# data[].attributes.body
Smallpox likely first appeared in Africa, in agricultural settlements. The disease probably spread via Egyptian merchants.

# data[].attributes.attachment_link.title
Smallpox- The Triumph over the most Terrible of the Ministers of Death.pdf

# data[].attributes.headline
3,000 BC: Documented Smallpox Case in Egypt

# data[].attributes.subject
3,000 BC: Documented Smallpox Case in Egypt

# data[].attributes.body
Few traces of the smallpox virus have been found by swabbing th head of the mummy of Pharaoh Rameses V. -Justin

# data[].attributes.attachment_link.readable_text
Smallpox began causing illness and death more than a thousand years ago. Follow its spread and eventual eradication in the timeline below.

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.

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.

Page last reviewed:

# data[].attributes.attachment_link.description
Smallpox began causing illness and death more than a thousand years ago. Follow its spread and eventual eradication in the timeline below. 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.

# data[].attributes.body
Bishop Marius of Avicentum first used the term variola. This is a Latin term that means "pox" or "pustule." This term would go on the become the name of the smallpox virus.

# data[].attributes.attachment_link.readable_text
History

The history of smallpox is uncertain. Genetic analyses of viral DNA isolated from a mummified child who had been interred in a church in Lithuania suggest that variola virus had evolved by at least the 17th century. It is likely, however, that the virus was circulating in human populations much earlier, based on the recovery of variola virus DNA from teeth and bones of human remains dated to 600-1050 that were uncovered in the region of modern-day Denmark and Russia. Prior to that discovery, the disease had been thought by some scholars to have arisen among settled agricultural populations in Mesopotamia as early as the 5th millennium bce and in the Nile River valley in the 3rd millennium bce, though evidence for those events was lacking. Around 570, Bishop Marius of Avicentum (near Lausanne, Switzerland) introduced the Latin term variola (meaning "pox" or "pustule"). The English term pox was used to describe various eruptive diseases, including a pox disease that came to be known as smallpox. In the 16th century, variola became popularly known as the "small pox," to distinguish it from syphilis (the "Great Pox"). By that time the "small pox" seems to have succeeded plague as the most-feared pestilence in Europe.

A huge pandemic reached from Europe to the Middle East in 1614, and epidemics arose regularly in Europe throughout the 17th and 18th centuries. There were frequent outbreaks in the American colonies and in British India as well. Introduced to the Americas by European conquerors and settlers, smallpox decimated native populations from the Plains Indians of Canada and the United States to the Aztecs of Mexico and the Araucanians of Chile. The Australian Aboriginals also suffered large losses from the disease in the 19th century.

Though medical science had not yet grasped the concept of infectious organisms such as viruses, it was understood that smallpox was somehow a contagious disease and that its victims had to be separated from the general populace. Little could be done for the victims. The first edition of the Encyclopædia Britannica (1768) repeats the general approach of 17th-century English physician Thomas Sydenham, which included procedures such as bloodletting, induction of vomiting, and administration of enemas in order to "keep the inflammation of the blood within due bounds." In all parts of the world, smallpox outbreaks brought on desperate pleas by believers for divine assistance in lifting the scourge. Beyond that, the only hope lay in preventing outbreaks from occurring.

In southwestern Asia it had been known for centuries that a healthy person could be made immune to smallpox by being injected with pus taken from the sores of an infected person. Another technique, practiced in China, was to grind the scabs of a smallpox victim and blow the powder through a tube into the nose of a healthy person. People inoculated in this way would suffer a brief illness themselves and would be contagious for a period, and a few would contract a serious infection and die; but the risk of dying was far less than in a smallpox epidemic (roughly 2 percent, compared with 20 to 30 percent), and the benefit of immunity was clear. In the early 18th century several European doctors and, most prominently, Lady Mary Wortley Montagu, the wife of Britain's ambassador to Turkey, began to publicize the value of inoculation (or variolation, as it came to be known), and the practice was soon adopted by royalty and people of means in Europe and America. However, the procedure was expensive and difficult, and it had little influence beyond the well-to-do classes and certain military forces.

A much safer procedure was developed by Edward Jenner, a physician in Gloucestershire, England. In 1796 Jenner deliberately infected a small boy with variolae vaccinae, or cowpox, a bovine version of smallpox. The boy suffered only a mild noncontagious reaction and then showed no reaction to a subsequent inoculation with variola major. The superiority of vaccination, as this technique came to be known, was immediately recognized. During the 19th century, vaccination programs, many of them compulsory, were instituted in many countries. At first vaccine was obtained directly from vaccinated persons, but soon it was being commercially harvested from pustules grown on the skin of inoculated calves. Later in the century it became apparent that the cowpox virus had been supplanted in vaccines by a different strain. It is still not certain whether the new virus, called vaccinia, was a mutation of cowpox virus or a completely separate strain, but it remains the virus used for vaccine production to this day.

