="Special:BookSources/978-1-9804-5522-6"><bdi>978-1-9804-5522-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Last+Days+of+Smallpox%3A+Tragedy+in+Birmingham&rft.place=UK&rft.pub=Amazon+KDP&rft.date=2018&rft.isbn=978-1-9804-5522-6&rft.aulast=Pallen&rft.aufirst=Mark&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFReinhardt2015" class="citation book cs1">Reinhardt BH (2015). The End of a Global Pox: America and the Eradication of Smallpox in the Cold War Era. University of North Carolina Press. pp. xviii, 268.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+End+of+a+Global+Pox%3A+America+and+the+Eradication+of+Smallpox+in+the+Cold+War+Era&rft.pages=xviii%2C+268&rft.pub=University+of+North+Carolina+Press&rft.date=2015&rft.aulast=Reinhardt&rft.aufirst=Bob+H.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTucker2001" class="citation book cs1">Tucker JB (2001). <a rel="nofollow" class="external text" href="https://archive.org/details/scourgeoncefutur00tuck">Scourge: The Once and Future Threat of Smallpox</a>. New York: Grove Press. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-8021-3939-9" title="Special:BookSources/978-0-8021-3939-9"><bdi>978-0-8021-3939-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Scourge%3A+The+Once+and+Future+Threat+of+Smallpox&rft.place=New+York&rft.pub=Grove+Press&rft.date=2001&rft.isbn=978-0-8021-3939-9&rft.aulast=Tucker&rft.aufirst=Jonathan+B.&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fscourgeoncefutur00tuck&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWharncliffeThomas1861" class="citation book cs1">Wharncliffe L, Thomas WM, eds. (1861). The Letters and Works of Lady Mary Wortley Montagu. Vol. 1. London: Henry G. Bohn.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Letters+and+Works+of+Lady+Mary+Wortley+Montagu&rft.place=London&rft.pub=Henry+G.+Bohn&rft.date=1861&rfr_id=info%3Asid%2Fen.wikipedia.org%3ASmallpox" class="Z3988"></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output .side-box-flex{display:flex;align-items:center}.mw-parser-output .side-box-text{flex:1;min-width:0}}@media(min-width:720px){.mw-parser-output .side-box{width:238px}.mw-parser-output .side-box-right{clear:right;float:right;margin-left:1em}.mw-parser-output .side-box-left{margin-right:1em}}</style><style data-mw-deduplicate="TemplateStyles:r1250146164">.mw-parser-output .sister-box .side-box-abovebelow{padding:0.75em 0;text-align:center}.mw-parser-output .sister-box .side-box-abovebelow>b{display:block}.mw-parser-output .sister-box .side-box-text>ul{border-top:1px solid #aaa;padding:0.75em 0;width:217px;margin:0 auto}.mw-parser-output .sister-box .side-box-text>ul>li{min-height:31px}.mw-parser-output .sister-logo{display:inline-block;width:31px;line-height:31px;vertical-align:middle;text-align:center}.mw-parser-output .sister-link{display:inline-block;margin-left:4px;width:182px;vertical-align:middle}@media print{body.ns-0 .mw-parser-output .sistersitebox{display:none!important}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-v2.svg"]{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-v2.svg"]{background-color:white}}</style><div role="navigation" aria-labelledby="sister-projects" class="side-box metadata side-box-right mw-collapsible sister-box sistersitebox plainlinks"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409"> <div class="side-box-abovebelow" style="clear: both"> Smallpox at Wikipedia's <a href="/wiki/Wikipedia:Wikimedia_sister_projects" title="Wikipedia:Wikimedia sister projects">sister projects</a></div> <div class="side-box-flex mw-collapsible-content"> <div class="side-box-text plainlist"><ul><li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/0/06/Wiktionary-logo-v2.svg/27px-Wiktionary-logo-v2.svg.png" decoding="async" width="27" height="27" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/0/06/Wiktionary-logo-v2.svg/41px-Wiktionary-logo-v2.