APFN
WHAT YOU NEED TO KNOW ABOUT SMALLPOX
Sat Dec 7 17:45:40 2002
208.152.73.1

WHAT YOU NEED TO KNOW ABOUT SMALLPOX
http://www.citizenspokane.net/smallpoxinfo.htm

Transmission

The smallpox virus can live only in humans — not in animals or insects. Smallpox was spread from person to person, generally through close contact with an infected person. Generally, someone had to be within six feet of an infected person for a prolonged period of time to catch the disease. People who had smallpox could not pass the disease on to others until they began to show symptoms, themselves.

Incubation period

When people were exposed to the virus, they did not have any symptoms for about 12 to 14 days. During this "incubation period," which could range from 7 to 17 days, they felt fine and could not infect others.

Symptoms

Pre-rash
The first symptoms were much like the flu: sudden onset of fever, tiredness, severe back pain, and sometimes stomach pain and vomiting. This lasted 2 to 3 days, and at this time the people became highly contagious to others.


Rash
As the fever began to drop and the people began to feel better, a rash developed in the nose and mouth. The rash became bumps that spread to the face, hands, and forearms, and then spread to the trunk and legs. The bumps were even found on the palms of the hands and on the soles of the feet. All of the bumps evolved at the same rate, and were most dense on the face and extremities.

The following chart shows the progression of the disease after the rash began.

Days 1-4

Two to four days after the fever began a rash appeared as small red spots on the tongue and in the mouth. These developed into sores that broke open and spread large amounts of the virus into the mouth and throat. At this time, the person was the most highly contagious.

Within 24 hours the rash spread to skin in the form of small bumps. These bumps started on the face, arms, and legs and quickly spread to the trunk, hands, and feet.

By the 3rd day, the bumps filled with a thick, opaque fluid and often had a depression in the center.

Over the next five to ten days the bumps became sharply raised, round, and firm. They had the feel of a small round object under the skin. The person’s fever usually increased and remained high until scabs formed over the bumps.

Days 11-14

The person’s fever began to drop, but the fever usually remained until all of the scabs had formed
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Eurosurveillance Weekly 2002; 6: 5 December [edited]



Interim guidelines for smallpox response and management published in the
United Kingdom
-------------------------------------------------
On 2 Dec 2002, the Department of Health in England published guidelines for
responding to a deliberate release of smallpox (1,2). The guidelines, which
are for discussion over the next month, describe vaccination strategies
prior to and in the event of an outbreak, procedures for diagnosis and
management of the initial cases, and other essential outbreak preparedness
and control measures.

The level of threat of a deliberate release is unknown but is likely to be
extremely low. While smallpox remains eradicated, the risks from adverse
effects of vaccination outweigh the risks from disease. Experience in the
United States in the late 1960s found that among people aged over 20 years
who were being vaccinated for the first time severe adverse vaccine related
events occurred at a rate of around 1500 per million people vaccinated,
with about one death per million people vaccinated (3).

The number of people to be vaccinated will therefore be limited to a few
hundred specialist health care workers who would be required to assess and
manage any initial cases. In the event of a heightened threat, for example
if smallpox re-emerges elsewhere in the world, a greater number of health
care, emergency, and other essential personnel will be offered vaccination
in case they are required to respond to a smallpox emergency in the United
Kingdom (UK).

Rapid diagnosis and response to the first cases is essential to limit the
size of any outbreak. To help familiarise clinicians with the symptoms and
signs of smallpox, a diagnostic algorithm is to be distributed:
.

A network of teams of vaccinated workers including infectious disease (ID)
physicians will be available to visit and assess cases of suspicious
illness. If smallpox is suspected, these emergency diagnosis and response
teams will be called out to initiate laboratory investigation and further
management of the patient. Regional directors of public health in England
have been given responsibility for establishing networks of ID physicians
and emergency teams. Members will be identified and then vaccinated, and it
is hoped that this can be completed by the end of January 2003.