By the beginning of the 20th century, smallpox was no longer endemic in several countries of continental Europe. Endemic smallpox was eradicated from the United Kingdom in 1934, the U.S.S.R. in 1936, Canada in 1946, the United States in 1949, Japan in 1951, and China in 1961. Still, in an age of global travel only an international effort could completely eradicate the disease. In 1967 WHO began to vaccinate entire populations around every reported outbreak of smallpox. The disease was no longer endemic in India by 1975 and in Ethiopia by 1976. The last endemic case of smallpox (actually an infection of variola minor) was recorded in Somalia in 1977. No cases were reported from 1977 to 1980, with the exception of two cases in England in 1978 whose source was in a laboratory, and in 1980 the disease was declared exterminated.

With the disappearance of the global threat, there was less incentive for prevention. In the United States, routine vaccination already had been discontinued in 1971, and production of vaccine was suspended in 1982. Stocks of variola major were kept in only two countries, the United States and Russia, which had cultivated the virus as part of their biological weapons programs during the Cold War. At the beginning of the 21st century, the increasing sophistication and viciousness of international terrorist groups raised concerns that entire populations were now vulnerable to deliberate infestation. In response, many countries began to produce and store fresh stocks of vaccine for use in emergencies.

In 2007 the Food and Drug Administration in the United States approved a new smallpox vaccine, the only new vaccine for smallpox to be approved since 1931. The new vaccine, called ACAM2000, is produced using basic cell-culture techniques that allow it to be made quickly and in sufficient quantity in the event of a national smallpox emergency.

# data[].attributes.attachment_link.title
Smallpox | Definition, History, Vaccine, & Facts

# data[].attributes.attachment_link.description
Smallpox, infectious disease that begins with fever and headache and proceeds to an eruption of the skin that leaves pockmarks. For centuries smallpox was one of the world's most-dreaded diseases. But it was also one of the first diseases to be controlled by a vaccine, which led to its eradication in 1980.

# data[].attributes.body
Because of the ease and successfulness of the silk road, smallpox finds its way into Asia minor aka present-day Turkey on its way to Europe. -Justin

# data[].attributes.attachment_link.readable_text
Smallpox is believed to have first infected humans around the time of the earliest agricultural settlements some 12,000 years ago. No surviving evidence of it, however, predates the so-called New Kingdom of Egypt, which lasted from about 1570 B.C. to 1085 B.C.

A few mummies from that era contain familiar-looking skin lesions. Ramses V, for example, who ruled for roughly four years in the 12th century B.C., looks to have had the raised bumps on his face and body for which smallpox is named (it's derived from the Latin word for "spotted").

Moreover, an ancient Egyptian papyrus scroll briefly describes what could be smallpox, as do Hittite clay tablets. The Hittites, who lived in the Middle East, even accused the Egyptians of infecting them during a war between the two empires.

Many historians speculate that smallpox likewise brought about the devastating Plague of Athens in 430 B.C. and the Antonine Plague of A.D. 165 to 180, the later of which killed an estimated 3.5 million to 7 million people, including Emperor Marcus Aurelius, and hastened the decline of the Roman Empire.

At any rate, it reached Europe no later than the 6th century, when a bishop in France unmistakably described its symptoms-a violent fever followed by the appearance of pustules, which, if the patient survived, eventually scabbed over and broke off. By that time, the contagious disease, caused by the variola virus, had spread all across Africa and Asia as well, prompting some cultures to worship special smallpox deities.

In the Old World, the most common form of smallpox killed perhaps 30 percent of its victims while blinding and disfiguring many others. But the effects were even worse in the Americas, which had no exposure to the virus prior to the arrival of Spanish and Portuguese conquistadors.

Tearing through the Incas before Francisco Pizarro even got there, it made the empire unstable and ripe for conquest. It also devastated the Aztecs, killing, among others, the second-to-last of their rulers. In fact, historians believe that smallpox and other European diseases reduced the indigenous population of North and South America by up to 90 percent, a blow far greater than any defeat in battle.

Recognizing its potency as a biological weapon, Lord Jeffrey Amherst, the commander-in-chief of British forces in North America during the French and Indian War, even advocated handing out smallpox-infected blankets to his Native American foes in 1763.

Knowing that no one can contract smallpox twice, survivors of the disease were often called upon to try and nurse victims back to health. Throughout much of the last millennium, this involved herbal remedies, bloodletting and exposing them to red objects.

One prominent 17th-century English doctor realized that those who could afford care actually seemed to be dying at a higher rate than those who couldn't. Yet that didn't stop him from telling a smallpox-infected pupil to leave the windows open, to draw the bed sheets no higher than his waist and to drink profuse quantities of beer.