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/0/06/Wiktionary-logo-v2.svg/54px-Wiktionary-logo-v2.svg.png 2x" data-file-width="391" data-file-height="391" /><a href="https://en.wiktionary.org/wiki/Special:Search/Smallpox" class="extiw" title="wikt:Special:Search/Smallpox">Definitions</a> from Wiktionary</li><li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/20px-Commons-logo.svg.png" decoding="async" width="20" height="27" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/30px-Commons-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/40px-Commons-logo.svg.png 2x" data-file-width="1024" data-file-height="1376" /><a href="https://commons.wikimedia.org/wiki/Category:Smallpox" class="extiw" title="c:Category:Smallpox">Media</a> from Commons</li><li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Wikiquote-logo.svg/23px-Wikiquote-logo.svg.png" decoding="async" width="23" height="27" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Wikiquote-logo.svg/35px-Wikiquote-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fa/Wikiquote-logo.svg/46px-Wikiquote-logo.svg.png 2x" data-file-width="300" data-file-height="355" /><a href="https://en.wikiquote.org/wiki/Smallpox" class="extiw" title="q:Smallpox">Quotations</a> from Wikiquote</li><li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/26px-Wikisource-logo.svg.png" decoding="async" width="26" height="27" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/39px-Wikisource-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4c/Wikisource-logo.svg/51px-Wikisource-logo.svg.png 2x" data-file-width="410" data-file-height="430" /><a href="https://en.wikisource.org/wiki/1911_Encyclop%C3%A6dia_Britannica/Smallpox" class="extiw" title="s:1911 Encyclopædia Britannica/Smallpox">Texts</a> from Wikisource</li><li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/df/Wikispecies-logo.svg/23px-Wikispecies-logo.svg.png" decoding="async" width="23" height="27" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/df/Wikispecies-logo.svg/35px-Wikispecies-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/df/Wikispecies-logo.svg/46px-Wikispecies-logo.svg.png 2x" data-file-width="941" data-file-height="1103" /><a href="https://species.wikimedia.org/wiki/Variola_virus" class="extiw" title="species:Variola virus">Taxa</a> from Wikispecies</li></ul></div></div> </div> <ul><li><a rel="nofollow" class="external text" href="http://www.smallpoxbiosafety.org/">Smallpox Biosafety: A Website About Destruction of Smallpox Virus Stocks</a></li> <li><a rel="nofollow" class="external text" href="http://www.cidrap.umn.edu/cidrap/content/bt/smallpox/biofacts/index.html">Detailed CIDRAP Smallpox overview</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20130506170240/http://www.cidrap.umn.edu/cidrap/content/bt/smallpox/biofacts/index.html">Archived</a> 6 May 2013 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li> <li><a rel="nofollow" class="external text" href="https://web.archive.org/web/20100628224033/http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/smallpox.html">Agent Fact Sheet: Smallpox</a>, Center for Biosecurity</li> <li><a rel="nofollow" class="external text" href="http://www.logicalimages.com/resourcesBTAgentsSmallpox.htm">Smallpox Images and Diagnosis Synopsis</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20080729020333/http://www.logicalimages.com/resourcesBTAgentsSmallpox.htm">Archived</a> 29 July 2008 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li> <li><a rel="nofollow" class="external text" href="http://www.viprbrc.org/brc/home.do?decorator=pox">Virus Pathogen Database and Analysis Resource (ViPR): Poxviridae</a>[<a href="/wiki/Wikipedia:Link_rot" title="Wikipedia:Link rot">permanent dead link</a>‍]</li> <li><a rel="nofollow" class="external text" href="https://www.pbs.org/video/vaccines-huvzkv/">Episode 1 (of 4): Vaccines</a> of the <a href="/wiki/BBC_Four" title="BBC Four">BBC Four</a> and <a href="/wiki/PBS" title="PBS">PBS</a> show: <a rel="nofollow" class="external text" href="https://www.pbs.org/show/extra-life-short-history-living-longer/">Extra Life: A Short History of Living Longer</a> (2021)</li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output 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dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q12214" class="extiw" title="d:Q12214">D</a></div><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#2054716425">1E70</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/B03">B03</a></li><li><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=050">050</a></li><li><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D012899">D012899</a></li><li><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb12219.htm">12219</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/001356.htm">001356</a></li><li><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/emerg/885-overview">emerg/885</a></li><li><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/Smallpox">Smallpox</a></li><li>Scholia: <a class="external