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Zncubation Period (Duration: 7 to 17 days) Not contagious Initial Symptoms (Prodrome) (Duration: 2 to 4 days) Sometimes contagious* Early Rash (Duration: about 4 days) Host contagious Rash distribution: Smallpox Disease ExpoS. are to the virus is followed by an incubation period during which people do nol~ave any symptoms and may feel fine. This incubation period averages about ~2 to :[4 days but can range from 7 to 17 days. During this time, people are not~ contaqious. The fi~t symptoms of smallpox include fever, malaise, head and body aches, and so~. etimes vomiting. The fever is usually high, in the range of 101 to 104 degree~ Fahrenheit. At this time, people are usually too sick to carry on their normal activities. This is called the prodrome phase and may last for 2 to 4 days.. A rash!emerges first as small red spots on the tongue and in the mouth. These ~pots develop into sores that break open and spread large amounts of the vi~_s into the mouth and throat. At this time, the person becomes most conta~ous. Aroun~the time the sores in the mouth break down, a rash appears on the skin, s~arting on the face and spreading to the arms and legs and then to the hands rand feet. Usually the rash spreads to all parts of the body within 24 hours, r~,s the rash appears, the fever usually falls and the person may start to feel better. By the'third day of the rash, the rash becomes raised bumps. By theifourth day, the bumps fill with a thick, opaque fluid and often have a depresillion in the center that looks like a bellybutton. (This is a major distinguishing characteristic of smallpox.) Pustular Rash (Duration: about 5 days) Contagious Pustules and Scabs (Duration: about 5 days) Contagious Resolving Scabs (Duration: about 6 days) Contagious Fever ¢~ten will rise again at this time and remain high until scabs form over the bumps. The bu',mps become pustules--sharply raised, usually round and firm to the touch ~s if there's a small round object under the skin. People often say the bumps~ feel like BB pellets embedded in the skin. The p~tules begin to form a crust and then scab. By thei~nd of the second week after the rash appears, most of the sores have scabbed over. The scrubs begin to fall off, leaving marks on the skin that eventually become pitted ~cars. Host scabs will have fallen off three weeks after the rash appeara. The person is contagious to others until all of the scabs have fallen off. Scabs resolved Scabs §ave fallen off. Person is no longer contagious. Not contagious ;- *Smallpox may be contagious ddring the prodrome phase, but is most infectious during the first 7 to 10 days following rash onset. For more information, visit www.cdc.aov/smallDox, or call the CDC public response hotline at (888) 246-2675 (~l~lnglish), (888) 246-2857 (Espafiol), or (866) 874-2646 (TTY) . December 9, 2002 DEPARTHiENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER,HEALTHIER, PEOPI. E"