Far more effective was inoculation, also called variolation, which involved taking pus or powdered scabs from patients with a mild case of the disease and inserting them into the skin or nose of susceptible, healthy people. Ideally, the healthy people would suffer only a slight infection this way and, in so doing, would develop immunity to future outbreaks.

Some people did die, but at a much lower rate than those who contracted smallpox naturally. Practiced first in Asia and Africa, variolation spread to the Ottoman Empire around 1670 and then to the rest of Europe within a few decades. Its first proponent in the present-day United States was Cotton Mather, a Puritan minister best known for vigorously supporting the Salem witch trials. Benjamin Franklin, who lost a son to smallpox, was another early American supporter.

Variolation notwithstanding, smallpox continued wreaking havoc on princes and paupers alike. In the 17th and 18th centuries, it killed several reigning European monarchs, including Habsburg Emperor Joseph I, Queen Mary II of England, Czar Peter II of Russia and King Louis XV of France, as well as an Ethiopian king, a Chinese emperor and two Japanese emperors.

Queen Elizabeth I of England and U.S. President Abraham Lincoln also apparently contracted smallpox during their time in office, though they fortuitously lived to tell the tale. Meanwhile, in Europe alone, an estimated 400,000 commoners were succumbing to smallpox annually.

Finally, in 1796, English doctor Edward Jenner performed an experiment that would, in good time, cause the virus' downfall. By inserting pus from a milkmaid with cowpox, a disease closely related to smallpox, into the arms of a healthy 8-year-old boy and then variolating him to no effect, Jenner was able to conclude that a person could be protected from smallpox without having to be directly exposed to it. This was the world's first successful vaccine, a term that Jenner himself coined. He tried to get his results published by the prestigious Royal Society, only to be told not to "promulgate such a wild idea if he valued his reputation."

Persisting anyway, his vaccine gradually started catching on. The advantages over variolation were many. Unlike a variolated person, a vaccinated person could not spread smallpox to others. Moreover, the vaccine seldom left a rash and proved fatal in only the rarest of circumstances.

"Future generations will know by history only that the loathsome smallpox existed and by you has been extirpated," U.S. President Thomas Jefferson wrote to Jenner in 1806. The following year, Bavaria declared vaccination mandatory, and Denmark did the same in 1810.

Because the vaccine originally had to be transferred from arm to arm, its use spread slowly. It was also much less effective in tropical countries, where the heat caused it to quickly deteriorate. Nonetheless, one country after another managed to rid itself of the disease. The last reported U.S. case came in 1949.

Spurred by two new technological advances-a heat-stable, freeze-dried vaccine and the bifurcated needle-the World Health Organization then launched a global immunization campaign in 1967 with the goal of wiping out smallpox once and for all. That year, there were 10 million to 15 million cases of smallpox and 2 million deaths, according to WHO estimates. Yet just a decade later, the number was down to zero. No one has naturally contracted the virus since a Somali hospital worker in 1977 (though a laboratory accident in England did kill someone in 1978).

After searching far and wide for any remaining trace of smallpox, the WHO's member states passed a resolution on May 8, 1980, declaring it eradicated. "The world and all its peoples have won freedom from smallpox," the resolution stated, adding that this "unprecedented achievement in the history of public health ... demonstrated how nations working together in a common cause may further human progress."

Today, guarded laboratories in Atlanta and Moscow hold the only known stores of the virus. Some experts say these should be destroyed, whereas others believe they should be kept around for research purposes just in case smallpox somehow remerges.

# data[].attributes.attachment_link.description
Take a look back at the history of the pernicious disease.

# data[].attributes.body
The crusades provide ample opportunity for the smallpox virus to be exchanged between European Christians and the Middle East. -Justin

# data[].attributes.attachment_link.readable_text
Smallpox ranks among the most devastating illnesses ever suffered by humankind. It dramatically altered the course of human history, even contributing to the decline of civilizations. Officially the deadly virus no longer exists. After a final outbreak in the United States in 1949, the virus was declared eradicated in 1980 following a successful vaccination program regarded as one of the greatest triumphs of modern medicine.

Smallpox is an acute contagious disease caused by the variola virus. It gets its name from the Latin word for "spotted," referring to the raised, pustular bumps that break out over the face and body of those affected. Historically the virus killed around 30 percent of people who caught it. Those who survived were often left blind, sterile, and with deep pitted scars, or pockmarks, on the skin.

Spread through direct contact with infected people, body fluids, or contaminated objects such as bedding, the disease had two main types. Variola major was the most common form-and most lethal. Variola minor produced a milder disease, which was fatal in less than one percent of cases. Two other, rarer forms also existed: hemorrhagic and malignant. Both invariably resulted in death.

