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Interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication era
IX Enhanced surveillance following an outbreak
Identification of the source of infection
There may have been an overt release of virus. All those deemed to have been exposed, according to an evaluation at the site and time of release, will then be managed as category A contacts.
It is more likely that the virus will be released covertly. Detection of the location of the event will depend on analysis of information given by patients about their movements during the incubation period. This information will be collated and analysed by SSOCC in order to identify potential sources of infection, which may be other cases or the initial release.
If a potential source of infection is identified from common exposure histories, then others who have shared the same exposure should be regarded as category A contacts and traced as a matter of urgency.
Case finding following a release
At Alert Level 1, clinicians will be informed of the nature of the heightened threat, reminded of the presenting clinical features and case definitions, and the procedure for reporting and assessment of patients with suspicious illnesses (see
Section VI).
At Alert Levels 2 and 3,
cases may arise in individuals who are being monitored as contacts, or in individuals who have no known epidemiological link to other cases. The latter will be assessed by one of the expanded number of SDEs.
More intensive surveillance will be necessary to ensure that all cases are recognised and control measures implemented as early as possible. Clinicians will again be reminded of the presenting clinical features and case definitions, and the procedure for reporting and assessment of patients with suspicious illnesses (see
Section VI).
SDEs will be issued with
Smallpox Reporting Forms (see
Appendix 16) including a
Smallpox Reporting Telephone Number for reporting of suspected cases to RSOCC. Arrangements for establishing this telephone number are discussed in
Section X.
Active surveillance of hospitals may be required in order to reliably exclude additional cases. All hospital inpatients with suspicious illnesses, and recent unexplained deaths, should be reviewed retrospectively to exclude the diagnosis of smallpox.
The NHS Helpline and NHS24 may be able to use algorithms combining details about symptoms and exposures in order to assess the significance of symptoms in concerned individuals and provide reassurance or referral to local experts if necessary.
Handling data
Even a small outbreak may generate considerable quantities of epidemiological data. Forms and tools to assist with the collection, collation and analysis of information about cases and contacts can be found in
Appendix 16. These include:
[Need to expand this Section based on work at CAMR.]
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