In 1878, the midst of the drought, smallpox resurfaced in Ceará, where the thousands of desperate emigrants wedged in refugee camps posed a prime environment for the transmission of disease.[1] With an estimated 95% of Fortaleza's population lacking vaccination, over the next three months over 15,000 lives were claimed by smallpox.[66] Though smallpox was prevalent throughout Brazil prior to the Grande Seca, it is difficult to ascertain whether the disease would have reappeared so ferociously without the prone to disease, malnourished, condensed population of Ceará.