History of Smallpox | Smallpox

Origin of Smallpox

The origin of smallpox is unknown. The finding of smallpox-like rashes on Egyptian mummies suggests that smallpox has existed for at least 3,000 years. The earliest written description of a disease like smallpox appeared in China in the 4^th century CE (Common Era). Early written descriptions also appeared in India in the 7^th century and in Asia Minor in the 10^th century.

Spread of Smallpox

Historians trace the global spread of smallpox to the growth of civilizations and exploration. Expanding trade routes over the centuries also led to the spread of the disease.

Highlights from History:

• 6^th Century—Increased trade with China and Korea brings smallpox to Japan.
• 7^th Century—Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.
• 11^th Century—Crusades further spread smallpox in Europe.
• 15^th Century—Portugal occupies part of western Africa, bringing smallpox.
• 16^th Century—European settlers and the African slave trade import smallpox into:
  • The Caribbean
  • Central and South America
• 17^th Century—European settlers bring smallpox to North America.
• 18^th Century—Explorers from Great Britain bring smallpox to Australia.

Early Control Efforts

Smallpox was a terrible disease. On average, 3 out of every 10 people who got it died. People who survived usually had scars, which were sometimes severe.

One of the first methods for controlling smallpox was variolation, a process named after the virus that causes smallpox (variola virus). During variolation, people who had never had smallpox were exposed to material from smallpox sores (pustules) by scratching the material into their arm or inhaling it through the nose. After variolation, people usually developed the symptoms associated with smallpox, such as fever and a rash. However, fewer people died from variolation than if they had acquired smallpox naturally.

The basis for vaccination began in 1796 when the English doctor Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. Jenner also knew about variolation and guessed that exposure to cowpox could be used to protect against smallpox. To test his theory, Dr. Jenner took material from a cowpox sore on milkmaid Sarah Nelmes’ hand and inoculated it into the arm of James Phipps, the 9-year-old son of Jenner’s gardener. Months later, Jenner exposed Phipps several times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise “On the Origin of the Vaccine Inoculation.” In this work, he summarized his discoveries and expressed hope that “the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice.”

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

Traces of smallpox pustules found on the head of the 3000-year-old mummy of the Pharaoh Ramses V. Photo courtesy of World Health Organization (WHO)

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Edward Jenner (1749–1823). Photo courtesy of the National Library of Medicine.

Global Smallpox Eradication Program

In 1959, the World Health Organization (WHO) started a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from a lack of funds, personnel, and commitment from countries, and a shortage of vaccine donations. Despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks across South America, Africa, and Asia.

The Intensified Eradication Program began in 1967 with a promise of renewed efforts. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Other factors that played an important role in the success of the intensified efforts included the development of the bifurcated needle, the establishment of a case surveillance system, and mass vaccination campaigns.

By the time the Intensified Eradication Program began in 1967, smallpox was already eliminated in North America (1952) and Europe (1953). Cases were still occurring in South America, Asia, and Africa (smallpox was never widespread in Australia). The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977).

Last Cases of Smallpox

In late 1975, three-year-old Rahima Banu from Bangladesh was the last person in the world to have naturally acquired variola major. She was also the last person in Asia to have active smallpox. She was isolated at home with house guards posted 24 hours a day until she was no longer infectious. A house-to-house vaccination campaign within a 1.5-mile radius of her home began immediately. A member of the Smallpox Eradication Program team visited every house, public meeting area, school, and healer within 5 miles to ensure the illness did not spread. They also offered a reward to anyone who reported a smallpox case.

Ali Maow Maalin was the last person to have naturally acquired smallpox caused by variola minor. Maalin was a hospital cook in Merca, Somalia. On October 12, 1977, he rode with two smallpox patients in a vehicle from the hospital to the local smallpox office. On October 22, he developed a fever. At first healthcare workers diagnosed him with malaria, and then chickenpox. The smallpox eradication staff then correctly diagnosed him with smallpox on October 30. Maalin was isolated and made a full recovery. Maalin died of malaria on July 22, 2013, while working in the polio eradication campaign.

