Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-C-1 – Smallpox

be treated with careful monitoring of oxygenation, fluids, blood pressure and diuretics as indicated. Patients who have a cough during the first 2 weeks of the infection are highly

contagious. Encephalitis

This complication occurs in about 1 out of every 500 cases of smallpox. The symptoms generally appear between the 6 th and 10 th day of illness when the rash is still in the papular or vesicular stage. Vaccination With the exception of the military and persons currently working with smallpox virus in a controlled setting, vaccination of the general public is not recommended in the absence of endemic disease. Because a single vaccination does not confer life-long immunity, persons previously vaccinated are no longer considered immune to the disease. Persons vaccinated multiple times may have some residual immunity. In the event that smallpox is intentionally released, federal, state and local health departments would coordinate vaccination programs. Vaccination is most effective if given before or within 3 - 4 days after the first exposure date. Some experts say that vaccination up to 7 days after the first exposure date may be effective in preventing or, at the vary least, ameliorating the disease. Unless assessed by a physician, vaccination is contraindicated for persons and their household, sexual or other close physical contacts if they have any of the following conditions: ? Current burns, impetigo, atopic dermatitis, contact dermatitis, varicella zoster or other skin conditions, ? Pregnancy (all trimesters), ? Current treatment for cancer (chemo/radiationtherapy), receiving large doses of corticosteroids; altered immune system, ? HIV infection or AIDS, ? Allergies to polymixin B, streptomycin, tetracycline, neomycin. Passive immunoprophylaxis with vaccinia immune-globulin (VIG) is available in a limited supply and is generally indicated for treatment of severe complications related to smallpox vaccination. The dose of VIG is 0.6 mL/kg of body weight given intramuscularly. Due to the large volume (42 ml in a 70 Kg person), the dose should be divided and give n over a period of 24 – 36 hours. Post-vaccination complications for which VIG may be indicated include: ? Current or past history or eczema,

Eczema vaccinatum;

?

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