january 2003 variola virus photo courtesy of cdc/public health image library 1
TRANSCRIPT
![Page 1: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/1.jpg)
January 2003
Variola Virus
Photo Courtesy of CDC/Public Health Image Library1
![Page 2: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/2.jpg)
January 2003
History
• Ancient scourge – many millions killed
• Global eradication in 1977
![Page 3: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/3.jpg)
January 2003Photo Courtesy of National Archives
![Page 4: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/4.jpg)
January 2003Photo Courtesy of World Health Organization2
![Page 5: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/5.jpg)
January 2003
Bioweapon Potential
• Precedence– Prior use in French-Indian War
– Produced by USSR
![Page 6: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/6.jpg)
January 2003
Bioweapon Potential
• Reality of the risk– Viral stocks exist
– Non-immune population
![Page 7: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/7.jpg)
January 2003Photo Courtesy of CDC3
![Page 8: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/8.jpg)
January 2003
Epidemiology
• No animal reservoir/vector
• Mortality 25-30%
• Person-to-person transmission– Via respiratory droplets
– Household and face-to-face contacts
– High risk of nosocomial spread
– Secondary attack rate 25-40%
– Up to 20 contacts infected per case
![Page 9: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/9.jpg)
January 2003Photo Courtesy of World Health Organization4
![Page 10: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/10.jpg)
January 2003
Epidemiology
• Aerosol route of transmission– Likely in bioterrorism setting
![Page 11: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/11.jpg)
January 2003
Virology
• Orthopoxviridae DNA Viruses– Variola variants
• Variola major – high mortality• Variola minor – low mortality, 20th Century
– Vaccinia• Current smallpox vaccine
![Page 12: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/12.jpg)
January 2003
Virology
• Orthopoxviridae DNA Viruses– Other pox viruses
• Cowpox• Monkeypox
![Page 13: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/13.jpg)
January 2003
Pathogenesis
Virus contacts respiratory mucosa Carried to lymph nodes Primary viremia Organ seeding WBCs infected Dermal invasion Vesicle Sepsis
![Page 14: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/14.jpg)
January 2003
Clinical Features
• Incubation Stage– Asymptomatic
– 10-12 days (range 7-17)
![Page 15: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/15.jpg)
January 2003
Clinical Features
• Prodromal Stage– Sudden nonspecific flu-like illness
• High fevers• Headache• Backache• Prostration
– 2-5 days duration
![Page 16: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/16.jpg)
January 2003
Clinical Features
• Eruptive Stage– Characteristic rash
• Centrifugal location• Grouping• Depth of lesions
![Page 17: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/17.jpg)
January 2003Photo Courtesy of World Health Organization5
![Page 18: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/18.jpg)
January 2003
Clinical Features
• Distribution of the rash
![Page 19: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/19.jpg)
January 2003Photo Courtesy of World Health Organization6
![Page 20: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/20.jpg)
January 2003Photo Courtesy of World Health Organization7
![Page 21: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/21.jpg)
January 2003Photo Courtesy of National Archives
![Page 22: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/22.jpg)
January 2003Photo Courtesy of National Archives
![Page 23: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/23.jpg)
January 2003Photo Courtesy of World Health Organization8
![Page 24: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/24.jpg)
January 2003Photo Courtesy of World Health Organization9
![Page 25: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/25.jpg)
January 2003Photo Courtesy of World Health Organization10
![Page 26: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/26.jpg)
January 2003Photo Courtesy of World Health Organization11
![Page 27: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/27.jpg)
January 2003Photo Courtesy of World Health Organization12
![Page 28: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/28.jpg)
January 2003Photo Courtesy of World Health Organization13
![Page 29: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/29.jpg)
January 2003Photo Courtesy of World Health Organization14
![Page 30: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/30.jpg)
January 2003Photo Courtesy of World Health Organization15
![Page 31: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/31.jpg)
January 2003Photo Courtesy of World Health Organization16
![Page 32: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/32.jpg)
January 2003Photo Courtesy of World Health Organization17
![Page 33: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/33.jpg)
January 2003Photo Courtesy of CDC/James Hicks18
![Page 34: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/34.jpg)
January 2003Photo Courtesy of CDC19
![Page 35: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/35.jpg)
January 2003
Clinical Features
• Severity of the classical rash– Discrete (<10% mortality)
– Semi-confluent (25-50%)
– Confluent (50-75%)
![Page 36: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/36.jpg)
January 2003
Discrete Smallpox
Photo Courtesy of National Archives
![Page 37: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/37.jpg)
January 2003
Semi-Confluent Smallpox
Photo Courtesy of World Health Organization20
