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|Smallpox|22Smallpox

Smallpox is contagious, deadly, and would disrupt military missions.

Smallpox is a highly contagious disease that spreads from one person to another.


Smallpox is caused by a germ called variola virus.
Smallpox spreads by face-to-face contact with a contagious person over an hour or more.
Contact with infected skin can also transmit the virus.
Infection through contact with inanimate objects (e.g., clothing, towels, linens) is also possible, but uncommon.
Once infected, a person will usually begin to experience symptoms 12 to 14 days after exposure.
People with smallpox become contagious after their temperature goes over 101°F (38.3°C). Soon after, a rash appears which develops into whitish blisters. Eventually these blisters scab over. A person is contagious until all their scabs fall off.
Not everybody who talks with or is near a smallpox patient will get the disease. Historically, people with smallpox infect about half of the people in their household.
On average, each infected person may infect about 3 to 5 other people.
Animals and insects do not carry or transmit smallpox disease.

Smallpox is a deadly disease that killed millions worldwide over hundreds of years.


In the past, 3 out of every 10 people infected with smallpox died. Modern medicine might reduce this proportion, but the effects of a large-scale outbreak would still be catastrophic.
People who survive smallpox are often permanently scarred. In rare cases, they become blind as well.
There is currently no method to treat smallpox. Medications can only help control the pain and fever.

A smallpox outbreak would be highly disruptive, and significantly affect military readiness.


A smallpox outbreak could cause many casualties among unvaccinated troops, disrupting a unit’s ability to perform its mission.
If a smallpox outbreak occurred, troops would not be able to cross international borders until they had been vaccinated.
Because there is no way to cure smallpox patients, an outbreak would severely stress military medical operations.
Most of our Armed Forces are vulnerable to smallpox. Most Service Members have never been vaccinated. Those who have were vaccinated so long ago that their immunity has greatly diminished over time. They now need another dose to restore their immunity.

Smallpox vaccine prevents smallpox and we will use it carefully.

Efficacy: The World Health Organization successfully used smallpox vaccine to eradicate natural smallpox from the planet.


Smallpox vaccine contains live vaccinia viruses. Once administered, it evokes an immune response that protects against variola virus, the virus that causes smallpox.
Smallpox vaccine is so effective that it eradicated the natural disease from the planet.
About 95% of people are protected within 10 days of getting a single smallpox vaccination.
Smallpox vaccination up to 3 days after someone is exposed to smallpox virus will prevent or reduce the severity of smallpox in most people. Vaccination 4 to 7 days after exposure will likely offer partial protection.
Solid protection lasts for 3 to 5 years after first vaccination. Solid protection after revaccination lasts about 10 years. Partial protection lasts longer, but people need to be revaccinated if too much time has passed.
Published studies show that diluted smallpox vaccine is as effective as full-strength vaccine.

Side Effects: All vaccines cause side effects, but smallpox vaccine has unique features that require special handling.

Expected Effects and Side Effects:

All vaccines cause side effects, but smallpox vaccine causes a unique reaction at the vaccination site.
After smallpox vaccination, a red blister appears that should turn white 6 to 8 days after vaccination. Then it will turn into a scab. This shows successful vaccination. Most people experience normal, usually mild, reactions, such as swollen lymph nodes, sore arm, fever, headache, body ache, and fatigue. These symptoms may peak 3 to 12 days after vaccination.
Note: Vaccine viruses are present on the skin at the vaccination site. People need to be careful not to touch the site and spread those viruses somewhere else.

SIDE EFFECTS, SERIOUS:

Very rarely, smallpox vaccine can cause serious side effects.
Serious side effects are generally more rare after revaccination, compared to first vaccinations.
In the past, about 1,000 out of every 1,000,000 vaccinated people experienced reactions that were serious, but not life-threatening. Most of these reactions involved spread of vaccine virus elsewhere on the body. In the past, between 14 and 52 people out of 1,000,000 vaccinated for the first time experienced potentially life-threatening reactions. These reactions included serious skin reactions and inflammation of the brain (encephalitis). From past experience, one or two people in 1 million who receive smallpox vaccine may die as a result.
Serious side effects are generally more rare after revaccination, compared to first vaccinations. We will try to reduce the risk of side effects by actively looking for and exempting out people whose immune system is not working fully and people who have or had certain skin conditions.
After the first 500,000 military smallpox vaccinations thru Dec 03, few serious reactions occured. Some first-time vaccinees had chest pain due to myo-pericarditis (inflammation in or around the heart). These cases ranged from mild to serious. One case of lupus-like illness may have been triggered by vaccination.
A few heart attacks, some fatal, have been reported. At this time, they are not believed to be caused by vaccine. DoD medically exempts people with heart conditions. Further investigation is underway.
We try to reduce the risk of side effects by exempting people who should not receive this vaccine.