text" href="https://tools.wmflabs.org/scholia/topic/Q12214">Q12214</a></li></ul></div></div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1130092004">.mw-parser-output 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.portal-bar-header{text-align:center;flex:0;padding-left:0.5em;margin:0 auto}.mw-parser-output .portal-bar-related{font-size:100%;align-items:flex-start}.mw-parser-output .portal-bar-content{display:flex;flex-flow:row wrap;align-items:center;flex:0;column-gap:1em;border-top:1px solid #a2a9b1;margin:0 auto;list-style:none}.mw-parser-output .portal-bar-content-related{border-top:none;margin:0;list-style:none}}.mw-parser-output .navbox+link+.portal-bar,.mw-parser-output .navbox+style+.portal-bar,.mw-parser-output .navbox+link+.portal-bar-bordered,.mw-parser-output .navbox+style+.portal-bar-bordered,.mw-parser-output .sister-bar+link+.portal-bar,.mw-parser-output .sister-bar+style+.portal-bar,.mw-parser-output .portal-bar+.navbox-styles+.navbox,.mw-parser-output .portal-bar+.navbox-styles+.sister-bar{margin-top:-1px}</style><div class="portal-bar noprint metadata noviewer portal-bar-bordered" role="navigation" aria-label="Portals"><a href="/wiki/Wikipedia:Contents/Portals" title="Wikipedia:Contents/Portals">Portals</a>:<ul class="portal-bar-content"><li class="portal-bar-item"><img alt="icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/8px-WHO_Rod.svg.png" decoding="async" width="8" height="19" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/12px-WHO_Rod.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/16px-WHO_Rod.svg.png 2x" data-file-width="107" data-file-height="250" /> <a href="/wiki/Portal:Medicine" title="Portal:Medicine">Medicine</a></li><li class="portal-bar-item"><a href="/wiki/File:Sida-aids.png" class="mw-file-description"><img alt="icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2f/Sida-aids.png/19px-Sida-aids.png" decoding="async" width="19" height="19" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2f/Sida-aids.png/29px-Sida-aids.png 1.5x, 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.navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Viral_cutaneous_conditions" title="Template:Viral cutaneous conditions"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Viral_cutaneous_conditions" title="Template talk:Viral cutaneous conditions"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Viral_cutaneous_conditions" title="Special:EditPage/Template:Viral cutaneous conditions"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Skin_infections,_symptoms_and_signs_related_to_viruses" style="font-size:114%;margin:0 4em"><a href="/wiki/Skin_infection" title="Skin infection">Skin infections</a>, symptoms and signs related to <a href="/wiki/Virus" title="Virus">viruses</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/DNA_virus" title="DNA virus">DNA virus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Herpesviridae" title="Herpesviridae">Herpesviridae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alphaherpesvirinae" title="Alphaherpesvirinae">Alpha.</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Herpes_simplex_virus" title="Herpes simplex virus">HSV</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Herpes" title="Herpes">Herpes simplex</a></li> <li><a href="/wiki/Herpetic_whitlow" title="Herpetic whitlow">Herpetic whitlow</a></li> <li><a href="/wiki/Herpes_gladiatorum" title="Herpes gladiatorum">Herpes gladiatorum</a></li> <li><a href="/wiki/Herpes_simplex_keratitis" title="Herpes simplex keratitis">Herpes simplex keratitis</a></li> <li><a href="/wiki/Herpes" title="Herpes">Herpetic sycosis</a></li> <li><a href="/wiki/Neonatal_herpes_simplex" class="mw-redirect" title="Neonatal herpes simplex">Neonatal herpes simplex</a></li> <li><a href="/wiki/Genital_herpes" title="Genital herpes">Genital herpes</a></li> <li><a href="/wiki/Cold_sore" title="Cold sore">Cold sore</a></li> <li><a href="/wiki/Eczema_herpeticum" title="Eczema herpeticum">Eczema herpeticum</a></li> <li><a href="/wiki/Herpes_esophagitis" title="Herpes esophagitis">Herpetiform esophagitis</a></li> <li><a href="/wiki/Herpetic_gingivostomatitis" title="Herpetic gingivostomatitis">Herpetic gingivostomatitis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/B_virus" title="B virus">B virus</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/B_virus" title="B virus">B virus infection</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Varicella_zoster_virus" title="Varicella