![]() The Centers for Disease Control and Prevention (CDC) has developed an evaluation tool for clinicians caring for patients presenting with a rash illness that resembles smallpox based upon major and minor criteria. Major criteria for smallpox include febrile prodrome, classic lesion appearance, and lesions in the same stage of development. Airborne transmission in hospital and laboratory settings has been described, and smallpox requires enhanced infection control and isolation precautions. Transmission can occur from the onset of lesions until all crusts have sloughed. Infectious viral particles are released from sloughing of oropharyngeal lesions and resultant aerosolization of viral particles. Smallpox transmission occurs through airborne respiratory droplet secretions or direct contact with lesions or contaminated fomites. The last naturally-occurring case of smallpox was found in Somalia in 1977. ![]() Case fatality rates were approximately 30% overall, although survivors frequently suffered significant morbidity including blindness and skin scarring. In the 20 century, prior to eradication, the global death toll was over 300 million. Vaccinia virus eventually replaced cowpox as the viral agent used for smallpox vaccination although genetically distinct from cowpox, the origins of vaccinia are uncertain. In the late 1700s, Edward Jenner successfully demonstrated that cowpox virus could vaccinate people against smallpox. Smallpox is a human disease without animal reservoirs, which became an important factor in its successful eradication.
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