« Previous | Contents | Next »
Listen
Interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication era
Appendix 17: advice and consent forms for smallpox contacts
iii: consent for smallpox vaccination
Important notes: please read this information carefully, and sign the declaration at the bottom of the page - you cannot be vaccinated unless you do.
Smallpox is a severe viral infection, particularly for children. Successful vaccination before contact with the virus provides almost complete protection from infection. Smallpox vaccination in the early days after contact is not guaranteed to prevent infection but any illness is likely to be much less severe.
Smallpox vaccine contains vaccinia virus, a distant relative of the smallpox virus, which is much less virulent than smallpox itself. It is given by scratching or pricking the vaccine into the surface of the skin, just below the left shoulder. Successful vaccination causes a mild infection: within 3 days, a patch of small pimples appears, which develop into blisters. The blisters become scabbed, and heal by 10 to 12 days after vaccination in most people. The spots are sometimes itchy or a little sore.
Side effects may occur following smallpox vaccination. Care needs to be taken to avoid introducing vaccinia virus into the eyes, mouth or genitals. The vaccinia virus multiplies very well in skin affected by eczema: several new blisters can occur in different skin areas in people with eczema, even when care has been taken to avoid contact spread. This is usually more inconvenient than dangerous, but in severe eczema cases it can be a problem. Rarely, vaccinia infection may spread in the blood or into the underlying tissues if the skin fails to heal. Encephalitis (inflammation of the brain) may occur rarely, as with other live virus vaccines.
Vaccines containing live viruses are not usually given to people whose immune systems have been affected by medical disorders (eg. some cancers or HIV infection) or treatments (eg. chemotherapy or high-dose steroids). However, smallpox is such a dangerous disease that the risk of vaccination is acceptable in most cases where there has been a genuine exposure to infection. Many pregnant women have been safely vaccinated with vaccinia virus over the centuries. However, in a few cases, unborn babies have been infected by the virus, resulting in stillbirth.
Form iv: information for smallpox contacts
What is smallpox?
Smallpox is a viral infection caused by the variola virus. It was previously declared eradicated in 1980. It now appears that further cases have emerged, which suggests that the virus has been released deliberately.
What are the symptoms?
Symptoms tend to begin suddenly with high fever, tiredness and an aching head and back. Patients are very unwell and usually bed ridden. A distinctive rash then develops: fluid filled lumps appear all over the body, particularly on the face, arms and legs, and also in the mouth and throat. After a couple of weeks, these form scabs, which eventually fall away after 3-4 weeks. When smallpox occurs in people who have no immunity it is a serious illness, and is often fatal.
How do you catch smallpox?
Smallpox is spread by inhaling virus particles breathed out by infectious patients or by direct contact with virus particles on their clothes and belongings. Patients do not become infectious until they are unwell.
It usually requires long periods in close contact with infectious patients to catch smallpox. Contacts of smallpox patients can be divided into two categories:
Category A (highest risk of infection): have spent substantial periods of time in very close contact with infectious patients or their belongings.
Category B (lower risk of infection): have spent shorter periods at a greater distance in contact with infectious patients.
How long does it take for the illness to develop?
It usually takes 10 to 16 days for the fever to develop, and the rash appears about 4 to 7 days later.
Can smallpox be prevented?
There is an effective vaccine against smallpox, worldwide use of which led to the eradication of the virus. The vaccine contains vaccinia, a virus related to variola. Successful vaccination before contact with the virus provides almost complete protection from infection. Vaccination in the early days after contact is not guaranteed to prevent infection but any illness is likely to be much less severe. People who were vaccinated years ago may no longer be protected, and should be re-vaccinated if they have close contact with an infectious patient. The vaccine has a number of side effects, which is why it has not been used routinely since the virus was eradicated.
Form v: information about smallpox vaccination
What happens after vaccination?
Successful vaccination causes a mild infection: within 3 days a patch of small pimples appears, which develop into blisters by 6 to 7 days. The blisters become scabbed, and heal by 10 to 12 days after vaccination in most people to produce a scar. The spots are sometimes itchy or a little sore.
What are the side effects of smallpox vaccination?
Vaccinia virus is mildly infectious. It can be transferred from the blisters to other parts of your skin, or to others, by contact. Vaccinia blisters can then occur in inconvenient or dangerous locations, such as the eye, mouth or private parts. You are therefore advised to avoid contact sports and to be careful when holding babies and young children. Many people also prefer to avoid sexual contact until the blisters have healed. The position of the blisters on the upper arm makes accidental contact less likely.
The vaccinia virus multiplies very well in skin affected by eczema: several new blisters can occur in different skin areas in people with eczema, even when care has been taken to avoid contact spread. This is usually more inconvenient than dangerous, but in severe eczema cases it can be a problem.
Rarely, vaccinia infection may spread in the blood or into the underlying tissues if the skin fails to heal. Inflammation of the brain may occur rarely.
How do I take care of my vaccination?
The site should be covered at all times with one of the dressings provided.
When a dressing falls off, it should be placed and sealed inside one of the small yellow bags provided, and taken back to the vaccination centre for disposal.
Do not apply antiseptics, or wash with antiseptic soap or skin gels; these could kill the viruses and invalidate the vaccination.
Do not go swimming, or soak the skin in the bath, until the skin has healed.
Do not take part in contact sports, such as rugby, wrestling, boxing or self-defence, as this may spread the vaccinia virus on your own skin, or the skin of others.
It is advisable to avoid sexual contact until the skin has healed.
