What are the Symptoms of Smallpox?

Updated at: May 01, 2012
What are the Symptoms of Smallpox?

Smallpox Signs and Symptoms - Initial symptoms of smallpox include fever (101 to 104 degrees Fahrenheit), head and body aches, and generally feeling very sick. Rashes occur a few days later.

Dr Poonam Sachdev
Communicable DiseasesWritten by: Dr Poonam SachdevPublished at: Aug 10, 2011

The first symptoms of smallpox after infection with the virus usually occur after 12 to 14 days (the usual duration of incubation period). During the incubation period (which can range from seven to 17 days) the person appears and feels healthy and cannot infect others.


Symptoms of Smallpox


After the incubation period, the person suddenly develops flu-like signs and symptoms which include:

  • Fever.
  • Malaise, tiredness and discomfort.
  • Headache.
  • Severe fatigue or tiredness (prostration).
  • Severe body and back pain.
  • Vomiting and/or diarrhoea.

Smallpox rash develops a few days later. The rash characteristically appears as flat, red spots (lesions)of which many become small blisters filled with clear fluid (vesicles) and later, with pus (pustules) in a day or two. The rashes appear initially on the face, hands and forearms, and then spread to the trunk. It is initially most noticeable on the palms of the hands and the soles of the feet. Lesions can involve the mucous membranes of your nose and mouth as well.

After the pustules develop, the pain can be excruciating. After eight to nine days, scab begins to form, which falls off and leaves deep pitted scars. Unlike chickenpox in which rashes occur in crops, in smallpox all the lesions present in a specific area progress at the same rate through the different stages.

If a person does not recover, death usually occurs during the second week of illness.
Smallpox vs. Chickenpox: In the past, smallpox was often confused with chickenpox which is another viral illness with rashes.  However, there are many important differences between chickenpox and smallpox:


  • Severity and location of lesions: Skin lesions of chickenpox are much more superficial as compared to smallpox and occur more on the trunk, than on the face, arms and hands.
  • Types of lesions: Lesions of all stages (scabs, vesicles and pustules) are present in a person with chickenpox in a given area unlike smallpox, in which all the lesions in a given area happen at the same stage.
  • Timing of transmission: A person infected with chickenpox becomes infective even before the symptoms develop, whereas a person with smallpox becomes infectious only when signs and symptoms appear. People with chickenpox remain contagious until scabs fall of from the pustules. Smallpox is most contagious in its initial stages (that is after the fever develops and during the first week of the rash).


Read more articles on Smallpox Signs and Symptoms




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