Background
*highly contagious
*caused by the DNA virus variola.
*last known natural case of smallpox occurred in 1977 in Somalia
*spread most efficiently in droplets or aerosols from the oropharynx of infected individuals.
*also can be spread by direct contact with infected lesions or with clothing or bed linens contaminated with the virus.

Back to Top of Page

Course
*After an incubation period of 7 to 17 days (mean 12 days) the period of infectivity begins as an exanthema and a rash characterized by maculae progressing to papules, vesicles, and pustules all in the same stage, developing first on the face and extremities.
*Patients remain contagious until the scabs have been shed.

Back to Top of Page

Patient Care
*If a suspect case of smallpox appears, isolate the patient with Airborne and Contact precautions, contact Infection Control (6-1638), and record names and contact information of those exposed.
*Patients with vaccinia skin lesions should also be placed on Contact and Airborne precautions in order to prevent person-to-person transmission.
*proper use of personal protective equipment (PPE-gloves, gowns, mask) is sufficient to provide protection against the acquisition of smallpox or vaccinia.
*Immunization would provide protection for persons exposed prior to placing patients on precautions

Back to Top of Page

Vaccine (DryVax)
*Presidential declaration: smallpox vaccination should be offered to the military, health care teams and eventually to the general public.
*uses the vaccinia virus to elicit immunity to smallpox and similar poxviruses.
*produces immunity in only 7-10 days in persons never vaccinated.
*Immunity is boosted in fewer days in persons with past immunization

Contraindications to vaccine (in HCW, close contact, or household member)
*Eczema or atopic dermatitis (even if the condition is not currently active, mild or experienced as a child)
*Skin conditions such as burns, chickenpox, shingles, impetigo, herpes, severe acne, or psoriasis (postpone until skin condition resolves).
*Weakened immune system (cancer chemotherapy, an organ transplant, HIV, or medications to treat autoimmune disorders and other illnesses that can weaken the immune system).
*Pregnancy or plans to become pregnant within one month of vaccination.

Contraindications to vaccine (in HCW only).
*Allergy to the vaccine or any of its ingredients.
*Moderate or severe short-term illness (postpone until illness resolves).
*Currently breastfeeding

Back to Top of Page