Mpox vs. Smallpox: 7 Key Differences You Need to Understand

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Discover the 7 key differences between mpox and smallpox, two Orthopoxviruses with distinct impacts on global health. Learn about their transmission, symptoms, mortality rates, and more in this comprehensive guide for 2024.

Both smallpox and mpox are viral infections that have at various times in history attracted interest from around the world. Despite certain commonalities, such as their classification as orthopoxviruses, they differ significantly in important ways. Comprehending these distinctions is essential for efficacious public health interventions, clinical supervision, and individual consciousness. Here are seven important distinctions between smallpox and mpox that you should be aware of.

1. Causative Agent

– Smallpox : The Orthopoxvirus genus includes the Variola virus, which causes smallpox. There are two main strains of the Variola virus: Variola minor, which is less severe, and Variola major, which is more severe and lethal..

– Mpox: Another member of the Orthopoxvirus genus, the monkeypox virus, is the cause of mpox, also referred to as monkeypox. The monkeypox virus is divided into two clades: the less severe West African clade and the more severe Central African (Congo Basin) clade.

Key Point : While both diseases are caused by Orthopoxviruses, they are different viruses with distinct epidemiological characteristics.

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2. Historical Impact and Current Status

– Smallpox : Smallpox, especially in its Variola major form, was a deadly disease that caused great suffering. Over centuries, it was the cause of millions of deaths. On the other hand, smallpox was officially declared extinct in 1980 as a result of an effective worldwide immunization drive spearheaded by the World Health Organization (WHO).

– Mpox : Compared to smallpox, mpox has not had the same extensive impact. With occasional outbreaks in other parts of the world, it mainly affects regions in Central and West Africa. In contrast to smallpox, which has been eradicated, mpox remains a public health concern, especially in regions where the virus is prevalent.

Key Point : Smallpox is a historical disease with no current cases, whereas mpox remains an active public health issue in certain regions.

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3. Transmission

– Smallpox : In intimate, face-to-face contact with an infected individual, respiratory droplets are the main way that smallpox is transmitted. Additionally, it can spread by coming into contact with contaminated clothing or bedding. Particularly when the rash was still in its early stages, the virus was extremely infectious.

– Mpox : Direct contact with an infected human or animal’s body fluids, skin lesions, or respiratory droplets can result in the spread of mpox. Additionally, coming into contact with contaminated materials can spread it. Mumps is less contagious than smallpox and usually spreads through closer, longer contact.

Key Point : Mpox has a lower transmission rate compared to smallpox, with different modes of transmission that often require direct contact with infected individuals or animals.

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4. Symptoms and Disease Progression

– Smallpox : Smallpox symptoms include high fever, exhaustion, headache, and back discomfort. A rash that starts on the face and spreads to the extremities is the typical smallpox symptom. From macules to papules, vesicles and pustules, and finally scabs, the rash developed. Smallpox progressed predictably and had a more severe course of the illness.

– Mpox : Along with a rash that frequently begins on the face and moves to other parts of the body, such as the palms and soles, mpox symptoms also include fever, headache, muscular aches, and other symptoms. While more confined in nature, smallpox and mpox lesions are comparable. Smallpox rarely exhibits lymphadenopathy, or enlarged lymph nodes, which is a characteristic of mpox.

Key Point : Both diseases cause rashes, but mpox often presents with swollen lymph nodes and a more localized rash, whereas smallpox had a more severe and widespread rash without lymphadenopathy.

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5. Mortality Rate

– Smallpox : Depending on the strain, smallpox mortality rates differed. Variola major was an extremely deadly disease, with a death rate of roughly 30%. Variola minor usually has a mortality rate of about 1%.

– Mpox : Compared to smallpox, mpox has a substantially lower death rate. The monkeypox virus’s West African clade has a fatality rate of less than 1%, while the Central African clade has a mortality rate of over 10%.

Key Point : Smallpox had a much higher mortality rate than mpox, with the potential to kill a significant proportion of those infected.

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6. Vaccine Development and Availability

– Smallpox : The first vaccination to be developed successfully was the smallpox vaccine, which was created by Edward Jenner in 1796 using the cowpox virus. The smallpox epidemic was eradicated worldwide in large part thanks to this vaccination. Since smallpox has been eradicated, vaccinations against it are no longer regularly given.

– Mpox : Modified smallpox vaccines, including JYNNEOS (also known as Imvamune or Imvanex), are the basis for mpox vaccines. Currently, those who are more susceptible to contracting mpox, such as healthcare personnel and residents of areas where the disease is endemic, are administered these vaccinations.

