Snapshot You are an infectious disease fellow who has been designated to be part of a smallpox response team in response to a recent bioterrorism scare a month ago. As a precautionary measure, you are administered the smallpox vaccine. Introduction Classification virus DNA enveloped poxvirus variola Presentation Smallpox flu-like symptoms for 2-4 days rash begins in mouth, spreading to entire body as soon as 24 hours rash is synchronous i.e., all vesicles in same stage of development characteristics (smallpox vs chickenpox) synchronous lesions (vs asynchronous) deep lesions (vs superficial) centrifugal spread (vs centripetal) pox on face (vs pox on chest) Evaluation Clinical Laboratory confirmation Differential Chickenpox Treatment No known treatment 30% mortality survivors are scarred for life Prognosis, Prevention, and Complications Vaccine live, attenuated Eradicated 1977