Care of the Vaccination Site: Don’t touch the smallpox vaccination site. You may spread virus somewhere else, either on your body or somebody else’s.


Don’t touch a smallpox vaccination site. This is the best way to avoid spreading the virus. Frequent hand washing also helps prevent spreading virus in the event you touch the vaccination site by accident. An information sheet with detailed instructions about how to take care of the vaccination site will be provided to vaccine recipients.
If 1,000,000 people get smallpox vaccine, up to about 600 cases of auto-inoculation (also called accidental infection) can result when people touch their vaccination site and then transfer virus to their eyes, genitals, or other itchy places on their body.
Vaccinia virus can also be spread to others by touch. In the 1960s, the risk of spreading vaccinia virus to others (usually a household member) was about 30 per 1,000,000 vaccinations overall. Most cases of vaccinia caused by contact do not lead to serious illness. However, about 30% of such cases result in a severe skin infection in individuals who have eczema or other chronic skin problems.
Until the vaccination scab falls off, avoid close or household contact with people who are exempt from getting smallpox vaccine themselves. Do not share sleeping space (eg. bed, bunk, cot) with these people. Do not share clothes, towels, linen, or toiletries either. Occupational settings (eg. vehicles, tanks, aircraft) are not affected, if the vaccine site is simply covered with a Band Aid and a sleeve.
Today, there are many people in the community living with problems to their immune systems. Follow instructions about caring for your vaccination site to minimize the chance of spreading vaccinia virus to someone else.
The risk of severe complications after smallpox vaccination for people infected with human immunodeficiency virus (HIV) is not known. At present, there is no evidence that smallpox vaccination accelerates the progression of HIV-related disease. Nevertheless, until additional information becomes available, it is prudent that people who have HIV infection not be vaccinated, except in an emergency.

Exemption from Vaccination: Some people should not get smallpox vaccine, except under emergency situations.

If you have clinical questions related to vaccination, please contact the DoD Vaccine Clinical Call Center at 1-866-210-6469.
In the event of a smallpox outbreak, even people with the exemptions listed below should get smallpox vaccination if they were exposed to someone contagious with smallpox.

People whose immune system is not working fully (due to disease, medication, or radiation), such as HIV/AIDS, cancer, transplant, immune deficiency.
People diagnosed with eczema or atopic dermatitis, now or earlier in life.
People with current skin conditions, such as burns, impetigo, contact dermatitis, chickenpox, shingles, psoriasis, or uncontrolled acne, until the condition clears up.
Pregnant women.
People with a household contact who meets any of the conditions above.
People with serious heart or vessel conditions (such as angina, heart attack, artery disease, congestive heart failure, stroke, other cardiac problem).
People with 3 cardiac risk factors (smoking, high blood pressure or cholesterol, diabetes, family history).
People taking steroid eye drops or ointment.
Breastfeeding mothers.
Anyone who had problems after previous doses or is allergic to the vaccine or any component.

Smallpox Vaccine:

Smallpox vaccine contains live vaccinia viruses, which produce protection against smallpox. The vaccine was prepared on the skin of calves. The calves’ lymph was purified, concentrated, freeze-dried, and stored in a freezer until recently.
This same vaccine has been administered to many millions of Americans, including Service Members during World War I, up until the 1980's.
FDA recently licensed a limited supply of smallpox vaccine made by Wyeth Laboratories, called Dryvax®. The vaccine had been stored in a freezer since the late 1970s. Recent tests show that Dryvax® has remained potent. It passed all tests required by the FDA.
If a smallpox outbreak occurs, the Defense Department may run out of FDA-licensed smallpox vaccine. In that case, the FDA will allow the DoD to use previously licensed smallpox vaccine, but it must be called “investigational” and the DoD must tell you how it differs from licensed vaccine.
There is one main difference between licensed and investigational smallpox vaccines: Investigational smallpox vaccine has five times more liquid than usual mixed with it, to help make the vaccine available to more people. We call this a 1:5 (one-to-five) dilution, because one dose of diluted vaccine would contain only 20% as much vaccinia virus as full-strength vaccine.
Despite these differences, the investigational vaccine has passed all tests required by the FDA.
DoD will be using the only FDA-licensed smallpox vaccine in its current, pre-outbreak smallpox vaccination program.

