The Scottish Government

Images of smallpox

Key features of smallpox

• Patient has had chickenpox.

• Severe prodrome for 2-3 days, with prostration, myalgia, rigors, vomiting, abdominal pain or confusion

• Lesions are deep in the skin (like hard, deep-seated pearls).

• Lesions are dense on the head and peripheries, with >5 spots on any palm or sole.

• Lesions in any body area are at same stage of development.

• Lesions evolve slowly:

• macules for 1 ^st to 2 ^nd day;

• papules for 2 ^nd to 4 ^th day;

• vesicles and then pustules for 5 ^th to 12 ^th day..

Patient is extremely unwell.

Images of chickenpox

Definitions of contact with smallpox patients

Category A: Household contacts: living or staying at the same address during the infectious period.

Face to face contacts: prolonged interactions within a distance of 2 metres (6.5 feet) during the infectious period.

Fomite contacts: direct contact with soiled clothing or articles.

Category B: Shared rooms or other enclosed spaces or air-conditioned buildings with infectious cases - eg. work colleagues, and people who have visited the same premises or travelled on the same public transport.

Clinical features

Rash with or without fever, but no key features

Vesicular rash with fever and 2 or fewer key features

Vesicular rash with fever and 3 or more key features

No identifiable contact with smallpox patient

OR

Immunised with documented "take" within last 12 months

LOW RISK

LOW RISK

MEDIUM RISK

Has shared the same general area as a smallpox patient 7 to 16 days prior to onset of illness, but has not had category A or B contact

AND

Unimmunised or immunised more than 12 months before exposure or immunised more than 3 days after exposure or immunised without a documented "take"

LOW RISK

MEDIUM RISK

MEDIUM RISK

Category A or B contact with smallpox patient 7 to 16 days prior to onset of illness

AND

Unimmunised or immunised more than 12 months before exposure or immunised more than 3 days after exposure or immunised without a documented "take"

HIGH RISK

HIGH RISK

HIGH RISK

Risk category

Management

LOW RISK

• Manage according to normal procedures for treatment, referral and laboratory investigation.

• Arrange for EM and PCR of vesicle fluid if available.

• Review at least daily for the development of additional key features.

MEDIUM RISK

• Isolate the patient in a single room.

• Call the local Smallpox Diagnostic Expert (SDE) immediately - see contact details below.

• Manage according to location - see additional protocols.

• Maintain supportive care and treat alternative diagnoses as appropriate - if investigations such as X-ray or ultrasound are required then use mobile facilities and leave them in the room until, smallpox is excluded or decontamination completed.

• Maintain infection control and do not allow contaminated fomites to leave the room.

• Identify contacts and ask those present to remain close by.

• The SDE will attend to assess the patient and arrange for further investigation and management by the Regional Smallpox Diagnosis and Response Team if necessary.

HIGH RISK

• Isolate the patient in a single room.

• Call the Regional Smallpox Outbreak Control Centre (RSOCC) immediately -contact details will be provided as required.

• Maintain supportive care and treat alternative diagnoses as appropriate - if investigations such as X-ray or ultrasound are required then use mobile facilities and leave them in the room until, smallpox is excluded or decontamination completed.

• Maintain infection control and do not allow contaminated fomites to leave the room.

• Identify contacts and ask those present to remain close by.

• RSOCC will arrange transfer to a Smallpox Care Centre for further investigation and management.

Contact details for local Smallpox Diagnostic Experts