CBRNE - Smallpox Treatment & Management

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

No prehospital care is indicated except to stabilize the patient. Strict blood, body fluid, and droplet protection are required for all personnel involved with treating or transporting patients with known or suspected smallpox. All EMS personnel exposed to the patient require quarantine and vaccination.


Emergency Department Care

In the emergency department (ED), containment of the disease is the single most important intervention in patients in whom variola infection is suggested. ED considerations are as follows:

  • Immediate contact and droplet isolation of the patient is required.
  • The patient and any individual who came into contact with the patient up to 17 days prior to the illness (including the treating physician and nursing staff) should remain in isolation until a definite diagnosis is made. Presently, this requires sending a viral culture to the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga.
  • Notify the local health authorities immediately.
  • 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 one infected patient can subsequently infect 20 new contacts during the infectious stage of the illness.
  • The presentation of a clinically apparent case implies that a larger population has probably been infected.
  • Because of the medicolegal and social implications of quarantine and isolation for a minimum of 17 days, coordinated involvement on the federal, state, and local levels is mandatory. In practicality, a strict quarantine of a large segment of the population is probably not possible.


Consult the infectious disease service early since it may help determine the diagnosis. As mentioned previously, contact the state, federal, and local public health authorities.