Janet Parker was the last person to die of smallpox. In 1978, Parker was a medical photographer at England’s Birmingham University Medical School. She worked one floor above the Medical Microbiology Department where staff and students conducted smallpox research. She became ill on August 11 and developed a rash on August 15 but was not diagnosed with smallpox until 9 days later. She died on September 11, 1978. Her mother, who was providing care for her, developed smallpox on September 7, despite having been vaccinated two weeks earlier. An investigation suggested that Janet Parker had been infected either via an airborne route through the medical school building’s duct system or by direct contact while visiting the microbiology corridor.

World Free of Smallpox

Almost two centuries after Jenner hoped that vaccination could annihilate smallpox, the 33^rd World Health Assembly declared the world free of this disease on May 8, 1980. Many people consider smallpox eradication to be the biggest achievement in international public health.

Stocks of Variola Virus

Following the eradication of smallpox, scientists and public health officials determined there was still a need to perform research using the variola virus. They agreed to reduce the number of laboratories holding stocks of variola virus to only four locations. In 1981, the four countries that either served as a WHO collaborating center or were actively working with variola virus were the United States, England, Russia, and South Africa. By 1984, England and South Africa had either destroyed their stocks or transferred them to other approved labs. There are now only two locations that officially store and handle variola virus under WHO supervision: the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia.

Three-year-old Rahima Banu with her mother in Bangladesh. Rahima was the last known person to have had naturally acquired smallpox in the world. An 8-year-old girl named Bilkisunnessa reported the case to the local Smallpox Eradication Program team and received a 250 Taka reward. Source: CDC/World Health Organization; Stanley O. Foster M.D., M.P.H.

WHO poster commemorating the eradication of smallpox in October 1979, which was officially endorsed by the 33rd World Health Assembly on May 8, 1980. Courtesy of WHO.

The Spread and Eradication of Smallpox | Smallpox

Smallpox began causing illness and death more than a thousand years ago.

Follow its spread and eventual eradication in the timeline below.

Smallpox is present in the Egyptian Empire

Traces of smallpox pustules found on the head of a 3,000-year-old mummy of the Pharaoh Ramses V. By G. Elliot Smith, Public Domain.

A written description of a disease that clearly resembles smallpox appears in China

In China, people appealed to the god Yo Hoa Long for protection from smallpox. Image taken from Recherche sur les Superstitions en Chine (Research on Chinese Superstitions) by Henri Dore, Shanghai, 1911-1920. Bibliotheque nationale de France.

Increased trade with China and Korea introduces smallpox into Japan.

Drawing of a woman defeating the “smallpox demon” by wearing red. A myth commonly believed around the world advocated that red light would cure smallpox. In Japan, families who fell sick with smallpox set up shrines to the “smallpox demon” in their homes with the hope they would appease the demon and be cured. By Sensai Eitaku (鮮斎永濯, Japanese, *1843, †1890) – scanned from ISBN 978-4-309-76096-4., Public Domain]

Smallpox is widespread in India. Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.

Figurine of Indian smallpox goddess Shitala Mata worshipped in northern India. She was considered both the cause and cure of smallpox disease. Symbolically, she represents the importance of good hygiene in people’s health and motivates worshipers to keep their surroundings clean. Photo courtesy of the National Library of Medicine.

Smallpox spreads to Asia Minor, the area of present-day Turkey.

The map shows the Ottoman Empire in 1801, which then extended from Turkey (Anatolia) to Greece, Hungary, Bulgaria, Romania, as well as northern Africa and parts of Middle East. Smallpox is thought to arrive to the area from Asia through major trade routes, like the Silk Road.

Entrance into Europe

Crusades further contribute to the spread of smallpox in Europe with the European Christians moving to and from the Middle East during the next two centuries.

Smallpox moves north

Population expansion and more frequent travel renders smallpox endemic in previously unaffected Central and North Europe, with severe epidemics occurring as far as Iceland.

Smallpox is widespread in many European countries, and Portuguese expeditions to African west coast and new trade routes with eastern parts of Africa introduce the disease into West Africa.