zoster virus">VZV</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chickenpox" title="Chickenpox">Chickenpox</a></li> <li><a href="/wiki/Shingles" title="Shingles">Herpes zoster</a></li> <li><a href="/wiki/Ramsay_Hunt_syndrome_type_2" title="Ramsay Hunt syndrome type 2">Herpes zoster oticus</a></li> <li><a href="/wiki/Herpes_zoster_ophthalmicus" title="Herpes zoster ophthalmicus">Ophthalmic zoster</a></li> <li><a href="/wiki/Disseminated_herpes_zoster" class="mw-redirect" title="Disseminated herpes zoster">Disseminated herpes zoster</a></li> <li><a href="/wiki/Postherpetic_neuralgia" title="Postherpetic neuralgia">Zoster-associated pain</a></li> <li><a href="/wiki/Modified_varicella-like_syndrome" class="mw-redirect" title="Modified varicella-like syndrome">Modified varicella-like syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Betaherpesvirinae" title="Betaherpesvirinae">Beta.</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Human_herpesvirus_6" title="Human herpesvirus 6">Human herpesvirus 6</a>/<a href="/wiki/Roseolovirus" title="Roseolovirus">Roseolovirus</a> <ul><li><a href="/wiki/Roseola" title="Roseola">Exanthema subitum</a></li> <li><a href="/wiki/Roseola_vaccinia" title="Roseola vaccinia">Roseola vaccinia</a></li></ul></li> <li><a href="/wiki/Cytomegalovirus" title="Cytomegalovirus">Cytomegalic inclusion disease</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gammaherpesvirinae" title="Gammaherpesvirinae">Gamma.</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Kaposi%27s_sarcoma-associated_herpesvirus" title="Kaposi's sarcoma-associated herpesvirus">Kaposi's sarcoma-associated herpesvirus</a> <ul><li><a href="/wiki/Kaposi%27s_sarcoma" title="Kaposi's sarcoma">Kaposi's sarcoma</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Poxviridae" title="Poxviridae">Poxviridae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Orthopoxvirus" title="Orthopoxvirus">Ortho.</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Variola</a> <ul><li><a class="mw-selflink selflink">Smallpox</a></li> <li><a href="/wiki/Alastrim" class="mw-redirect" title="Alastrim">Alastrim</a></li></ul></li> <li><a href="/wiki/Monkeypox_virus" title="Monkeypox virus">Monkeypox virus</a> <ul><li><a href="/wiki/Mpox" title="Mpox">Monkeypox</a></li></ul></li> <li><a href="/wiki/Cowpox" title="Cowpox">Cowpox</a></li> <li><a href="/wiki/Vaccinia_virus" class="mw-redirect" title="Vaccinia virus">Vaccinia virus</a> <ul><li><a href="/wiki/Vaccinia" title="Vaccinia">Vaccinia</a></li> <li><a href="/wiki/Generalized_vaccinia" title="Generalized vaccinia">Generalized vaccinia</a></li> <li><a href="/wiki/Eczema_vaccinatum" title="Eczema vaccinatum">Eczema vaccinatum</a></li> <li><a href="/wiki/Progressive_vaccinia" title="Progressive vaccinia">Progressive vaccinia</a></li></ul></li> <li><a href="/wiki/Buffalopox" title="Buffalopox">Buffalopox</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Parapoxvirus" title="Parapoxvirus">Para.</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Farmyard_pox" title="Farmyard pox">Farmyard pox</a>: <a href="/wiki/Milker%27s_nodule" title="Milker's nodule">Milker's nodule</a></li> <li><a href="/wiki/Bovine_papular_stomatitis" title="Bovine papular stomatitis">Bovine papular stomatitis</a></li> <li><a href="/wiki/Paravaccinia_virus" title="Paravaccinia virus">Pseudocowpox</a></li> <li><a href="/wiki/Orf_(disease)" title="Orf (disease)">Orf</a></li> <li><a href="/wiki/Sealpox" title="Sealpox">Sealpox</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Yatapoxvirus" title="Yatapoxvirus">Yatapoxvirus</a>: <a href="/wiki/Tanapox" title="Tanapox">Tanapox</a></li> <li><a href="/wiki/Yaba_monkey_tumor_virus" title="Yaba monkey tumor virus">Yaba monkey tumor virus</a></li> <li><a href="/wiki/Molluscum_contagiosum_virus" title="Molluscum contagiosum virus">Molluscum contagiosum virus</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Papillomaviridae" title="Papillomaviridae">Papillomaviridae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="HPV" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Papillomaviridae" title="Papillomaviridae">HPV</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Wart" title="Wart">Wart</a>/<a href="/wiki/Plantar_wart" title="Plantar wart">plantar wart</a></li> <li><a href="/wiki/Heck%27s_disease" title="Heck's disease">Heck's disease</a></li> <li><a href="/wiki/Genital_wart" title="Genital wart">Genital wart</a> <ul><li><a