In the event of an outbreak, a search and containment strategy will be
deployed, with rapid isolation of cases and tracing, vaccination, and
monitoring of contacts. To prepare for this all regions have been asked to
identify smallpox care centres and smallpox vaccination centres that could
be opened within 24 hours to provide isolation for cases and vaccination
for contacts. Search and containment measures will focus on close contacts
of smallpox patients, since they are most at risk from infection.

References:
1. Department of Health. Interim guidelines for smallpox response and
management in the post-eradication era. London: Department of Health, 2002.

2. Health workers to be vaccinated against smallpox. 10 Downing Street
website.
3. Advisory Committee on Immunization Practices. Vaccinia (smallpox)
vaccine. Recommendations of the Advisory Committee on Immunization
Practices (ACIP), 2001. Atlanta, US: CDC, 2001.


Reported by Richard Harling (rharling@phls.org.uk), Public Health
Laboratory Service Communicable Disease Surveillance Centre, London, England.

-- ProMED-mail [The UK is currently undergoing a process similar to those ongoing in the USA, Canada, and Israel -- the development of a smallpox vaccination strategy in the event of an intentional release of smallpox virus. ProMED-mail has covered the USA smallpox vaccination strategy development in great detail (see references below). One can argue that the use of the old vaccinia preparations (NYBOH [New York Board of Health]and Lister strains) in current times would classify as a "re-emerging" infectious disease -- we really do not know whether the reported side effect rates from the 60s and 70s still apply, given the higher numbers of immune-compromised individuals in the general population, and we don't know much about long term immunity and supposed safety of revaccination. The interim plan for the UK smallpox strategy can be found at . Page 39 of this interim smallpox plan specifically mentions: "Smallpox vaccination carries a risk of complications, which occurred at a higher frequency than that now acceptable for a modern vaccine. These complications occurred more frequently in people who were immunosuppressed, people with eczema, and pregnant women. Because of this, mass vaccination of the population is not a first-line option either prior to or in the event of an outbreak." The interim response plan is well thought out. Several of the newswire reports that surrounded the public release of this interim smallpox plan focused on the possibility of increased public demand for the vaccine that might lead to greater availability of the vaccine in the general population. One hopes that sound public health recommendations will not be compromised by popular demand. - Mod.MPP] [see also: Smallpox vaccination strategies - USA (08) 20021112.5785 Smallpox vaccination strategies - USA (07) 20021018.5591 Smallpox vaccination hazards (03) 20021017.5571 Smallpox vaccine hazards (02) 20021015.5559 Smallpox vaccination strategies - USA (06) 20021006.5479 Smallpox vaccination strategies - USA (05) 20020924.5390 Smallpox vaccination strategies - USA (04) 20020923.5383 Smallpox vaccination strategies - USA (03) 20020915.5312 Smallpox vaccination strategy - Israel 20020820.5095 Smallpox vaccine hazards 20020817.5080 Smallpox vaccine, criticism of choice - UK 20020730.4892 Smallpox vaccination strategies - USA (02) 20020726.4868 Smallpox containment strategies - USA 20020711.4725 Smallpox vaccination (02) 20020710.4715 Smallpox vaccination strategies - USA 20020709.4710 Smallpox vaccine, ACIP recommendations - USA (02) 20020621.4560 Smallpox vaccine, ACIP recommendations - USA 20020620.4542 Smallpox vaccination 20020611.4468] ..........................mpp/sh/mpp/pg/sh  *##########################################################* * * * Please support the 2002 ProMED-mail Internet-a-thon! * * http://www.isid.org/netathon2002.shtml  * * * ************************************************************ ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the information, and of any statements or opinions based thereon, are not guaranteed. The reader assumes all risks in using information posted or archived by ProMED-mail. ISID and its associated service providers shall not be held responsible for errors or omissions or held liable for any damages incurred as a result of use or reliance upon posted or archived material. ************************************************************ Visit ProMED-mail's web site at . Send all items for posting to: promed@promedmail.org  (NOT to an individual moderator). If you do not give your full name and affiliation, it may not be posted. Send commands to subscribe/unsubscribe, get archives, help, etc. to: majordomo@promedmail.org . For assistance from a human being send mail to: owner-majordomo@promedmail.org . ############################################################