Conjunctivitis and subclinical infection in smallpox

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Abstract
SUMMARY Attempts were made to demonstrate variola virus in the conjunctival exudate of 84 smallpox patients who developed conjunctivitis in the acute stage of the illness or during convalescence. Variola virus was isolated from 60 but not from the remaining 24. Of the 64 from whom virus was isolated the conjunctivitis developed from the onset up to the 15th day of illness. From conjunctivitis developing later virus was not recovered. In some patients who developed conjunctivitis early in the disease we failed to recover virus from the conjunctival exudate. Of 55 close family contacts who stayed in hospital with smallpox patients four developed smallpox. In 21, conjunctivitis but no other illness developed. From 12 of these, variola virus was recovered from the conjunctival exudate and four of these 12, who were further investigated, showed after the appearance of conjunctivitis antibody titres similar to those seen in typical smallpox cases. From nine of the contacts who developed conjunctivitis virus was not recovered. One of these had antibody titres in serum collected before the onset of conjunctivitis which indicated recent smallpox infection. In another there was a marked antibody rise during her hospital stay although examination of conjunctival exudate on three separate occasions failed to yield variola virus. Twenty-six family contacts who developed no illness in hospital had antibody determinations made on sera collected soon after admission to hospital. In eight of these antibody titres were such as to indicate recent smallpox infection although there were no signs, in the form of scarring, or history of recent smallpox infection. These findings have been discussed in relation to the occurrence of minimal and subclinical infection in close family contacts of smallpox patients. This investigation was supported in part by Public Health Service Grant AI–1632–16 VR from the National Institute of Allergy and Infectious Diseases, by the World Health Organization and by the Marcus T. Reynolds III Fund.