Statue of Shapona, the West African god of smallpox. Smallpox was thought to be a disease forced upon humans due to Shapona’s “divine displeasure,” and formal worship of the god of smallpox was highly controlled by specific priests in charge of shrines to the god. People believed that the priests themselves were capable of causing smallpox outbreaks. Even though the British colonial rulers banned the worship of Shapona in 1907, worship of the deity continued. Source: CDC, photo credit James Gathany.

European colonization and the African slave trade import smallpox into the Caribbean and Central and South America.

Illustration by the Franciscan missionary Bernardino de Sahagun who wrote detailed accounts of the Aztec history during his life there from 1545 until his death in 1590 into 12 books entitled “General History of the Things of New Spain.” Introduction of smallpox into Mexico by the Spanish around 1520 was one of the factors that led to the demise of Aztec Empire. Scanned from (2009) Viruses, Plagues, and History: Past, Present and Future, Oxford University Press, USA, p. 60. Public Domain.

Variolation—a process of grinding up dried smallpox scabs from a smallpox patient and inhaling them or scratching them into an arm of an uninfected person—is being used in China (inhalation technique) and India (cutaneous technique) to control smallpox.

A container from Ethiopia used to store the powdery variolation material, which was produced by grinding up dried smallpox scabs taken from a smallpox patient. Source: CDC, photo credit Brian Holloway.

Increased use of variolation

Variolation (cutaneous technique) is a widespread method for preventing smallpox in the Ottoman Empire (former Asia Minor, present-day Turkey) and North Africa.

Smallpox spreads into North America

European colonization imports smallpox into North America.

Variolation is introduced into England by Lady Mary Wortley Montagu, the wife of the British ambassador to Turkey.

Lady Mary Wortley Montagu, the wife of the British ambassador, learned about variolation during their appointment in Turkey. A survivor of smallpox herself, she had both of her children variolated and was the foremost person responsible for the introduction of the technique to England.

In 1796, Edward Jenner, an English doctor, shows the effectiveness of previous cowpox infection in protecting people from smallpox, forming the basis for vaccination.

Edward Jenner (1749–1823). Photo courtesy of the National Library of Medicine.

Smallpox is widespread in Africa, Asia, and South America in the early 1900s, while Europe and North America have smallpox largely under control through the use of mass vaccination.

The map shows the worldwide distribution of smallpox and the countries in which it was endemic in 1945. Source: CDC, photo credit Dr. Michael Schwartz.

After a global eradication campaign that lasted more than 20 years, the 33rd World Health Assembly declares the world free of smallpox in 1980.

WHO poster commemorating the eradication of smallpox in October 1979, which was later officially endorsed by the 33rd World Health Assembly on May 8, 1980. Courtesy of WHO.

transmission, pathogen, causes, symptoms, signs, diagnosis, treatment, prevention

Smallpox is an infectious disease caused by the Variola virus (VARV) belonging to the genus Orthopoxvirus. The disease is characterized by fever, symptoms of intoxication, the appearance of a rash on the skin and mucous membranes.

The official start of vaccination against smallpox infection in Russia is October 23, 1768. The vaccine was first administered to Empress Catherine II and her heirs. The material for vaccination was obtained from a smallpox boy of peasant origin. Subsequently, not only children were vaccinated, but also the grandchildren of the Empress.

By the beginning of the 19th century (1804-1810), about 8 million people had already been infected with smallpox in Russia. As a result, for 827 thousand patients, the outcome of the disease was fatal. In our country, mass vaccination and revaccination began in 1919 and became mandatory after the Great October Revolution. Serious success in the prevention of smallpox was achieved only in the USSR. By 1936, the disease had been eradicated.

By the early 1960s, smallpox had been completely eradicated in Europe and North America. In the first half of the 1970s, WHO set the task of completely coping with the causative agent of the disease. This required preventing variolation and closely monitoring smallpox outbreaks.

The last case of viral infection was reported at the end of October 1977. In 1980, global eradication of smallpox was certified by WHO.

How smallpox is transmitted

The causative agent of the disease is the Variola virus (VARV), which can infect humans and animals. The pathogen has excellent resistance to various environmental factors, easily tolerates both low temperatures and drying. In the frozen state, the causative agent of smallpox is able to maintain viability for several years. After drying at an increase in temperature to 100°C, the death of the pathogen occurs within 5-10 minutes.

