West Virginia Department of Health and Human Resources Smallpox: Information for Public Health Officials


Unique Epidemiological Characteristics

  • No natural reservoir anywhere in the world
  • Implications for investigation: Case is BT until proven otherwise (i.e., lab accident)
  • Incubation period: 7-17 days
  • Person-to-person transmission by droplets > contact with contaminated clothing and bedding > aerosol
  • Mortality: 30% in pre-erradication era
  • Environmental: not environmentally hardy.
  • Prophylaxis: vaccine is effective if administered within 72 hours of exposure
  • Treatment: none

Laboratory confirmation:

  • CDC
  • Implications: Hospital personnel must be trained in recognition of smallpox so that persons are presumptively isolated.

Employee Health:

  • Vaccine and personal protective equipment recommended for persons who will have contact with smallpox-infected individuals
  • Contraindications (pre-event – not a comprehensive list):
    • immunosuppression, eczema or exfoliative skin condition, or pregnancy in vaccine candidate OR household member of vaccine candidate
    • Age < 18
    • Vaccine component allergy
  • Employees who will have face-to-face contact with smallpox patients MUST have been vaccinated (with documented take) AND fit-tested with an N-95 mask. In addition, contact precautions (gloves, gown) are required.

Lifesaving interventions – in order:

  1. Recognition / reporting / case-finding + airborne and contact isolation of cases
  2. Contact tracing and ring vaccination
  3. Collect and analyze risk information to identify source AND
    • identify the exposed population to be place under surveillance AND
    • identify household contacts of exposed so they can be vaccinated

Training considerations

  • Physicians: recognition / reporting / isolation / employee health
  • ICPs: reporting, active surveillance procedures / vaccination / isolation / employee health
  • Labs: procedure for referral of specimens to CDC.
  • Local health departments, regional epidemiologists: Investigation / vaccination / isolation/ employee health
  • IDEP / DSDC / BPH: employee health / investigation / isolation / vaccination / priorities for prevention and control


Related Links

CDC - Smallpox Page