Scottish Government

Interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication era

These are interim guidelines which will be modified to take account of comments
received by 6 January 2003. All comments should be sent by e-mail to

joe.brown@scotland.gsi.gov.uk ..

This document is also available in pdf format (442k)

Contents

I Background

II Introduction

III Natural history and clinical features of variola major in a non-immune individual
Clinical features
Laboratory features
Differential diagnosis
Mortality
Atypical presentations
Modified smallpox

IV Epidemiology
Incubation period
Transmission
Organism survival

V Case definitions and laboratory investigation
Case classification
Laboratory networks

VI Planning for outbreaks of smallpox
Diagnosis and response to initial cases
Action in the event of initial probable cases
Action in the event of confirmed cases
Cases arising in hospital
Cases arising at Port Health Control Units

VII Management of cases and contacts during an outbreak
Co-ordination of the public health response
Isolation of cases
Care of cases
Smallpox care centres
Contacts: classification and management
Category A primary contacts
Category B primary contacts
Secondary contacts
Transient and distant contacts
Identification and tracing of contacts
Vaccination of contacts
Arrangements for vaccination
Special issues relating to contacts

VIII Vaccination
General principles
Efficacy and take rate
Contraindications and complications
Vaccination strategies at progressive Alert Levels
Vaccination of essential personnel

IX Enhanced surveillance following an outbreak
Identification of the source of infection
Case finding following a release
Handling data

X Communication
Clinical, laboratory and epidemiological information
Public and media

Annex: key contacts

Figures
1,2,3,4,5,6,7: Management of initial cases at different locations
8: Summary of management of cases and contacts
9: Lines of communication and accountability during an outbreak
10: Smallpox Diagnostic Algorithm

Appendices
1: Collecting and transporting diagnostic clinical specimens
2: Guidelines for developing laboratory contingency plans
3: Summary of Alert Levels and action required
4: Suggested equipment and supplies for Smallpox Diagnosis and Response Teams
5: Minimum specifications for hospital isolation facilities to receive initial cases
6: Specifications for Smallpox Care Centres
7: Infection control procedures for managing smallpox patients
8: Specification for Smallpox Vaccination Centres
9: Contraindications to vaccination
10: Complications of vaccination
11: Vaccine distribution, supply, storage and dilution
12: Vaccination techniques including examination for vaccine "take"
13: Use of Human Anti-Vaccinia Immunoglobulin (VaIG)
14: Use of cidofuvir
15: Disinfection and decontamination
16: Case and contact reporting and monitoring forms
17: Contact and vaccinee information forms
18: Disposal of the deceased
19: Training of healthcare staff