Early Victims

Smallpox is thought to have originated in India or Egypt at least 3,000 years ago. The earliest evidence for the disease comes from the Egyptian Pharaoh Ramses V, who died in 1157 B.C. His mummified remains show telltale pockmarks on his skin.

The disease later spread along trade routes in Asia, Africa, and Europe, eventually reaching the Americas in the 1500s. Indigenous peoples there had no natural immunity. An estimated 90 percent of indigenous casualties during European colonization were caused by disease rather than military conquest.

Smallpox contributed to the decline of the Aztec Empire, in what is now Mexico, following the virus's arrival with Spanish conquerors in 1519. More than three million Aztec succumbed to the disease. Severely weakened, the Aztec were easily defeated. Likewise, smallpox claimed the life of an Inca emperor and wiped out much of the Inca population in western South America.

In Europe, smallpox is estimated to have claimed 60 million lives in the 18th century alone. In the 20th century, it killed some 300 million people globally.

Vaccination Victory

The human fight against smallpox dates back some 2,000 years. In Asia, a technique known as variolation involved deliberately infecting a person by blowing dried smallpox scabs up their nose. Those who received this treatment contracted a mild form of the disease, developing a lifelong immunity.

A key breakthrough came in 1796 when an experiment by English doctor Edward Jenner showed that inoculation using closely related cowpox could protect against smallpox. Jenner's discovery paved the way for later vaccination programs-especially crucial since there is no effective treatment for smallpox.

In 1967, a year when some 10 million to 15 million people contracted smallpox, the World Health Organization launched a worldwide eradication campaign based on vaccination. Gradually, the disease was pushed back to the Horn of Africa, and the last known natural case occurred in Somalia in 1977.

Despite being consigned to the history books, there's still a chance of smallpox coming back to haunt us-as a biological weapon. Such fears escalated dramatically in the United States following the September 11, 2001, terrorist attacks. While the risk of such a bioterror attack is considered very low, the U.S. has since stockpiled enough of the vaccine to inoculate every citizen.

# data[].attributes.attachment_link.description
Smallpox ranks among the most devastating illnesses ever suffered by humankind. It dramatically altered the course of human history, even contributing to the decline of civilizations. Officially the deadly virus no longer exists. After a final outbreak in the United States in 1949, the virus was declared eradicated in 1980 following a successful vaccination program regarded as one of the greatest triumphs of modern medicine.

# data[].attributes.body
Variolation is intentionally infecting an uninfected individual with a disease to promote immunity. This was done by grinding up the scabs of infected individuals and blowing the bits into an uninfected individual's nose.

# data[].attributes.attachment_link.readable_text
Smallpox began causing illness and death more than a thousand years ago. Follow its spread and eventual eradication in the timeline below.

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.

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.

Page last reviewed:

# data[].attributes.attachment_link.description
Smallpox began causing illness and death more than a thousand years ago. Follow its spread and eventual eradication in the timeline below. 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.

# data[].attributes.body
Smallpox vastly contributed to the destruction of the Aztec empire, in what is now Mexico, following the virus's arrival with Spanish conquistadors. More than three million Aztec perished from the disease, and severely weakened, the empire was easily defeated.

# data[].attributes.attachment_link.readable_text
Smallpox ranks among the most devastating illnesses ever suffered by humankind. It dramatically altered the course of human history, even contributing to the decline of civilizations. Officially the deadly virus no longer exists. After a final outbreak in the United States in 1949, the virus was declared eradicated in 1980 following a successful vaccination program regarded as one of the greatest triumphs of modern medicine.

Smallpox is an acute contagious disease caused by the variola virus. It gets its name from the Latin word for "spotted," referring to the raised, pustular bumps that break out over the face and body of those affected. Historically the virus killed around 30 percent of people who caught it. Those who survived were often left blind, sterile, and with deep pitted scars, or pockmarks, on the skin.

Spread through direct contact with infected people, body fluids, or contaminated objects such as bedding, the disease had two main types. Variola major was the most common form-and most lethal. Variola minor produced a milder disease, which was fatal in less than one percent of cases. Two other, rarer forms also existed: hemorrhagic and malignant. Both invariably resulted in death.

Early Victims

Smallpox is thought to have originated in India or Egypt at least 3,000 years ago. The earliest evidence for the disease comes from the Egyptian Pharaoh Ramses V, who died in 1157 B.C. His mummified remains show telltale pockmarks on his skin.

The disease later spread along trade routes in Asia, Africa, and Europe, eventually reaching the Americas in the 1500s. Indigenous peoples there had no natural immunity. An estimated 90 percent of indigenous casualties during European colonization were caused by disease rather than military conquest.

Smallpox contributed to the decline of the Aztec Empire, in what is now Mexico, following the virus's arrival with Spanish conquerors in 1519. More than three million Aztec succumbed to the disease. Severely weakened, the Aztec were easily defeated. Likewise, smallpox claimed the life of an Inca emperor and wiped out much of the Inca population in western South America.