The source of infection is a person with smallpox. High infectivity is observed during the first ten days, however, the release of viral particles into the environment occurs during the entire period of the appearance of rashes. The asymptomatic course of the disease, as well as the carriage of the pathogen in this pathology, is uncharacteristic, as is the transition to the chronic form.

Places of localization of variola in the human body are the mucous membranes of the respiratory organs, as well as the oral cavity. The causative agent is excreted with coughing, sneezing and breathing. The infection can be transmitted from the patient by airborne droplets and airborne dust. An aerosol with pathogenic microflora is able to travel long distances, infecting people who are in the same room with a sick person.

Human susceptibility to infection is very high. People who are not immunized are most often infected. After the illness, the formation of stable long-term immunity (more than 10 years) is noted.

Of the available candidates for the “relatives” of the Variola virus, monkeypox and cowpox are of the greatest interest.

The first of these is a rare infectious disease that can affect both animals and humans. The main signs of monkeypox are general intoxication of the body, a high rise in temperature, and the formation of exanthema on the skin.

The causative agent is genetically close to the human smallpox virus. To date, there has been an increase in monkeypox. So, in May 2021, an infected patient was identified in the UK, on ​​June 2 and 24, two more cases of the disease were registered. In the US, on July 16, 2021, an American was diagnosed with monkeypox. All of them have been to Nigeria.

Varicella is a highly contagious viral disease caused by the Varicella Zoster virus, which belongs to the herpes family of viruses. The pathogen, with a decrease in immunity, causes a severe disease – herpes zoster. Chickenpox predominantly affects children. Most often, their disease is milder than in adults.

Clinical manifestations of human smallpox

The duration of the incubation period of the disease ranges from 9 days to two weeks. In some cases, an increase of up to three weeks is possible. Symptoms of smallpox will depend on the severity of the disease.

The following stages are distinguished in the clinical course of the disease:

• prodromal period;
• rash stage;
• suppuration of contents of eruptions;
• recovery period.

The duration of the prodromal stage is from two to four days. During this period, there are symptoms of intoxication of the body, which are accompanied by a rise in body temperature, the presence of a headache, a feeling of chills, weakness, the appearance of pain in the muscles, the lumbar region. The skin of the thighs and chest is covered with eruptions similar to the exanthema characteristic of scarlet fever or measles. By the end of the prodrome stage, the temperature index is normalized. By the fifth day, rashes appear, which are initially represented by small roseolas, turning into papules and vesicles with many chambers. They are surrounded by hyperemic skin and have an umbilical depression in the central part. Vesicles are localized in the face, torso, upper and lower limbs. With the progression of the rash, the symptoms of intoxication increase again.

After 5-7 days from the onset of the disease, the stage of suppuration begins. During this period, there is a sharp rise in temperature, the condition worsens. The pockmarks form a purulent pustule and become painful. After about a week, they open up, leaving blackened necrotic crusts. Also at this stage there is a strong skin itch.

By the twentieth day of illness, the recovery period begins. Body temperature gradually decreases, pockmarks begin to heal, peeling of the skin is noted in their place, and scars remain in the future.

The clinic of the disease is characterized by several degrees of severity:

1. Severe – papular-hemorrhagic, confluent, smallpox purpura.
2. Moderately severe – disseminated smallpox.
3. Light. The disease proceeds without obvious signs of intoxication, there are no rashes.

Most often, a mild form of the disease occurs in people vaccinated against smallpox. A severe pathology with a hemorrhagic component has a tendency to complication with a fatal outcome.

Clinical manifestations of monkeypox

The duration of the incubation period is from one to three weeks. The onset of the disease is acute, accompanied by complaints of severe headache, there is a rise in temperature to high numbers. The patient feels weakness, chills. Lymph nodes located near the site of infection increase in size, become inflamed, and become painful on palpation. The patient complains of nausea, vomiting, loss or lack of appetite, which is associated with intoxication of the body.

