Smallpox vs Monkeypox: A list of must-know differences

Table of content:

• What is smallpox?

• What is monkeypox?

• History of Smallpox vaccination

• Why Smallpox vs Monkeypox?

• Similarities between Monkeypox vs Smallpox

• Smallpox vs Monkeypox

• Case fatality rate: Chickenpox vs Monkeypox and Smallpox vs Monkeypox

• Vaccination: Smallpox vs Monkeypox

• Therapeutics: Monkeypox vs Smallpox

• Global concern: Smallpox vs Monkeypox

• Smallpox vs Monkeypox: Recent database for early diagnosis of monkeypox

• 12 ways of rash relief in monkeypox

• FAQ on Smallpox vs Monkeypox

What is Smallpox?

Smallpox is a highly contagious disease caused by the Variola virus, a member of the  Orthopoxvirus. The disease appears as rashes which are diagnostic of the viral infection. World Health Organisation declared the eradication of smallpox in 1980.

What is monkeypox?

Monkeypox is a rare zoonotic infection caused by Orthopoxvirus. The viral infection was previously seen in Africa, but today it is spread to 96 countries.

History of Smallpox vaccination

In 1796, Edward Jenner created the smallpox vaccine. This was the first successful smallpox vaccine developed. The history behind this developed vaccine lies in the observation of milkmaids.

The milkmaids who caught cowpox previously did not catch smallpox. This indicated that smallpox could be prevented using a similar type of inoculation.

Why Smallpox vs Monkeypox?

Viruses of the Orthopoxvirus family cause smallpox and monkeypox. Smallpox spreads more rapidly than Monkeypox and is very contagious compared to Monkeypox. Smallpox has been eradicated, but today Monkeypox poses a challenge to healthcare as both conditions have similarities and make diagnosis challenging.

Symptoms of Monkeypox:

The symptoms of monkeypox are fever, chills, headache, muscle pain, back pain, low energy, swelling of lymph nodes and bumpy rash

Similarities between Monkeypox vs Smallpox

• The incubation period of both these viral diseases is the same, 7 to 17 days.

• The prodromal period is 1-4 days for both smallpox and monkeypox.

• The eruptive period is 14 to 28 days for both viral conditions.

• Malaise is moderate.

• Palmar-plantar lesions are present.

Source: CDC website

• The pattern of lesion distribution for both is centrifugal.

• The lesion appears homogenous and umbilicated in both conditions.

Image source: CDC website for smallpox

• Desquamation time is 14 to 21 days.

• Enanthema appear in the oral cavity in both smallpox and monkeypox.

Smallpox vs Monkeypox: Listing differences

Smallpox vs Monkeypox differences is listed below in the table. The table marks the most important clinical features which distinguish the two similar entities.

Rash relief: Monkeypox vs Smallpox

In monkeypox, the rash can be relieved by avoiding touching and scratching it. Hands must be thoroughly washed after touching the rashes. Oral histamines are topicals are very effective in rash care. 12 ways of rash relief in monkeypox are given below:

Compared to monkeypox, the most important rash care practice for smallpox, according to CDC is to cover the lesion so as to prevent the rash particles from becoming airborne.

Case fatality rate: Chickenpox vs Monkeypox and Smallpox vs Monkeypox

• West African clade of monkeypox has a 1 % case fatality rate.

• Congo basin or central African clade of monkeypox has a 10 % case fatality rate.

• Variola minor with a mortality rate of 1 %.

• Variola major with a mortality rate of 30 %

Vaccination: Smallpox vs Monkeypox

• Smallpox vaccines help protect against Monkeypox.

• Two vaccines are approved for the prevention of Monkeypox. They are MVA-BN and LC16.

Therapeutics: Monkeypox vs Smallpox

Tecovirimat is an antiviral agent licensed by European Medicines Agency for monkeypox in 2022. This antiviral was primarily developed for smallpox but is not yet widely available.

Global concern: Smallpox vs Monkeypox

Smallpox vaccination was protective and had a role in Monkeypox vaccination also, but people younger than 40 to 50 years are more susceptible to Monkeypox today because the smallpox vaccination has undergone cessation after the eradication of the disease.

Smallpox vs Monkeypox: Recent database for early diagnosis of monkeypox

A web-scraped Skin Image Database of Monkeypox, Chickenpox, Smallpox, Cowpox and Measles is prepared by researchers to develop machine learning and deep learning algorithm to gain authority in the early diagnosis of monkeypox. Though the case fatality rate with Monkeypox is low, early identification will aid in the isolation of the infected individuals and prevent community spread.

The database is available publicly and will be updated with the addition of new images.

References

World Health Organization (WHO)

Centers for Disease Control and Prevention