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Home , Smallpox

: 6/06

General Information Specimen Collection Procedures ONLY vaccinated individuals should perform .Direct contact with , body fluids or contaminated bedding collection of suspect smallpox specimens and towels Personal Protective Equipment (PPE): .Droplet inhalation (within 6 feet) Gloves and N95 Respirator Contagious: YES .With onset of and Specimens to be Collected .Once all scabs have fallen off, the patient is no longer contagious (A detailed specimen collection protocol and algorithm can be obtained through the local department or the NYS : 12-14 Days Laboratory) .Digital Photos: Prior to collecting specimens, upload digital Initial Symptoms photos to Epi-Photo (NYSDOH secure site) at: .High fever (101–104oF), , head and body aches https://commerce.health.state.ny.us/hpn/hanweb/hanapp.shtml#photo for further differential diagnosis by State and Rash Characteristics communication with the Local and State DOH and NYS . Biodefense Laboratory Begins on face which spreads to arms, legs, hands and feet. . All lesions on any one part of the body are in the same stage of Acceptable specimen types: Swab, touch prep and scabs development .3rd day: Rash becomes raised bumps Collection Kit Information .4th day: Become fluid-filled with a depressed center (bellybutton-like) Contact your Local Health Department to determine if a specimen needs to be collected and to obtain kit supply and protocols. Kits Can be Misidentified as include all disposable items needed for collection EXCEPT PPE. + + + + + NYS DOH Collection Kit

Smallpox (upper photos): Lesions present on palms of hands and soles of feet Chickenpox (lower photos): Distribution Lesions rarely seen on palms of hands and soles of feet Patient Evaluation for Smallpox

Patient with Acute, Generalized Vesicular or Pustular Rash Illness

Institute Airborne & Contact Precautions Alert Control on Admission

Moderate Risk of Smallpox Low Risk for Smallpox High Risk for Smallpox Febrile AND one other MAJOR smallpox criteria No Febrile Prodrome OR Febrile Prodrome AND Classic smallpox lesions AND OR Febrile Prodrome and <4 MINOR smallpox criteria lesions in same stage of development Febrile Prodrome and >4 MINOR smallpox criteria

History and Exam ID and/or Derm Consultation ID and/or Derm Consultation Diagnosis Highly Suggestive VZV +/- Other Lab Testing Alert Infx Control & Uncertain of Varicella as indicated Local and State Health Depts

No Diagnosis Made Test for VZV Non-Smallpox Public Healh Response Team Varicella Testing Ensure Adequacy of Specimen and Other Conditions Diagnosis Confirmed Collects Specimens and Optional ID or Derm Consultant as Indicated Report Results to Infx Control Advises on Management Re-Evaluates Patient

Cannot R/O Smallpox Testing at Wadsworth Center Contact Local/State Health Dept

Cannot R/O Smallpox Contact Local/State Health Dept NOT Smallpox SMALLPOX Further Testing

Major Smallpox Criteria Minor Smallpox Criteria SMALLPOX CHICKENPOX Febrile prodrome : Occurring 1 - 4 days before rash onset, Centrifugal distribution with Fever >101 o F AND at least one of the following: greatest concentration of lesions FEVER 2 to 4 days before rash At time of rash prostration, headache, backache, chills, vomiting or severe RASH on face and distal extremities .Appearance Pocks in same stage Pocks in several stages abdominal pain First lesions on the oral mucosa, .Developement Slow Rapid Classic smallpox lesions: Deep-seated, firm/hard vesicles face or forearms .Distribution More pocks on More pocks or pustules, may be umbilicated or confluent arms and legs on body Slow evolution of lesions: .On palms Usually present Usually absent Lesions in same stage of development: On any one part of macules to papules to pustules and soles the body all lesions are in the same stage of development Lesions on the palms and soles DEATH Usually 1 in 10 die Very uncommon (i.e.: all vesicles or all pustules) Patient appears toxic or moribund

Source: Centers for Disease Control and Prevention (CDC)