href="/wiki/Giant_condyloma_acuminatum" title="Giant condyloma acuminatum">giant</a></li></ul></li> <li><a href="/wiki/Laryngeal_papillomatosis" title="Laryngeal papillomatosis">Laryngeal papillomatosis</a></li> <li><a href="/wiki/Butcher%27s_wart" title="Butcher's wart">Butcher's wart</a></li> <li><a href="/wiki/Bowenoid_papulosis" title="Bowenoid papulosis">Bowenoid papulosis</a></li> <li><a href="/wiki/Epidermodysplasia_verruciformis" title="Epidermodysplasia verruciformis">Epidermodysplasia verruciformis</a></li> <li><a href="/wiki/Flat_wart" title="Flat wart">Verruca plana</a></li> <li><a href="/wiki/Pigmented_wart" title="Pigmented wart">Pigmented wart</a></li> <li><a href="/wiki/Verrucae_palmares_et_plantares" title="Verrucae palmares et plantares">Verrucae palmares et plantares</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bovine_papillomavirus" title="Bovine papillomavirus">Bovine papillomavirus</a> <ul><li><a href="/wiki/Equine_sarcoid" class="mw-redirect" title="Equine sarcoid">Equine sarcoid</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Parvoviridae" title="Parvoviridae">Parvoviridae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Parvovirus_B19" title="Parvovirus B19">Parvovirus B19</a> <ul><li><a href="/wiki/Fifth_disease" title="Fifth disease">Erythema infectiosum</a></li> <li><a href="/wiki/Reticulocytopenia" title="Reticulocytopenia">Reticulocytopenia</a></li> <li><a href="/wiki/Papular_purpuric_gloves_and_socks_syndrome" class="mw-redirect" title="Papular purpuric gloves and socks syndrome">Papular purpuric gloves and socks syndrome</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Polyomaviridae" title="Polyomaviridae">Polyomaviridae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Merkel_cell_polyomavirus" title="Merkel cell polyomavirus">Merkel cell polyomavirus</a> <ul><li><a href="/wiki/Merkel-cell_carcinoma" title="Merkel-cell carcinoma">Merkel cell carcinoma</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/RNA_virus" title="RNA virus">RNA virus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Paramyxoviridae" title="Paramyxoviridae">Paramyxoviridae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Measles_morbillivirus" class="mw-redirect" title="Measles morbillivirus">MeV</a> <ul><li><a href="/wiki/Measles" title="Measles">Measles</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Rubivirus" title="Rubivirus">Matonaviridae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Rubella_virus" title="Rubella virus">Rubella virus</a> <ul><li><a href="/wiki/Rubella" title="Rubella">Rubella</a></li> <li><a href="/wiki/Congenital_rubella_syndrome" title="Congenital rubella syndrome">Congenital rubella syndrome</a> ("German measles")</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alphavirus" title="Alphavirus">Togaviridae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alphavirus_infection" title="Alphavirus infection">Alphavirus infection</a></li> <li><a href="/wiki/Chikungunya" title="Chikungunya">Chikungunya fever</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Picornavirus" title="Picornavirus">Picornaviridae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Coxsackie_A_virus" title="Coxsackie A virus">Coxsackie A virus</a> <ul><li><a href="/wiki/Hand,_foot,_and_mouth_disease" title="Hand, foot, and mouth disease">Hand, foot, and mouth disease</a></li> <li><a href="/wiki/Herpangina" title="Herpangina">Herpangina</a></li></ul></li> <li><a href="/wiki/Foot-and-mouth_disease_virus" title="Foot-and-mouth disease virus">Foot-and-mouth disease virus</a></li> <li><a href="/wiki/Boston_exanthem_disease" title="Boston exanthem disease">Boston exanthem disease</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Ungrouped</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Asymmetric_periflexural_exanthem_of_childhood" title="Asymmetric periflexural exanthem of childhood">Asymmetric periflexural exanthem of childhood</a></li> <li><a href="/wiki/Post-vaccination_follicular_eruption" title="Post-vaccination follicular eruption">Post-vaccination follicular eruption</a></li> <li><a href="/wiki/Lipsch%C3%BCtz_ulcer" title="Lipschütz ulcer">Lipschütz ulcer</a></li> <li><a href="/wiki/Eruptive_pseudoangiomatosis" title="Eruptive pseudoangiomatosis">Eruptive pseudoangiomatosis</a></li> <li><a href="/wiki/Trichodysplasia_spinulosa" title="Trichodysplasia spinulosa">Viral-associated trichodysplasia</a></li> <li><a