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Figure 1. The last case of smallpox within a 20-nation area of west and central Africa was found in Nigeria on May 21, 1970. This event marked the success of a five-year program to eradicate smallpox from a large area in which it was endemic. The 27-year-old patient was the last victim in an epidemic of about 86 documented cases. She had been vaccinated about 10 days before these photographs were taken, as part of activities to control the outbreak after the discovery of smallpox in one other resident of her village a week previously.
These figures illustrate some classic features of smallpox: the patient appears weak or fatigued, the lesions have a peripheral distribution, there is facial edema, and the lesions are deep-seated, firm in appearance, and uniform in terms of stage of development (Panel A). The relatively small and variable size of the lesions on the left arm and the large pustule consistent with a successful primary vaccination (Panel B), as well as a relatively rapid course of illness (the photographs were taken on day 3 of the rash), suggest that this last case was modified (and almost prevented) by vaccination. This program's successful techniques were later used in the parts of the world where the disease was still endemic, ultimately leading to the complete cessation of natural transmission of smallpox in October 1977.
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