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Who is at Highest Risk for Getting Smallpox and Monkeypox?
The last known case of smallpox reportedly occurred in Somalia in 1977. In May 1980, smallpox was declared eradicated by the World Health Organization (WHO). There are two known smallpox virus stores remaining. One is located in the U.S. at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia and the other in a laboratory outside of Moscow, Russia. Some government health officials believe that secret smallpox stores exist and could someday be used for bioterrorism.1 Scientists who work in laboratories that contain the remaining smallpox stores are at highest risk for developing smallpox.2
An April 2018 published study examining the risk of smallpox reemergence concluded that persons between birth and 19 years were most at risk for developing smallpox if an outbreak were to occur. This conclusion was made due to the higher number of contacts that occur with others from those within this demographic.3
Monkeypox is generally found in the tropical rainforest regions of west and central Africa. Health officials believe that individuals who are at highest risk of developing monkeypox are those who come into direct contact with bodily fluids and blood, or the skin lesions and mucous membranes of infected animals. Persons who hunt, kill, and eat bushmeat in these regions are considered at highest risk of infection. Human to human transmission is believed to occur through respiratory secretions or by coming into contact with the skin lesions of an infected person. Contact may also occur if an individual touches items that have been recently contaminated by an infected individual. Transmission may also occur from mother to baby through the placenta, or during and after birth.4
Since May 2022, most cases of monkeypox outside of west and central Africa have occurred in men who have sex with other men.5
IMPORTANT NOTE: NVIC encourages you to become fully informed about smallpox and the smallpox vaccine by reading all sections in the Table of Contents, which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself. This information is for educational purposes only and is not intended as medical advice.
 Petersen BW, Harms TJ, Reynolds MG. et al. Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses — Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015. MMWR Mar. 18, 2016; 65(10): 257–262.
 MacIntyre C, Costantino V. Chen X. et al. Influence of Population Immunosuppression and Past Vaccination on Smallpox Reemergence. Emerg Infect Dis. Apr. 2018;24(4):646-653.