Big things come in small poxages

On July 1st, employees at a laboratory on the National Institutes of Health Bethesda campus found vials of smallpox from the 1950s while preparing for the lab's relocation to the FDA's main campus. This laboratory had been transferred from NIH to FDA in 1972, and the FDA has operated laboratories located on the NIH campus since then. The vials themselves have since been secured in the CDC's high-containment facility in Atlanta, and are currently undergoing testing for viability. Upon completion, if the samples are viable, they will be destroyed and, as per protocol, the World Health Organization has been invited to witness. Currently, there are two WHO-designated repositories for smallpox, the CDC and the State Research Centre of Virology and Biotechnology in Novosibirsk, Russia. The CDC's Division of Select Agents and Toxins is investigating the history of how these samples were originally prepared and stored in the FDA laboratory.

Gutstein Methyl Violet stain of smallpox skin lesion.
Viral particles stain light to dark violet
Image courtesy of CDC

Smallpox is a highly contagious and sometimes fatal infectious disease that has no specific treatment, only a vaccination. There are two forms of the virus, variola major (the most severe and most common) and variola minor, both of which are only hosted in humans. Variola major is divided into four types, ordinary (the most common), modified (occurring in those previously vaccinated), flat, and hemorrhagic (both rare and very severe). Variola major has on average a fatality rate of about 30%, but the last two are usually fatal.

Smallpox vs. chickenpox
rash distribution
Image courtesy of CDC

Direct and prolonged face-to-face contact is required to spread smallpox, but can be spread through direct contact with infected body fluids or contaminated objects. Symptoms begin with an onset of fever, malaise, head, and body aches with occasional vomiting. Small red spots on the tongue and mouth then emerge, spreading to the face and the rest of the body and lastly to the feet. This rash then becomes raised bumps filled with a thick, opaque fluid with a depression in the center. The bumps then become pustules-sharply raised, round and firm, which then begin to scab and eventually fall off, leaving pitted scars. The duration of the entire disease may be several week, but the person is most contagious for the week following the rash outbreak.

The disease is now eradicated thanks to a worldwide vaccination program. The last case in the U.S. was in 1949 and the last one globally was in Somalia in 1977. Routine vaccination was discontinued after smallpox's eradication.