Post-Event
Operational Issues
Variola
Major: Clinical Types
There are several
clinical types of smallpox that are generally differentiated based
on the rash characteristics. The following are the different types
of smallpox:

- Ordinary
(classic) type, which is characterized by raised, pustular lesions.
Ordinary type smallpox can come in three different forms: Confluent
(confluent rash on face and forearms), Semi-Confluent (confluent
rash on face, discrete elsewhere) and Discrete (areas of normal
skin between pustules, even on face).
- Modified
type smallpox, which is like ordinary type but with an accelerated
and less severe course.
- Variola Sine
Eruptione is characterized by a fever without rash caused by
variola virus, serological confirmation required. This type of
smallpox occurs in vaccinated individuals that probably have
enough immunity to blunt the development of the full clinical
illness and is evident by a significant rise in neutralizing
antibody titer.
- Flat type
smallpox is characterized by pustules remain flat, usually confluent
or semi-confluent. It is one of the most severe clinical forms
and associated with a very high mortality rate.
- Hemorrhagic
type smallpox causes widespread hemorrhages in skin and mucous
membranes.
Hemorrhagic
smallpox can be either the Early form which produces a purpuric
rash, or Late form which causes hemorrhage into base of lesions.
This type of smallpox, either Early or Late form, is one of the
most severe clinical forms and associated with a very high mortality
rate.
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