By the fourth day, the temperature begins to drop to 38.5 °C or lower. Rashes appear on the body, which go through several stages:

1. Formation of a small spot up to 1 cm in diameter with transformation into a tubercle.
2. Appearance of a vesicle, initially filled with clear contents, which gradually become cloudy.
3. Scab formation with scar formation.

At each stage, the temperature again rises to high values. In each of these periods, the patient notes a deterioration in well-being. An increase in lymph nodes is already noted over the entire surface of the body.

Due to the appearance of rashes on the mucous membrane of the pharynx, the disease is accompanied by the appearance of cough, dryness in the pharynx. In the presence of a rash in the mouth, increased salivation and a feeling of discomfort during chewing are noted. If the eyelids and genitals are affected, then painful sensations appear in these areas.

In the case of a purulent infection, the temperature rises, blood pressure decreases, the pulse becomes frequent, consciousness is disturbed. These signs indicate the development of infectious-toxic shock.

Smallpox diagnostics

Diagnosis of the disease is aimed at detecting the pathogen. To identify the smallpox virus, the contents of the rash and crusts are examined. The following methods are used, which allow not only to detect pathogenic microflora, but also antibodies to the virus:

• viroscopy;
• serological tests: ELISA, agar microprecipitation;
• blood test for antibodies: ELISA, RTGA, RSK, RN – are possible already from the 5-8th day of illness.

Treatment of smallpox

Therapy of the disease is carried out with the appointment of:

• drugs with antiviral action;
• immunoglobulins;
• antibacterial drugs of the penicillin group, cephalosporins and macrolides;
• means for intravenous drip administration, relieving intoxication;
• glucocorticoids.

Smallpox is also treated externally: rashes are treated with antiseptics.

Smallpox prophylaxis

In order to prevent infection with the pathogen, specific preventive measures are taken to exclude the importation of a dangerous infection from regions that are unfavorable in terms of the epidemic.

Successful eradication of the disease has been achieved through decades of immunization of the population. At the moment, the mass introduction of the smallpox vaccine is impractical.

If a sick person is identified, they are isolated, including those who were in contact. Disinfection of the focus of infection. Everyone who has been in contact with an infected person, if no more than 72 hours have passed, must be vaccinated.

The author of the article:

Ivanova Natalya Vladimirovna

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Smallpox. What is natural smallpox?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Smallpox is a highly dangerous human infectious disease caused by the Orthopoxvirus variola virus, characterized by fever, intoxication, and specific rashes on the skin and mucous membranes. The spread of smallpox occurs by aerosol, while the pathogen is so stable in the air that it can cause infection of people who are not only in the same room with the patient, but also in neighboring rooms. In the mid-70s of the twentieth century, the complete elimination of smallpox in developed countries led to the abolition of preventive vaccination against this disease.

• Exciter characteristic
• Smallpox symptoms
• Complications of smallpox
• Diagnosis and treatment of smallpox
• Prognosis and prevention of smallpox
• Prices for treatment

General information

Smallpox is a highly dangerous infectious human disease caused by the Orthopoxvirus variola virus, characterized by fever, intoxication, and specific rashes on the skin and mucous membranes.

Characteristics of the pathogen

The Orthopoxvirus variola virus belongs to the group of animal pox and human pox viruses, is stable in the environment, easily tolerates low temperatures and desiccation, and can remain viable when frozen for several years. At room temperature, it remains in smallpox crusts for up to a year, in sputum and mucus – up to three months. When heated to 100 ° C, the dried virus dies only after 5-10 minutes.

The reservoir and source of smallpox is the sick person. Isolation of the virus occurs throughout the entire period of rashes, especially patients are contagious in the first 8-10 days. Asymptomatic and convalescent carriage is not observed, chronization is not typical. The predominant localization of the pathogen in the human body is the mucous membranes of the oral cavity, nose, pharynx, upper respiratory tract, excretion occurs with coughing, sneezing, and during breathing. The skin can also serve as a site for excretion of the pathogen.

Smallpox is transmitted by aerosol mechanism mainly by airborne droplets and airborne dust. An aerosol with a pathogen is able to move with air current over a considerable distance, affecting people located in the same room with the patient, and penetrating into neighboring rooms. Smallpox tends to spread in multi-storey apartment buildings, medical institutions, crowded teams.