In Europe, smallpox is estimated to have claimed 60 million lives in the 18th century alone. In the 20th century, it killed some 300 million people globally.

Vaccination Victory

The human fight against smallpox dates back some 2,000 years. In Asia, a technique known as variolation involved deliberately infecting a person by blowing dried smallpox scabs up their nose. Those who received this treatment contracted a mild form of the disease, developing a lifelong immunity.

A key breakthrough came in 1796 when an experiment by English doctor Edward Jenner showed that inoculation using closely related cowpox could protect against smallpox. Jenner's discovery paved the way for later vaccination programs-especially crucial since there is no effective treatment for smallpox.

In 1967, a year when some 10 million to 15 million people contracted smallpox, the World Health Organization launched a worldwide eradication campaign based on vaccination. Gradually, the disease was pushed back to the Horn of Africa, and the last known natural case occurred in Somalia in 1977.

Despite being consigned to the history books, there's still a chance of smallpox coming back to haunt us-as a biological weapon. Such fears escalated dramatically in the United States following the September 11, 2001, terrorist attacks. While the risk of such a bioterror attack is considered very low, the U.S. has since stockpiled enough of the vaccine to inoculate every citizen.

# data[].attributes.attachment_link.description
Smallpox ranks among the most devastating illnesses ever suffered by humankind. It dramatically altered the course of human history, even contributing to the decline of civilizations. Officially the deadly virus no longer exists. After a final outbreak in the United States in 1949, the virus was declared eradicated in 1980 following a successful vaccination program regarded as one of the greatest triumphs of modern medicine.

# data[].attributes.body
European conquistadors spread Smallpox to native populations in the Americas. This disease effectively killed off large populations of Natives because they had no natural or artificial immunity.

# data[].attributes.attachment_link.readable_text
The story of vaccines did not begin with the first vaccine-Edward Jenner's use of material from cowpox pustules to provide protection against smallpox. Rather, it begins with the long history of infectious disease in humans, and in particular, with early uses of smallpox material to provide immunity to that disease.

Evidence exists that the Chinese employed smallpox inoculation (or variolation, as such use of smallpox material was called) as early as 1000 CE. It was practiced in Africa and Turkey as well, before it spread to Europe and the Americas.

Edward Jenner's innovations, begun with his successful 1796 use of cowpox material to create immunity to smallpox, quickly made the practice widespread. His method underwent medical and technological changes over the next 200 years, and eventually resulted in the eradication of smallpox.

Louis Pasteur's 1885 rabies vaccine was the next to make an impact on human disease. And then, at the dawn of bacteriology, developments rapidly followed. Antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague, typhoid, tuberculosis, and more were developed through the 1930s.

The middle of the 20 th century was an active time for vaccine research and development. Methods for growing viruses in the laboratory led to rapid discoveries and innovations, including the creation of vaccines for polio. Researchers targeted other common childhood diseases such as measles, mumps, and rubella, and vaccines for these diseases reduced the disease burden greatly.

Innovative techniques now drive vaccine research, with recombinant DNA technology and new delivery techniques leading scientists in new directions. Disease targets have expanded, and some vaccine research is beginning to focus on non-infectious conditions such as addiction and allergies.

More than the science behind vaccines, these timelines cover cultural aspects of vaccination as well, from the early harassment of smallpox variolators (see the intimidation of a prominent minister described in the 1721 Boston Smallpox Epidemic entry) to the establishment of vaccination mandates, to the effect of war and social unrest on vaccine-preventable diseases. Edward Jenner, Louis Pasteur, and Maurice Hilleman, pioneers in vaccine development receive particular attention as well.

This timeline category holds nearly all of the entries for the subject-specific timelines. A few of the entries have been left out in order to provide a broad overview.

# data[].attributes.attachment_link.description
The story of vaccines did not begin with the first vaccine-Edward Jenner's use of material from cowpox pustules to provide protection against smallpox. Rather, it begins with the long history of infectious disease in humans, and in particular, with early uses of smallpox material to provide immunity to that disease.

# data[].attributes.body
An epidemic in Boston took place and about 850 people died. Variolation was used, and only 3% of those variolated died compared to the 14% that were not variolated.

# data[].attributes.attachment_link.readable_text
The story of vaccines did not begin with the first vaccine-Edward Jenner's use of material from cowpox pustules to provide protection against smallpox. Rather, it begins with the long history of infectious disease in humans, and in particular, with early uses of smallpox material to provide immunity to that disease.

Evidence exists that the Chinese employed smallpox inoculation (or variolation, as such use of smallpox material was called) as early as 1000 CE. It was practiced in Africa and Turkey as well, before it spread to Europe and the Americas.

