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Smallpox is a disease caused by the Variola major virus. Some experts say that over the centuries it has killed more people than all other infectious diseases combined. Worldwide vaccination stopped the spread of smallpox three decades ago. The last case was reported in 1977. Two research labs still keep small amounts of the virus. Experts fear bioterrorists could use the virus to spread disease.

Smallpox spreads very easily from person to person. Symptoms are flu-like. They include:

• High fever
• Fatigue
• Headache
• Backache
• A rash with flat red sores

There is no treatment. Fluids and medicines for pain or fever can help control symptoms. Most people recover, but some can die. Those who do recover may have severe scars.

The U.S. stopped routine smallpox vaccinations in 1972. Military and other high-risk groups continue to get the vaccine. The U.S. has increased its supply of the vaccine in recent years. The vaccine makes some people sick, so doctors save it for those at highest risk of disease.

Mpox, which used to be called monkeypox, is a rare disease caused by infection with the mpox virus. The mpox virus is in the same family of viruses as the smallpox virus. But mpox is less contagious than smallpox. And its disease causes milder symptoms and is usually not fatal.

In the past, most of the people who got mpox lived in certain parts of central and western Africa, had traveled there, or had been exposed to infected animals imported from there. During the recent outbreak, the disease has been found in people who live in other countries, including the United States.

Mpox spreads in different ways:

• Through close, personal, often skin-to-skin contact with someone who has the virus:
  • Through direct contact with their rash, scabs, or body fluids.
  • By breathing in the virus during prolonged, face-to-face contact.
  • During intimate physical contact such as kissing, cuddling, hugging, massage or sex.
• During pregnancy, from the pregnant person to the baby.
• From touching items (such as clothes, bedding, or towels) that were used by someone who has the virus. The risk of getting mpox this way is low.
• From infected animals:
  • By being scratched or bitten by the animal.
  • By preparing or eating meat or using products from the animal.

Someone who has mpox can spread it from the time their symptoms start until their rash has fully healed, all scabs have fallen off, and a fresh layer of skin has formed. This usually takes 2-4 weeks.

Researchers have found that some people can spread mpox to others from 1 to 4 days before their symptoms appear. It is not known how often this happens.

The symptoms of mpox usually start within 3 weeks from the time you were exposed to the virus. The symptoms may include:

• A rash with sores that can look like pimples or blisters. It could be on the face, inside the mouth, and on other parts of the body, like the hands, feet, chest, genitals, or anus. It goes through different stages, including scabs, before healing. This can take 2-4 weeks.
• Fever.
• Chills.
• Swollen lymph nodes ("swollen glands").
• Exhaustion.
• Headache.
• Muscle aches and backache.
• Respiratory symptoms, such as a sore throat, nasal congestion, or cough.

You may have all or only a few symptoms:

• You may get a rash first, followed by other symptoms
• You may have flu-like symptoms and then develop a rash 1-4 days later
• You may only get a rash

To find out if you have mpox, your provider:

• Will ask about your symptoms and medical history.
• Will look at your rash.
• Will take a sample of tissue from one of the sores so it can be tested for mpox virus.
• May do blood tests to check for mpox virus or for antibodies to the virus. Antibodies are proteins that your immune system makes to fight foreign substances, such as viruses and bacteria.

There are no treatments specifically for mpox, but many people get better on their own.

Since mpox and smallpox are similar, antiviral medicines that protect against smallpox may also help treat mpox. Antiviral medicines may be recommended for people who are more likely to get severely ill, such as patients who have weakened immune systems.

There are steps you can take to help prevent mpox:

• Avoid close, skin-to-skin contact with the mpox rash. So, while a person is sick with mpox:
  • Do not touch their rash or scabs.
  • Do not kiss, hug, cuddle, or have sex with them.
  • Do not share eating utensils or cups with them.
• Do not touch the bedding, towels, or clothing of a person who has mpox.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially after contact with sick people.
• In Central and West Africa, avoid contact with animals that can spread mpox virus, such as rodents and primates. Also, avoid sick or dead animals, as well as any bedding or other materials they have touched.

If you are sick with mpox it is recommended that you stay home while you are sick, if possible. If you have an active rash or other symptoms, it would be best to stay in a separate room from your family members and pets if you can.

The U.S. government has two vaccines in the U.S. to protect against mpox. One was approved for smallpox and mpox (JYNNEOS), and the other was approved for smallpox (ACAM2000):

• JYNNEOS is the preferred vaccine to protect against mpox. It is a two-dose vaccine.
• ACAM2000 may be an alternative to JYNNEOS. ACAM2000 is a single-dose vaccine. But it has the potential for more side effects and adverse events than JYNNEOS. And it is not recommended for people who are pregnant, are under 12 months old, have severely weakened immune systems, or have certain medical conditions.

The U. S. Centers for Disease Control and Prevention (CDC) recommends vaccination for people who have been exposed to mpox or who are more likely to get mpox.

Centers for Disease Control and Prevention

A bioterrorism attack is the deliberate release of viruses, bacteria, or other germs to cause illness or death. These germs are often found in nature. But they can sometimes be made more harmful by increasing their ability to cause disease, spread, or resist medical treatment.

Biological agents spread through the air, water, or in food. Some can also spread from person to person. They can be very hard to detect. They don't cause illness for several hours or days. Scientists worry that anthrax, botulism, Ebola and other hemorrhagic fever viruses, plague, or smallpox could be used as biological agents.

Biodefense uses medical measures to protect people against bioterrorism. This includes medicines and vaccinations. It also includes medical research and preparations to defend against bioterrorist attacks.

Centers for Disease Control and Prevention