Human natural receptivity is high. Unimmunized persons become infected in the vast majority of cases, the percentage of unsusceptible persons is no more than 12 out of 100 unvaccinated (average 5-7%). After the transfer of the disease, a stable long-term (more than 10 years) immunity is formed.

Symptoms of smallpox

The incubation period for smallpox is usually 9-14 days, but can be extended up to 22 days. There are periods of the disease: prodromal (or the period of precursors), rashes, suppuration and convalescence. The prodromal period lasts from two to four days, there is fever, symptoms of intoxication (headache, chills, weakness, muscle pain, back pain). At the same time, a rash may appear on the thighs and chest, resembling exanthema in measles or scarlet fever.

By the end of the prodrome, the fever usually subsides. On the 4-5th day, a smallpox rash (rash period) appears, initially representing small roseolas progressing into papules, and after 2-3 days into vesicles. Vesicles look like multi-chamber small vesicles surrounded by hyperemic skin and having a small umbilical depression in the center. The rash is localized on the face, trunk, limbs, not excluding the palms and soles, unlike chicken pox, the elements of the rash in one zone are monomorphic. With the progression of the rash, fever and intoxication again increase.

By the end of the first week of the disease, at the beginning of the second, a period of suppuration begins: the temperature rises sharply, the condition worsens, the eruptive elements suppurate. The pockmarks lose their multi-chambered nature, merging into a single purulent pustule, and become painful. A week later, the pustules open, forming black necrotic crusts. The skin starts to itch a lot. On the 20-30th day, a period of convalescence begins. The patient’s body temperature gradually returns to normal from the 4-5th week of the disease, the pockmarks heal, leaving behind a pronounced peeling, and later – scars, sometimes very deep.

There are severe clinical forms of smallpox: papular-hemorrhagic (black pox), confluent and smallpox purpura. Moderate course has disseminated smallpox, mild – smallpox without rash and temperature: varioloid. In this form, smallpox usually occurs in vaccinated individuals. Characterized by rare rashes that do not leave scars, there are no intoxication symptoms.

Complications of smallpox

Most often, smallpox is complicated by toxic shock. Complications of an inflammatory nature from the nervous system are noted: myelitis, encephalitis, neuritis. There is a possibility of secondary infection and the development of purulent complications: abscesses, phlegmon, lymphadenitis, pneumonia and pleurisy, otitis, osteomyelitis. Sepsis may develop. After the transfer of smallpox, consequences in the form of blindness or deafness may remain.

Diagnosis and treatment of smallpox

Diagnosis of smallpox is performed by virological examination using an electron microscope, as well as by virological and serological methods: microprecipitation in agar, ELISA. The discharge of smallpox pustules and crusts is subject to research. From the 5th-8th day of the disease, it is possible to determine specific antibodies using RN, RSK, RTGA, ELISA.

The treatment of smallpox consists in the appointment of antiviral drugs (metisazon), the introduction of immunoglobulins. Skin affected by smallpox rash is treated with antiseptic agents. Additionally (due to the purulent nature of the infection), antibiotic therapy is prescribed: antibiotics of the groups of semi-synthetic penicillins, macrolides and cephalosporins are used. Symptomatic therapy consists in active detoxification with the help of intravenous infusion of glucose solutions, water-salt solutions. Sometimes glucocorticoids are included in therapy.

Prognosis and prevention of smallpox

The prognosis depends on the severity of the course and the condition of the patient’s body. The vaccinated persons, as a rule, carry smallpox in a mild form. Severe smallpox with a hemorrhagic component can result in death.

Currently, specific prophylaxis of smallpox is carried out in order to prevent its importation from epidemically dangerous regions. The eradication of smallpox in developed countries has been achieved through mass vaccination and revaccination of the population over several generations; at present, routine universal vaccination is not practical. In case of detection of a patient with smallpox, they isolate him, as well as carry out quarantine measures for everyone who had contact with the patient. Thorough disinfection is carried out in the focus of infection, contact persons are vaccinated within the first three days from the moment of contact.