Edward Jenner's innovations, begun with his successful 1796 use of cowpox material to create immunity to smallpox, quickly made the practice widespread. His method underwent medical and technological changes over the next 200 years, and eventually resulted in the eradication of smallpox.

Louis Pasteur's 1885 rabies vaccine was the next to make an impact on human disease. And then, at the dawn of bacteriology, developments rapidly followed. Antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague, typhoid, tuberculosis, and more were developed through the 1930s.

The middle of the 20 th century was an active time for vaccine research and development. Methods for growing viruses in the laboratory led to rapid discoveries and innovations, including the creation of vaccines for polio. Researchers targeted other common childhood diseases such as measles, mumps, and rubella, and vaccines for these diseases reduced the disease burden greatly.

Innovative techniques now drive vaccine research, with recombinant DNA technology and new delivery techniques leading scientists in new directions. Disease targets have expanded, and some vaccine research is beginning to focus on non-infectious conditions such as addiction and allergies.

More than the science behind vaccines, these timelines cover cultural aspects of vaccination as well, from the early harassment of smallpox variolators (see the intimidation of a prominent minister described in the 1721 Boston Smallpox Epidemic entry) to the establishment of vaccination mandates, to the effect of war and social unrest on vaccine-preventable diseases. Edward Jenner, Louis Pasteur, and Maurice Hilleman, pioneers in vaccine development receive particular attention as well.

This timeline category holds nearly all of the entries for the subject-specific timelines. A few of the entries have been left out in order to provide a broad overview.

# data[].attributes.attachment_link.description
The story of vaccines did not begin with the first vaccine-Edward Jenner's use of material from cowpox pustules to provide protection against smallpox. Rather, it begins with the long history of infectious disease in humans, and in particular, with early uses of smallpox material to provide immunity to that disease.

# data[].attributes.body
A vaccination stimulates an individual's immune system to produce antigens that will fight of a specific pathogen. Vaccinations are different than variolation because vaccinated individuals will not become ill, but variolation will likely cause illness. Edward Jenner created the first successful smallpox vaccine by using the cowpox virus.

# data[].attributes.attachment_link.readable_text
The history of smallpox holds a unique place in medicine. It was one of the deadliest diseases known to humans, and to date (2016) the only human disease to have been eradicated by vaccination. The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed. He observed that milkmaids who previously had caught cowpox did not catch smallpox and showed that inoculated vaccinia protected against inoculated variola virus.

The global eradication effort initially used a strategy of mass vaccination campaigns to achieve 80% vaccine coverage in each country, and thereafter by case-finding, followed by ring vaccination of all known and possible contacts to seal off the outbreak from the rest of the population.

In 1961 the bifurcated needle was developed as a more efficient and cost effective alternative, and was the primary instrument used during the eradication campaign from 1966 to 1977. The bifurcated needle vaccination required only one-fourth the amount of vaccine needed with previous methods and was simpler to perform.

Different types of vaccine

Smallpox vaccines produced and successfully used during the intensified eradication program are called first generation vaccines in contrast to smallpox vaccines developed at the end of the eradication phase or thereafter and produced by modern cell culture techniques. Second generation smallpox vaccines use the same smallpox vaccine strains employed for manufacture of first generation vaccines or clonal virus variants plaque purified from traditional vaccine stocks, whereas third generation smallpox vaccines represent more attenuated vaccine strains specifically developed as safer vaccines at the end of the eradication phase by further passage in cell culture or animals. Second and third generation vaccines are produced using modern cell culture techniques and current standards of Good Manufacturing Practices (GMP).

The need for WHO to maintain an emergency reserve of smallpox vaccine following eradication was recognized in 1980 when WHO was given a set of formal responsibilities for maintaining capacity and expertise to respond to a re-emergence of smallpox in the post-eradication era as both a component of a preparedness strategy and a possible deterrent to intentional release. The Smallpox Vaccine Emergency Stockpile (SVES) was originally created by consolidating WHO Member State donations given in support of the Intensified Smallpox Eradication Programme.

In 2002, World Health Assembly (WHA) Resolution 55.16 urged Member States to share expertise, supplies and resources to rapidly contain a public health emergency or mitigate its effects. The resolution further requested the WHO Director General to examine the possible development of collaborative mechanisms to prepare and stockpile resources for a potential PHEIC. The SVES currently consists of two components:

A physical stockpile of vaccine held by WHO Headquarters in Switzerland, which is composed of calf-lymph smallpox vaccines from a variety of sources dating from the final years of the eradication program that are regularly tested for potency. It is estimated to consist of approximately 2.4 million doses when reconstituted and delivered by bifurcated needle.

A pledged stockpile held by Donor countries in their respective national stockpiles for use in time of international need upon request by WHO, which currently consists of 31.01 million doses of smallpox vaccine held by France, Germany, Japan, New Zealand, and the United States.