Key Point : The development of smallpox vaccines led to the eradication of the disease, while mpox vaccines are adaptations of these vaccines, used primarily for at-risk populations.

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7. Global Public Health Response

– Smallpox : Throughout history, one of the most effective public health initiatives has been the worldwide response to smallpox. Launched in 1967, the World Health Organization’s Intensified Smallpox Eradication Programme resulted in the last smallpox case occurring naturally in 1977, with the disease being declared eradicated in 1980.

– Mpox : The response to mpox has been more localized, with efforts focused on surveillance, containment, and vaccination in regions where the virus is endemic. International attention to mpox has increased in recent years due to outbreaks outside Africa, prompting a more coordinated global response.

Key Point : Smallpox was eradicated through a concerted global effort, while mpox remains a public health challenge that requires ongoing attention, particularly in endemic regions.

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Conclusion

Critical distinctions between smallpox and mpox are highlighted in the comparison, with important ramifications for medical therapy, public health, and worldwide awareness. Through an unparalleled worldwide vaccination campaign, smallpox—once one of the deadliest illnesses in human history—was eradicated, demonstrating the strength of teamwork in defeating even the most difficult health threats. On the other hand, mpox continues to pose a chronic threat, especially in areas where the virus is endemic.

Although both diseases are related to the Orthopoxvirus genus, their effects and the approaches needed to treat them are different, as seen by the variations in their modes of transmission, degrees of disease severity, and death rates. Compared to smallpox, which is already eradicated, mpox presents a distinct kind of threat due to its lower death rate and less effective spread. Nonetheless, a strong basis for managing and possibly even eradicating mpox is provided by the availability of vaccinations and the knowledge acquired from the eradication of smallpox.

As global health continues to evolve, understanding these differences is crucial for developing effective public health policies, educating the public, and fostering international cooperation. By learning from the past and applying that knowledge to current and future challenges, we can better protect populations from the threats posed by diseases like mpox, ensuring a healthier and safer world for all.

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FAQs with Answers

1. What is the primary difference between mpox and smallpox?
Mpox is caused by the Monkeypox virus, while smallpox was caused by the Variola virus. Although both are Orthopoxviruses, they differ in severity, transmission, and global impact.

2. Are mpox and smallpox equally contagious?
No, smallpox was more contagious than mpox, spreading mainly through respiratory droplets. Mpox requires closer, prolonged contact with an infected person or animal.

3. Can mpox be as deadly as smallpox?
No, mpox generally has a lower mortality rate compared to smallpox. The Central African clade of the Monkeypox virus has a mortality rate of around 10%, while smallpox had a mortality rate of about 30% for Variola major.

4. How do the symptoms of mpox and smallpox differ?
Both diseases cause rashes, but mpox often includes swollen lymph nodes (lymphadenopathy), which is not typical in smallpox. Smallpox had a more severe and widespread rash.

5. Is there a vaccine for mpox?
Yes, vaccines like JYNNEOS, originally developed for smallpox, are used to protect against mpox, particularly for at-risk populations.

6. Why was smallpox eradicated, but mpox is not?
Smallpox was eradicated through a global vaccination campaign, whereas mpox continues to exist due to its zoonotic nature and the lack of a similarly coordinated global eradication effort.

7. Can smallpox come back?
Smallpox is considered eradicated, and there are no natural cases. However, concerns remain about potential use as a bioterrorism agent.

8. How does the rash in mpox differ from smallpox?
Mpox rashes often start on the face and spread to other parts of the body, including palms and soles. In contrast, smallpox rashes were more widespread and severe.

9. Where is mpox most commonly found?
Mpox is most commonly found in Central and West Africa, with occasional outbreaks in other regions due to travel or contact with infected animals.

10. What measures are taken to control mpox outbreaks?
Control measures include surveillance, isolation of cases, vaccination of at-risk individuals, and public health education.

11. Can animals spread mpox?
Yes, mpox can be transmitted from animals to humans, particularly through direct contact with infected animals or their bodily fluids.

12. Was there a similar global effort to eradicate mpox as there was for smallpox?
No, the global effort to eradicate smallpox was unique and highly coordinated, while efforts to control mpox are more localized and focused on endemic regions.

13. Is the smallpox vaccine effective against mpox?
Yes, the smallpox vaccine provides some cross-protection against mpox due to the similarity between the viruses.

14. Are there any long-term effects of surviving mpox?
Survivors of mpox may experience scarring from the rash, but long-term effects are generally less severe than those from smallpox, which could cause blindness and other complications.

15. How do public health responses to mpox differ from those to smallpox?
Public health responses to mpox focus on containment, vaccination, and education in endemic regions, while the smallpox response was a global eradication effort.

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