Unvaccinated household members with eczema or severely impaired immunity should avoid contact with a vaccinated person; it may be a good idea for them to stay with friends until the vaccinated person's skin has healed.
It is sensible to consult the doctor, or NHS24 if:
The vaccinated site becomes very painful (pain not controlled by paracetamol, ibuprofen or similar painkillers).
The vaccinated skin becomes very swollen and red (over an area more then 5-6 cm. (2-21/2 inches) in diameter.
Swellings or blisters appear in skin areas away from the vaccination area.
A high temperature develops (not controlled by paracetamol).
Persistent drowsiness or confusion occurs.
Form vi: certificate of vaccination
Form vii: advice for category A contacts
Why do I need to take action?
You have been in contact with a patient who appears to have infectious smallpox. There are therefore a number of actions that need to be taken immediately to protect you from infection. If the patient turns out not to have smallpox, you will be advised.
Should I be vaccinated against smallpox?
You will be offered vaccination at a designated centre. You will be assessed at the centre 3 days after vaccination to see whether it has been successful. Vaccination is most effective if given within 3 days of exposure. That is why it is not always possible to wait for the patient's diagnosis to be confirmed before vaccinating contacts.
Are there any special precautions for vaccination?
There are some medical conditions that put people at a greater risk of side effects from vaccination. These will be discussed with you. It is always necessary to weigh up the risk from side effects against the risk from disease.
What else do I need to do?
You should monitor yourself carefully for the next 16 days for symptoms of smallpox so that infection can be detected early and you can then be transferred to a specialist centre for observation or treatment. You will be given a thermometer, temperature chart and instructions on how to use them.
How do I monitor myself for symptoms?
You should take your temperature daily, at the same time each day, with the thermometer provided. You should record your daily temperature measurement on the chart that you have been given, and then report it to the
Smallpox Contacts Telephone Number, which is given below. If your temperature rises above 38
OC at any time (the red line on the chart), or if you feel unwell, you should immediately call the Smallpox Contacts Telephone Number.
Do I need to restrict my activities in any way?
If you have a temperature above 38
OC or feel unwell you should stay at home.
During the
restriction period indicated below, you should:
Not attend your normal place of work.
Avoid contact with unvaccinated individuals.
Remain within your local area.
Outside the restriction period you may continue your normal activities, although you should not travel abroad and should avoid travelling long distances within the UK for the next 16 days.
Form viii: advice for category B contacts
Why do I need to take action?
You have been in contact with a patient who appears to have infectious smallpox. However, you have not been in close contact with the patient and your risk of infection is low. However, as a precaution, there are a number of actions that need to be taken to protect you from infection. If the patient turns out not to have smallpox, you will be advised.
Should I vaccinated against smallpox?
You will be offered vaccination at a designated centre. You will given instructions on how to check your vaccination has been effective - if you are concerned, you may return to the vaccination centre to have the site checked by a professional.
Vaccination is most effective if given within 3 days of exposure. That is why it is not always possible to wait for the patient's diagnosis to be confirmed before vaccinating contacts.
Are there any special precautions for vaccination?
There are some medical conditions that put people at a greater risk of side effects from vaccination. These will be discussed with you. It is always necessary to weigh up the risk from side effects against the risk from disease.
What else do I need to do?
Over the next
16 days, if you develop a high temperature (above 38
OC) or if you feel unwell, you should immediately call the smallpox hotline (telephone number given below). This is so that smallpox infection can be detected early and you can then be transferred to a specialist centre for observation or treatment.
Do I need to restrict my activities in any way?
If you have high temperature or feel unwell you should stay at home. Otherwise, you may continue your normal activities, although you should not travel abroad for the next 16 days.
Form ix: advice for secondary contacts
Why do I need to take action?
You may be spending time with a person who has themselves had close contact with a patient who appears to have infectious smallpox. This person will be monitored for the development of symptoms of smallpox over the next 16 days. There are a number of actions that you need to take in case they develop symptoms. If the patient turns out not to have smallpox, you will be advised.
Should I vaccinated against smallpox?
You will be offered vaccination at a designated centre. You will given instructions on how to check your vaccination has been effective - if you are concerned, you may return to the vaccination centre to have the site checked by a professional.
Vaccination is most effective if given within 3 days of exposure. That is why it is not always possible to wait for the patient's diagnosis to be confirmed before vaccinating contacts.
Are there any special precautions for vaccination?
There are some medical conditions that put people at a greater risk of side effects from vaccination. These will be discussed with you. If you have any of these conditions, it would be preferable to avoid vaccination, and avoid spending time with the contact of the smallpox patient for the next 16 days.
What else do I need to do?
You do not need to take any special precautions, and need take no further action unless the contact of the smallpox patient develops symptoms, in which case you will be advised further. Over the next 16 days, if you have any concerns you may call the smallpox advice line (telephone number given below) for help.
Do I need to restrict my activities in any way?
No, you may carry on your normal activities, although if you have been vaccinated, you should not travel abroad for the next 16 days.
Form x: advice for concerned individuals
Why action do I need to take?
You have not had close contact with a smallpox patient, and therefore you do not have a significant risk of infection.
Should I vaccinated against smallpox?
You do not require vaccination. Smallpox vaccine can have unpleasant and sometimes fatal side effects and therefore it is not normally recommended for people who are not at significant risk of infection.
What else do I need to do?
You do not need to take any special precautions. Over the next
16 days, if you feel unwell or have any concerns you may call the smallpox advice line (telephone number given below) for help.
Do I need to restrict my activities in any way?
No, you may carry on your normal activities.
« Previous | Contents | Next »