CBRNE - Smallpox Follow-up

Updated: Dec 16, 2014
  • Author: Christopher J Hogan, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
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Follow-up

Further Outpatient Care

Plastic surgery consultation may be necessary for skin disfiguration.

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Further Inpatient Care

Supportive care is the primary intervention for a clinically evident smallpox infection. This includes hydration therapy for fluid loss through fever and skin barrier breakdown. Antibiotics may be needed for secondary skin infections. Maintain respiratory and contact isolation for 17 days or until the scabs fall off.

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Inpatient & Outpatient Medications

No medications are required for smallpox other than those previously mentioned (see Medication).

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Transfer

Make any transfer with full respiratory and contact isolation.

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Deterrence/Prevention

In a variola outbreak, the high rate of spread can be reduced by identification of the disease (a high index of suspicion is needed) and rapid containment.

The most likely scenario of a variola outbreak is from a terrorist attack.

Given the highly infective nature of the organism (not taking into account a genetically altered virus), researchers estimate that 1 infected patient could infect as many as 20 new contacts during the infectious stage of the illness. However, based upon historical data, 5-6 close friends or family members was the norm.

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Complications

Complications associated with high morbidity and mortality rates that can be reduced are secondary skin infections and dehydration.

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Prognosis

Smallpox is one of the most communicable of infectious diseases. Studies have shown that approximately 30% of susceptible contacts became infected. Only measles and influenza have a consistently higher attack rate.

In general, variola has a mortality rate of 30% in the unvaccinated population.

Pregnant women have a heightened morbidity to variola. The morbidity rate is 27% in vaccinated patients and 61% in unvaccinated patients versus a nonpregnant control morbidity rate of 6% (vaccinated) and 35% (unvaccinated).

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Patient Education

See the list below:

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