SAGE

Given the different set of vaccines available (1st generation vaccines used during the eradication campaign and made from the lymph or skin of inoculated animals, 2nd generation vaccines produced in tissue cells and further attenuated, and 3rd generation vaccines based on replicating or non-replicating virus) WHO needs to be able to make an informed decision on which vaccines to include in the stockpile for use in case of a re-emergence of smallpox. Therefore, Strategic Advisory Group of Experts on immunization (SAGE) was asked to respond to the following questions: Which vaccine should be recommended for use during an outbreak of smallpox and how many doses should be stockpiled? What groups should be targeted for vaccination if an outbreak occurs? Which groups should be vaccinated for preventive use and with which vaccine?

GACVS

The Global Advisory Committee on Vaccine Safety (GACVS) was requested to review the safety of smallpox vaccination. The Committee was provided with updated safety information for 1st, 2nd and 3rd generation smallpox vaccines in order to make informed decisions regarding emergency smallpox vaccine stockpiling and future use. The safety update also included an overview of the safety of smallpox vaccines used in the smallpox eradication efforts.

WHO Smallpox Vaccine Emergency Stockpile

This document describes the WHO Smallpox Vaccine Emergency Stockpile (SVES) and the considerations and processes needed for countries to request vaccine in the event of a smallpox outbreak.

Smallpox vaccine readings

# data[].attributes.attachment_link.description
The history of smallpox holds a unique place in medicine. It was one of the deadliest diseases known to humans, and to date (2016) the only human disease to have been eradicated by vaccination. The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed.

# data[].attributes.headline
Early 1900s: Effects of the Smallpox Vaccine

# data[].attributes.subject
Early 1900s: Effects of the Smallpox Vaccine

# data[].attributes.body
While North America and Europe are benefitting heavily from decreased smallpox rates due to inoculation, South America and Africa suffer great losses due to the disease. -Justin

# data[].attributes.attachment_link.description
Smallpox is an acute contagious disease caused by Variola virus, a member of the orthopoxvirus family. It was one of the world's most feared diseases until it was eradicated by a collaborative global vaccination programme led by WHO.

# data[].attributes.body
The bifurcated needle was used to give vaccinations of the smallpox virus. This instrument allowed for quick inoculation and required only a fraction of the vaccine to work.

# data[].attributes.attachment_link.readable_text
The history of smallpox holds a unique place in medicine. It was one of the deadliest diseases known to humans, and to date (2016) the only human disease to have been eradicated by vaccination. The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed. He observed that milkmaids who previously had caught cowpox did not catch smallpox and showed that inoculated vaccinia protected against inoculated variola virus.

The global eradication effort initially used a strategy of mass vaccination campaigns to achieve 80% vaccine coverage in each country, and thereafter by case-finding, followed by ring vaccination of all known and possible contacts to seal off the outbreak from the rest of the population.

In 1961 the bifurcated needle was developed as a more efficient and cost effective alternative, and was the primary instrument used during the eradication campaign from 1966 to 1977. The bifurcated needle vaccination required only one-fourth the amount of vaccine needed with previous methods and was simpler to perform.

Different types of vaccine

Smallpox vaccines produced and successfully used during the intensified eradication program are called first generation vaccines in contrast to smallpox vaccines developed at the end of the eradication phase or thereafter and produced by modern cell culture techniques. Second generation smallpox vaccines use the same smallpox vaccine strains employed for manufacture of first generation vaccines or clonal virus variants plaque purified from traditional vaccine stocks, whereas third generation smallpox vaccines represent more attenuated vaccine strains specifically developed as safer vaccines at the end of the eradication phase by further passage in cell culture or animals. Second and third generation vaccines are produced using modern cell culture techniques and current standards of Good Manufacturing Practices (GMP).

The need for WHO to maintain an emergency reserve of smallpox vaccine following eradication was recognized in 1980 when WHO was given a set of formal responsibilities for maintaining capacity and expertise to respond to a re-emergence of smallpox in the post-eradication era as both a component of a preparedness strategy and a possible deterrent to intentional release. The Smallpox Vaccine Emergency Stockpile (SVES) was originally created by consolidating WHO Member State donations given in support of the Intensified Smallpox Eradication Programme.

In 2002, World Health Assembly (WHA) Resolution 55.16 urged Member States to share expertise, supplies and resources to rapidly contain a public health emergency or mitigate its effects. The resolution further requested the WHO Director General to examine the possible development of collaborative mechanisms to prepare and stockpile resources for a potential PHEIC. The SVES currently consists of two components:

A physical stockpile of vaccine held by WHO Headquarters in Switzerland, which is composed of calf-lymph smallpox vaccines from a variety of sources dating from the final years of the eradication program that are regularly tested for potency. It is estimated to consist of approximately 2.4 million doses when reconstituted and delivered by bifurcated needle.

