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. Author manuscript; available in PMC: 2015 Oct 28.
Published in final edited form as: Vaccine. 2013 Aug 27;31(45):5192–5201. doi: 10.1016/j.vaccine.2013.08.039

Table 2.

Disease course comparisons between human smallpox infection and surrogate models.

Disease stages (day of onset)
Incubation Prodrome Rash Resolution
Smallpox human exposure
dose and strain varies
“Respiratory Droplet”
[5961]
Day 0–9
(range 0–16)
Day 10–12
(range 7–17)
Day 12–15
(range 9–20)
Day 26–28
(range 24–37)
Asymptomatic Fever, headache, chills,
backache, vomiting
Maculopapularto papular within 1–2 days,
vesicular by day 4–5 and pustular by day 7 and
scabbed by day 14
Death (~30%) or
survival and
desquamation
Smallpox macaque 108 pfu
harper particle size <1µm
aerosol [62,63]
Day 0–5 Day 5–7 Day 7–8 (range 6–11) Day 10–11
Asymptomatic Malaise, fever, primary
bronchopneumonia
Centrifugal distribution papular to vesicular to
pustule (within 5 days)
Death (~1%) or survival
and desquamation
Monkeypox macaque
104–105 pfu zaire 79 particle
size = 1.2 µm aerosol [64]
Day 0–6 Absent Day 6–8 Day 11
Asymptomatic Primary bronchopneumonia, papular to
vesicular to scabbed (within 3–4 days),
hemorrhagic lesions
Death (100%)
Monkeypox macaque
3.4 × 106 pfu zaire 79 particle
size = 8 µm intratracheal
aerosol[65]
Day 0–3 Day 3–8 Day 8–10 Day 12–18
Asymptomatic Fever, malaise,
lymphadenopathy,
weight loss
Primary bronchopneumonia papular to
vesicular to pustular to scabbed (within 4–6
days), hemorrhagic lesions
Death (~30%) or
survival and
desquamation
Ectromelia mice(C57BL/6) 800 pfu
Moscow intranasal [6669]
Day 0–5 Absent Day 5–7 Day 9–11
Asymptomatic Death (~80%)
Monkeypox Mice(CAST/EiJ)
103 pfu MPXV-Z79-CB2
intranasal [70,71]
Day 0–6 Absent Day 6–8 Day 8–10
Asymptomatic No rash, weight loss, ruffling, hunching,
lethargy
Death (~60%) or
survival
Monkeypox ground squirrel
500–5000 pfu
MPXV-Z79-CB2 intranasal
[70,72,73]
Day 0–6 Absent Day 6 Day 6–9
Asymptomatic Lethargy, anorexia, frequent nosebleeds, and
terminal respiratory distress
Death (100%)
Monkeypox prairie dog
103–104 pfu MPXV-ROC-268
intranasal [7479]
Day 0–5 Day 5–7 Day 9–11 Day 12–17
Asymptomatic Weight loss,
inappetence
Maculopapularto papular within 1–2 days,
vesicular by day 3–4 and pustular by day 4–7
and scabbed by day 9–11
Death (~30–50%)or
survival and
desquamation