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May stop additional isolation when:
All lesions have crusted over
Symptoms
Acute with malaise, fever, rigors, vomiting, head ache, and backache.
2 –3 days later macules appear and then papuler and then pustular
vesicles. Vesicles will develop at the same time and are more
abundant on the extremities and face.
Comments:
The Orthomyxovirus Variola virus is now officially only in designated
freezers in the US and Russia, although there is concern that the
virus may be used as an agent of bioterrorism. The last reported case
of smallpox occurred in October 1977 in Somalia. It is the only
infectious disease as of yet to be eradicated by a vaccination
effort. Disease was caused by two strains, Variola minor (alastrim)
with a case fatality of 1% and Variola major (ordinary) with a
case fatality of 20-40%.
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Incubation Period
7-19 days, commonly 10-14 days
Period of Communicability
From development of lesions to the resolution of all scabs, about 3
weeks. *Note: as a bioterrorism agent, aerosolized.
Cohort (Inf. with Inf./Exp. with Exp./Non-Exp. with Non-Exp.)
Yes, both healthcare workers and patients
Transport Issues
Use HEPA filters, Healthcare workers should wear
respiratory protection (PAPR/N-95), gowns, and gloves.
Healthcare workers should be vaccinated to transport personnel with
suspected small pox.
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Who’s susceptible
General. Vaccination produces protective immunity. Vaccination
ended in the US and there is concern that few US residents have
sufficient protective immunity
Who’s exposed
Highly communicable agent. Expect exposure for anyone with contact
with infected patients, including persons in close proximity.
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Exclusion of symptomatic personnel from duty
Yes, until fit to work and all lesions have resolved
Exclusion of exposed susceptible personnel from duty
Yes, until about 20 days after exposure unless vaccinated within 4 days
Isolation of exposed susceptible asymptomatic patients
Yes, needs cohorting
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Prophylaxis for exposed
Vaccination in coordination with state and federal authorities should
be instituted immediately. Vaccine can be given up to 96 hours
after exposure and prevent disease. Vaccinia immune globulin can
be given if available.
Treatment for ill
Cidofivir (effective in vitro)
Military/Institutional Populations Special Issues
Special precautions should be followed if smallpox dissemination is likely
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