href="/wiki/Gianotti%E2%80%93Crosti_syndrome" title="Gianotti–Crosti syndrome">Gianotti–Crosti syndrome</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Eradication_of_infectious_diseases" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Eradication_of_infectious_disease" title="Template:Eradication of infectious disease"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Eradication_of_infectious_disease" title="Template talk:Eradication of infectious disease"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Eradication_of_infectious_disease" title="Special:EditPage/Template:Eradication of infectious disease"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Eradication_of_infectious_diseases" style="font-size:114%;margin:0 4em"><a href="/wiki/Eradication_of_infectious_diseases" title="Eradication of infectious diseases">Eradication of infectious diseases</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Eradication of human diseases</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:left;">Successful</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Smallpox</a> (<a href="/wiki/Eradication_of_smallpox" class="mw-redirect" title="Eradication of smallpox">Eradication of smallpox</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:left;">Underway (global)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dracunculiasis" title="Dracunculiasis">Dracunculiasis</a> (<a href="/wiki/Eradication_of_dracunculiasis" title="Eradication of dracunculiasis">Eradication of dracunculiasis</a>)</li> <li><a href="/wiki/Polio" title="Polio">Polio</a> (<a href="/wiki/Polio_eradication" title="Polio eradication">Polio eradication</a>)</li> <li><a href="/wiki/Malaria" title="Malaria">Malaria</a> (<a href="/wiki/Eradication_of_malaria" class="mw-redirect" title="Eradication of malaria">Eradication of malaria</a>)</li> <li><a href="/wiki/Yaws" title="Yaws">Yaws</a> (<a href="/wiki/Eradication_of_yaws" class="mw-redirect" title="Eradication of yaws">Eradication of yaws</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:left;">Underway (regional)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hookworm_infection#Eradication_programmes" title="Hookworm infection">Hookworm</a></li> <li><a href="/wiki/Lymphatic_filariasis#Epidemiology" title="Lymphatic filariasis">Lymphatic filariasis</a></li> <li><a href="/wiki/Measles" title="Measles">Measles</a> <ul><li><a href="/wiki/Measles_vaccine" title="Measles vaccine">vaccine</a></li> <li><a href="/wiki/Epidemiology_of_measles" title="Epidemiology of measles">epidemiology</a></li></ul></li> <li><a href="/wiki/Rubella#Epidemiology" title="Rubella">Rubella</a></li> <li><a href="/wiki/Trachoma#Epidemiology" title="Trachoma">Trachoma</a></li> <li><a href="/wiki/Onchocerciasis#Epidemiology" title="Onchocerciasis">Onchocerciasis</a></li> <li><a href="/wiki/Epidemiology_of_syphilis" title="Epidemiology of syphilis">Syphilis</a></li> <li><a href="/wiki/Prevalence_of_rabies" title="Prevalence of rabies">Rabies</a></li> <li><a href="/wiki/Leprosy" title="Leprosy">Leprosy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Eradication of agricultural diseases</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:left;">Successful</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Rinderpest" title="Rinderpest">Rinderpest</a> (<a href="/wiki/Eradication_of_rinderpest" class="mw-redirect" title="Eradication of rinderpest">Eradication of rinderpest</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:left;">Underway</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ovine_rinderpest" title="Ovine rinderpest">Ovine rinderpest</a></li> <li><a href="/wiki/Bovine_spongiform_encephalopathy#Epidemiology" title="Bovine spongiform encephalopathy">Bovine spongiform encephalopathy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Eradication programs</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:left;">Global</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/London_Declaration_on_Neglected_Tropical_Diseases" title="London Declaration on Neglected Tropical Diseases">London Declaration on Neglected Tropical Diseases</a></li> <li><a href="/wiki/Global_Polio_Eradication_Initiative" title="Global Polio Eradication Initiative">Global Polio Eradication Initiative</a></li> <li><a href="/wiki/Global_Certification_Commission" title="Global Certification Commission">Global Certification Commission</a></li> <li><a href="/wiki/Malaria_Eradication_Scientific_Alliance" title="Malaria