Preserving the health and safety of our people is our top concern.

Healthy troops complete their missions. Vaccines will keep you and your team healthy.


Vaccines shield you from dangerous germs. These germs can kill you or cause lasting harm. Vaccines prevent infections such as tetanus, typhoid fever, measles, yellow fever, smallpox, and anthrax, to name just a few.
Vaccines keep units fit to fight. We fight as a team. All team members need to be healthy. That's why voluntary vaccination is not an option.
Vaccines benefit both individuals and units. Vaccines keep people healthy so they can live better lives. Vaccines keep people healthy so they can do their mission. Vaccines help you return home healthy.

Vaccines have kept troops healthy since the days of George Washington.


We lost the Battle of Quebec in 1776 because our troops weren't protected against smallpox. Americans suffered 5,500 smallpox casualties among 10,000 colonial troops. The task force commander, Major General John Thomas, died of smallpox.
Afterwards, George Washington ordered his troops to be protected from smallpox in 1777 using a forerunner of vaccination called “variolation.”
From 1777 to today, vaccines protected American troops from dangerous infections. Typhoid vaccine reduced typhoid casualties from 20,000 in Spanish-American War of 1898 to just 1,500 in World War I. During all of World War II, only 12 cases of tetanus occurred among vaccinated US troops, but numerous tetanus deaths occurred among the unvaccinated German troops.
Vaccines are among the most important accomplishments in medicine. Vaccines have saved more lives throughout the world than any other medical invention. Vaccines have saved more lives than antibiotics or surgery. Only clean water has saved more lives than vaccines.

Vaccination offers a layer of protection against bioweapons, in addition to other measures, needed for certain members of the Armed forces.


We protect troops using detection devices, protective gear, training, and in other ways.
However, these means of Force Protection have their limitations. People can't stay in protective gear for days on end and perform well. Our bioweapon detectors don’t work fast enough to prevent exposure to the smallpox virus. There is no treatment, no antibiotic, for smallpox.
Vaccines are one of our best ways to keep you healthy. The President directed us to use safe and effective vaccines to protect against bioweapons and deployment infections.
Vaccines provide the only round-the-clock protection.
Vaccines, combined with other measures, offer the best chance for individual survival and mission accomplishment.

The Defense Department's smallpox vaccination program is part of our national strategy to safeguard Americans against smallpox attack.

The Defense Department is working with other federal departments to strengthen America’s defenses against smallpox.


Intentional release of smallpox (variola) virus as a bioweapon could result in smallpox cases over a wide area. The disease could cross boundaries, from military to civilian communities, and vice versa. Major disruptions in civil, political, medical, and economic order could follow.
The World Health Organization used smallpox vaccine to eradicate natural smallpox. Current supplies of smallpox vaccine are limited because production ceased in the early 1980’s. Additional supplies of smallpox vaccine are now being produced using modern production methods.
The federal government has ordered enough smallpox vaccine to protect each American in a potential bioterrorist attack.

The government has been preparing for some time for the remote possibility of an outbreak of smallpox as an act of terror.


Those preparations quickened after September 11, 2001. Although we are planning for this possibility to protect public health, we have no indication that there is an imminent threat.
If there is an outbreak of smallpox, post-outbreak vaccinations may only be required in the area around the outbreak to contain the spread. If health officials are not able to contain the outbreak, vaccination of a wider group of people may be needed.
One suspected case of smallpox is considered a public health emergency. Smallpox surveillance in the United States includes detecting a suspected case or cases and preventing further smallpox transmission. A suspected smallpox case should be reported immediately by telephone to health officials.