Smallpox

Signs and Symptoms

Indicators of smallpox begin acutely with malaise, fever, rigors, vomiting, headache, and backache. Two to three days later lesions appear which quickly progress from skin blotches to red bumps, and eventually to pus- filled blisters. They are more abundant on the extremities and face.

Diagnosis

Neither electron nor light microscopy are capable of discriminating variola from vaccinia, monkeypox or cowpox. The new PCR diagnostic techniques may be more accurate in discriminating between smallpox (variola) and other dangerous Orthopoxvirus, such as cowpox.

Treatment

At present there is no effective drug therapy for most developed cases of smallpox.

Preventative Measures

Federal health officials have put together guidelines for vaccinating within five days the entire U.S. population against smallpox in case of a bioterrorism attack.

Isolation and Decontamination

Droplet and Airborne Precautions for a minimum of 17 days following exposure for all contacts. Patients should be considered infectious until all scabs separate, and quarantined during this period.

In a civilian setting, strict quarantine of non-symptomatic contacts may prove to be impractical and impossible to enforce. A reasonable alternative would be to require contacts to check their temperatures daily.

Any fever above 38 C (101 F) during the 17-day period following exposure to a confirmed case would suggest the development of smallpox. The contact should then be isolated immediately, preferably at home, until smallpox is either confirmed or ruled out, and remain in isolation until all scabs separate.