Eradication Scientific Alliance">Malaria Eradication Scientific Alliance</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:left;">Regional</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/List_of_diseases_eliminated_from_the_United_States" title="List of diseases eliminated from the United States">United States</a> <ul><li><a href="/wiki/Boll_Weevil_Eradication_Program" title="Boll Weevil Eradication Program">Boll Weevil Eradication Program</a></li> <li><a href="/wiki/National_Malaria_Eradication_Program" title="National Malaria Eradication Program">National Malaria Eradication Program</a></li></ul></li> <li>India <ul><li><a href="/wiki/India_National_PolioPlus" title="India National PolioPlus">India National PolioPlus</a></li> <li><a href="/wiki/Pulse_Polio" title="Pulse Polio">Pulse Polio</a></li></ul></li> <li><a href="/wiki/Polio_in_Pakistan" title="Polio in Pakistan">Polio in Pakistan</a> <ul><li><a href="/wiki/Every_Last_Child" title="Every Last Child">Every Last Child</a></li> <li><a href="/wiki/The_Final_Inch" title="The Final Inch">The Final Inch</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related topics</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Globalization_and_disease" title="Globalization and disease">Globalization and disease</a></li> <li><a href="/wiki/Mathematical_modelling_of_infectious_disease" class="mw-redirect" title="Mathematical modelling of infectious disease">Mathematical modelling of disease</a></li> <li><a href="/wiki/Pandemic" title="Pandemic">Pandemic</a></li> <li><a href="/wiki/Transmission_(medicine)" class="mw-redirect" title="Transmission (medicine)">Transmission</a> <ul><li><a href="/wiki/Transmission_(medicine)#horizontal" class="mw-redirect" title="Transmission (medicine)">horizontal</a></li> <li><a href="/wiki/Vertically_transmitted_infection" title="Vertically transmitted infection">vertical</a></li></ul></li> <li><a href="/wiki/Tuberculosis_elimination" class="mw-redirect" title="Tuberculosis elimination">Tuberculosis elimination</a></li> <li><a href="/wiki/Vaccination" title="Vaccination">Vaccination</a></li> <li><a href="/wiki/Zoonosis" title="Zoonosis">Zoonosis</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="History_of_infectious_diseases" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:History_of_infectious_diseases" title="Template:History of infectious diseases"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:History_of_infectious_diseases" title="Template talk:History of infectious diseases"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:History_of_infectious_diseases" title="Special:EditPage/Template:History of infectious diseases"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="History_of_infectious_diseases" style="font-size:114%;margin:0 4em">History of <a href="/wiki/Infectious_diseases_(medical_specialty)" title="Infectious diseases (medical specialty)">infectious diseases</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Individual diseases</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/History_of_cholera" title="History of cholera">Cholera</a></li> <li><a href="/wiki/History_of_HIV/AIDS" title="History of HIV/AIDS">HIV/AIDS</a></li> <li><a href="/wiki/History_of_leprosy" title="History of leprosy">Leprosy</a></li> <li><a href="/wiki/History_of_malaria" title="History of malaria">Malaria</a></li> <li><a href="/wiki/History_of_plague" title="History of plague">Plague</a></li> <li><a href="/wiki/History_of_polio" title="History of polio">Polio</a></li> <li><a href="/wiki/History_of_smallpox" title="History of smallpox">Smallpox</a></li> <li><a href="/wiki/History_of_syphilis" title="History of syphilis">Syphilis</a></li> <li><a href="/wiki/History_of_tuberculosis" title="History of tuberculosis">Tuberculosis</a></li> <li><a href="/wiki/History_of_typhoid_fever" title="History of typhoid fever">Typhoid fever</a></li> <li><a href="/wiki/History_of_yellow_fever" title="History of yellow fever">Yellow fever</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">People</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alexander_Fleming" title="Alexander Fleming">Alexander Fleming</a></li> <li><a href="/wiki/Maurice_Hilleman" title="Maurice Hilleman">Maurice Hilleman</a></li> <li><a href="/wiki/Edward_Jenner" title="Edward Jenner">Edward Jenner</a></li> <li><a href="/wiki/Robert_Koch" title="Robert Koch">Robert Koch</a></li> <li><a href="/wiki/Louis_Pasteur" title="Louis Pasteur">Louis