A pledged stockpile held by Donor countries in their respective national stockpiles for use in time of international need upon request by WHO, which currently consists of 31.01 million doses of smallpox vaccine held by France, Germany, Japan, New Zealand, and the United States.

SAGE

Given the different set of vaccines available (1st generation vaccines used during the eradication campaign and made from the lymph or skin of inoculated animals, 2nd generation vaccines produced in tissue cells and further attenuated, and 3rd generation vaccines based on replicating or non-replicating virus) WHO needs to be able to make an informed decision on which vaccines to include in the stockpile for use in case of a re-emergence of smallpox. Therefore, Strategic Advisory Group of Experts on immunization (SAGE) was asked to respond to the following questions: Which vaccine should be recommended for use during an outbreak of smallpox and how many doses should be stockpiled? What groups should be targeted for vaccination if an outbreak occurs? Which groups should be vaccinated for preventive use and with which vaccine?

GACVS

The Global Advisory Committee on Vaccine Safety (GACVS) was requested to review the safety of smallpox vaccination. The Committee was provided with updated safety information for 1st, 2nd and 3rd generation smallpox vaccines in order to make informed decisions regarding emergency smallpox vaccine stockpiling and future use. The safety update also included an overview of the safety of smallpox vaccines used in the smallpox eradication efforts.

WHO Smallpox Vaccine Emergency Stockpile

This document describes the WHO Smallpox Vaccine Emergency Stockpile (SVES) and the considerations and processes needed for countries to request vaccine in the event of a smallpox outbreak.

Smallpox vaccine readings

# data[].attributes.attachment_link.description
The history of smallpox holds a unique place in medicine. It was one of the deadliest diseases known to humans, and to date (2016) the only human disease to have been eradicated by vaccination. The smallpox vaccine, introduced by Edward Jenner in 1796, was the first successful vaccine to be developed.

# data[].attributes.body
The WHO pushed for eradication of smallpox by means of mass vaccinations and using a system of detection. This effort began as twelve countries were experiencing smallpox epidemics.

# data[].attributes.attachment_link.readable_text
The story of vaccines did not begin with the first vaccine-Edward Jenner's use of material from cowpox pustules to provide protection against smallpox. Rather, it begins with the long history of infectious disease in humans, and in particular, with early uses of smallpox material to provide immunity to that disease.

Evidence exists that the Chinese employed smallpox inoculation (or variolation, as such use of smallpox material was called) as early as 1000 CE. It was practiced in Africa and Turkey as well, before it spread to Europe and the Americas.

Edward Jenner's innovations, begun with his successful 1796 use of cowpox material to create immunity to smallpox, quickly made the practice widespread. His method underwent medical and technological changes over the next 200 years, and eventually resulted in the eradication of smallpox.

Louis Pasteur's 1885 rabies vaccine was the next to make an impact on human disease. And then, at the dawn of bacteriology, developments rapidly followed. Antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague, typhoid, tuberculosis, and more were developed through the 1930s.

The middle of the 20 th century was an active time for vaccine research and development. Methods for growing viruses in the laboratory led to rapid discoveries and innovations, including the creation of vaccines for polio. Researchers targeted other common childhood diseases such as measles, mumps, and rubella, and vaccines for these diseases reduced the disease burden greatly.

Innovative techniques now drive vaccine research, with recombinant DNA technology and new delivery techniques leading scientists in new directions. Disease targets have expanded, and some vaccine research is beginning to focus on non-infectious conditions such as addiction and allergies.

More than the science behind vaccines, these timelines cover cultural aspects of vaccination as well, from the early harassment of smallpox variolators (see the intimidation of a prominent minister described in the 1721 Boston Smallpox Epidemic entry) to the establishment of vaccination mandates, to the effect of war and social unrest on vaccine-preventable diseases. Edward Jenner, Louis Pasteur, and Maurice Hilleman, pioneers in vaccine development receive particular attention as well.

This timeline category holds nearly all of the entries for the subject-specific timelines. A few of the entries have been left out in order to provide a broad overview.

# data[].attributes.attachment_link.description
The story of vaccines did not begin with the first vaccine-Edward Jenner's use of material from cowpox pustules to provide protection against smallpox. Rather, it begins with the long history of infectious disease in humans, and in particular, with early uses of smallpox material to provide immunity to that disease.

# data[].attributes.body
The world health assembly states that smallpox has been eradicated from the planet. -Justin

# data[].attributes.attachment_link.readable_text
Smallpox began causing illness and death more than a thousand years ago. Follow its spread and eventual eradication in the timeline below.

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.

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.

Page last reviewed:

# data[].attributes.attachment_link.description
Smallpox began causing illness and death more than a thousand years ago. Follow its spread and eventual eradication in the timeline below. 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.