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Small Pox                                                                          Detail see Small Pox  

KEY SUMMARY POINTS

Epidemiology:

• Highly infectious after aerosolization
• Person-to-person transmission occurs
• About 30% of susceptible contacts will become infected

Clinical:

• Incubation period is 12-14 days (ranges 7-17 days)
• Characteristic rash appears 2-3 days after nonspecific, flu-like prodrome (fever and headache)
• Maculopapular rash begins on face, hands, forearms and spreads to legs and centrally to trunk;
• Lesions are more predominant on the extremities than the trunk.
• Lesions progress synchronously from macules to papules to vesicles to pustules to crusty scabs

Diagnosis:

• Vesicular fluid is obtained by opening lesions with a scalpel and harvesting fluid on a clean microscopic slide; scabs can be removed by forceps
• Specimens from index cases will be examined at a national reference laboratory by PCR and/or RFLP, and confirmed by cell culture

Treatment:

• Supportive care is the mainstay of therapy
• In-vitro antiviral activity against poxviruses has been shown with adefovir, cidofovir, dipivoxil, and ribavirin. (Animal studies suggest that cidofovir may be most effective.)

Prophylaxis:

• Smallpox vaccine would be required for all persons exposed at the time of the bioterrorist attack or anyone with close personal contact with a smallpox case
• Vaccine is most effective if given before or within 3 days of exposure
• Ideally, all exposed persons should be placed in strict quarantine for 17 days after last contact with a smallpox case

Patient Isolation:

Strict isolation from the onset of the rash until all scabs separate

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