Pasteur</a></li> <li><a href="/wiki/Jonas_Salk" title="Jonas Salk">Jonas Salk</a></li> <li><a href="/wiki/Ignaz_Semmelweis" title="Ignaz Semmelweis">Ignaz Semmelweis</a></li> <li><a href="/wiki/John_Snow" title="John Snow">John Snow</a></li> <li><a href="/wiki/Israel_Jacob_Kligler" title="Israel Jacob Kligler">Israel Jacob Kligler</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/List_of_epidemics_and_pandemics" title="List of epidemics and pandemics">Major epidemics</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Black_Death" title="Black Death">Black Death</a> (1346–1353)</li> <li><a href="/wiki/Spanish_flu" title="Spanish flu">Spanish flu</a> (1918–1920)</li> <li><a href="/wiki/Epidemiology_of_HIV/AIDS" title="Epidemiology of HIV/AIDS">HIV/AIDS pandemic</a> (1981–present)</li> <li><a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a> (2019–present<abbr title="Peaked from 2020-2023">*</abbr>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Discovery_of_disease-causing_pathogens" title="Discovery of disease-causing pathogens">Discovery of disease-causing pathogens</a></li> <li><a href="/wiki/Smallpox_eradication" class="mw-redirect" title="Smallpox eradication">Smallpox eradication</a></li> <li><a href="/wiki/Social_history_of_viruses" title="Social history of viruses">Social history of viruses</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Taxon_identifiers" style="padding:3px"><table class="nowraplinks hlist navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Taxon_identifiers" style="font-size:114%;margin:0 4em"><a href="/wiki/Help:Taxon_identifiers" title="Help:Taxon identifiers">Taxon identifiers</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align: left;">Variola virus</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Wikidata" title="Wikidata">Wikidata</a>: <a href="https://www.wikidata.org/wiki/Q11877169" class="extiw" title="wikidata:Q11877169">Q11877169</a></li> <li><a href="/wiki/Catalogue_of_Life" title="Catalogue of Life">CoL</a>: <a rel="nofollow" class="external text" href="https://www.catalogueoflife.org/data/taxon/7FHPP">7FHPP</a></li> <li><a href="/wiki/Encyclopedia_of_Life" title="Encyclopedia of Life">EoL</a>: <a rel="nofollow" class="external text" href="https://eol.org/pages/540219">540219</a></li> <li><a href="/wiki/Global_Biodiversity_Information_Facility" title="Global Biodiversity Information Facility">GBIF</a>: <a rel="nofollow" class="external text" href="https://www.gbif.org/species/10436951">10436951</a></li> <li><a href="/wiki/Interim_Register_of_Marine_and_Nonmarine_Genera" title="Interim Register of Marine and Nonmarine Genera">IRMNG</a>: <a rel="nofollow" class="external text" href="https://www.irmng.org/aphia.php?p=taxdetails&id=11461155">11461155</a></li> <li><a href="/wiki/National_Center_for_Biotechnology_Information" title="National Center for Biotechnology Information">NCBI</a>: <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=10255">10255</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" 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colspan="2"><div id="Authority_control_databases_frameless&#124;text-top&#124;10px&#124;alt=Edit_this_at_Wikidata&#124;link=https&#58;//www.wikidata.org/wiki/Q12214#identifiers&#124;class=noprint&#124;Edit_this_at_Wikidata" style="font-size:114%;margin:0 4em"><a href="/wiki/Help:Authority_control" title="Help:Authority control">Authority control databases</a> <a href="https://www.wikidata.org/wiki/Q12214#identifiers" title="Edit this at Wikidata"><img alt="Edit this at Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">National</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><ul><li><a rel="nofollow" class="external text" href="https://d-nb.info/gnd/4135714-0">Germany</a></li><li><a rel="nofollow" class="external text" href="https://id.loc.gov/authorities/sh85123612">United States</a></li><li><a rel="nofollow" class="external text" href="https://catalogue.bnf.fr/ark:/12148/cb11962556k">France</a></li><li><a rel="nofollow" class="external text" href="https://data.bnf.fr/ark:/12148/cb11962556k">BnF data</a></li><li><a rel="nofollow" class="external text" href="https://id.ndl.go.jp/auth/ndlna/00573369">Japan</a></li><li><a rel="nofollow" class="external text" href="https://aleph.nkp.cz/F/?func=find-c&local_base=aut&ccl_term=ica=ph387196&CON_LNG=ENG">Czech Republic</a></li><li><a rel="nofollow" class="external text" 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