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Diagnosis and Management of Smallpox

NCJ Number
New England Journal of Medicine Volume: 346 Issue: 17 Dated: April 25, 2002 Pages: 1300-1308
Joel G. Breman M.D.; D. A. Henderson M.D.
Date Published
April 2002
9 pages
This article presents information on the diagnosis and management of smallpox.
The last case of endemic smallpox occurred in 1977, and the eradication was declared in 1980. Variola virus, which causes smallpox, exists only in laboratories. There is concern that variola virus resides outside these laboratories and could be used as a weapon by terrorists. Variola virus belongs to the family Poxviridae. The incubation period for smallpox is 7 to 17 days. The first phase, which lasts for 2 or 3 days, is characterized by severe headache, backache, and fever, all beginning abruptly. The temperature rises and then subsides over a period of 2 to 3 days. The rash begins as small, reddish macules, which become papules within a period of 1 or 2 days. Lesions occur first on the face and extremities but gradually cover the body. Severe chickenpox is most frequently misdiagnosed as smallpox, especially in adults who have an extensive rash. A possible case of smallpox is a public health emergency and of utmost international concern. State health officials should be contacted immediately. After the patient has been isolated, interviews should be conducted to identify contacts. All health care providers should use airborne and contact precautions. Smallpox spreads primarily through respiratory-droplet nuclei, but infected clothing or bedding can also spread infection. A suspect case of smallpox should be managed in a negative-pressure room, and the patient should be vaccinated, particularly if the illness is in an early stage. If performed very early in the incubation period, vaccination may prevent clinical manifestations of smallpox. Full protection occurs after a successful vaccination. Guidelines from the Centers for Disease Control address the release of vaccine in the event of bioterrorism. Persons who have immunologic disorders or severe eczema and pregnant women should not receive vaccinia or be in close contact with recent recipients. 1 figure, 3 tables, 49 references