![Page 38: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/38.jpg)
January 2003
Confluent Smallpox
Photo Courtesy of National Archives
![Page 39: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/39.jpg)
January 2003
Smallpox Complications
• Eye infection or blindness
• Arthritis
• Encephalitis
• Secondary bacterial infections
![Page 40: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/40.jpg)
January 2003
Differential Diagnosis
• Varicella (chickenpox)
• Monkeypox
• Drug eruptions
• Generalized vaccinia
• Multiple insect bites
• Molluscum contagiosum
• Secondary syphilis
• Viral exanthems (e.g. HHV-6, Cocksackie, etc)
![Page 41: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/41.jpg)
January 2003
Chickenpox
Photo Courtesy of World Health Organization21
![Page 42: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/42.jpg)
January 2003
Monkey Pox
Photo Courtesy of CDC22
![Page 43: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/43.jpg)
January 2003
Erythema Multiforme
Photo Courtesy of New England Journal of Medicine23
![Page 44: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/44.jpg)
January 2003
Generalized Vaccinia
Photo Courtesy of CDC24
![Page 45: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/45.jpg)
January 2003
Generalized Vaccinia
Photo Courtesy of CDC25
![Page 46: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/46.jpg)
January 2003
Molluscum Contagiosum
Photo Courtesy of American Academy of Pediatrics26
![Page 47: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/47.jpg)
January 2003
Secondary Syphilis
Photo Courtesy of American Academy of Pediatrics27
![Page 48: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/48.jpg)
January 2003
Hand-Foot-Mouth Disease(Enterovirus Infection)
Photo Courtesy of American Academy of Pediatrics28
![Page 49: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/49.jpg)
January 2003
Differential Diagnosis
• Chickenpox (varicella virus)– Distribution of rash
– Grouping of lesions• Asynchronous development
– Vesicle appearance• Shallow
– Short Prodrome
![Page 50: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/50.jpg)
January 2003
Chickenpox
Photo Courtesy of World Health Organization29
![Page 51: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/51.jpg)
January 2003Photo Courtesy of World Health Organization30
![Page 52: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/52.jpg)
January 2003Photo Courtesy of World Health Organization31
smallpox
chickenpox
![Page 53: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/53.jpg)
January 2003
Chickenpox
Photo Courtesy of American Academy of Pediatrics32
![Page 54: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/54.jpg)
January 2003
Chickenpox
Photo Courtesy of American Academy of Pediatrics33
![Page 55: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/55.jpg)
January 2003
Non-Classical Rash Presentations
• Modified variant of smallpox– Seen in ~25% of cases who were
previously vaccinated
– Much lower mortality, milder disease
– Harder to distinguish from chickenpox
– May be predominant form seen if cases appear in a vaccinated population
![Page 56: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/56.jpg)
January 2003
Modified Smallpox
Photo Courtesy of National Archives
![Page 57: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/57.jpg)
January 2003
Flat (Malignant) Smallpox
Photo Courtesy of World Health Organization34
![Page 58: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/58.jpg)
January 2003
Non-Classical Rash Presentations
• Flat (Malignant) variant of smallpox– 5-10% of smallpox cases in outbreak
setting
– Severe systemic disease
– Flat, leathery lesions
– Lesions coalesce, no discrete pustules
– Mortality 97%
– May be associated with compromised hosts
![Page 59: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/59.jpg)
January 2003
Flat (Malignant) Smallpox
Photo Courtesy of World Health Organization35
![Page 60: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/60.jpg)
January 2003
Hemorrhagic Smallpox
Photo Courtesy of World Health Organization36
![Page 61: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/61.jpg)
January 2003
Non-Classical Rash Presentations
• Hemorrhagic variant of smallpox– <5% of all cases– Rapidly progressive fulminant illness– Lesions become hemorrhagic before
pustules form– Predilection for pregnant women– May be difficult to diagnose– Differential diagnosis:
• Menigococcemia• DIC• Hemorrhagic Chickenpox
![Page 62: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/62.jpg)
January 2003
Meningococcemia
Photo Courtesy of American Academy of Pediatrics37
![Page 63: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/63.jpg)
January 2003
Hemorrhagic Chickenpox
Photo Courtesy of American Academy of Pediatrics38
![Page 64: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/64.jpg)
January 2003
Diagnosis
• Clinical– Classic rash is sufficient in outbreak
setting
– Must have high index of suspicion
![Page 65: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/65.jpg)
January 2003Photo Courtesy of World Health Organization39
![Page 66: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/66.jpg)
January 2003
Diagnosis
• Smallpox should be ruled out if:– Classic rash is present
– Suspicious rash with severe systemic illness
![Page 67: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/67.jpg)
January 2003
Diagnosis
• From vesicle/pustule fluid
• Traditional confirmation– Electron microscopy
– Culture
• Newer rapid tests– PCR
– Immunohistochemistry
– Reference labs (e.g. CDC)
![Page 68: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/68.jpg)
January 2003
Diagnosis
Photo Courtesy of CDC/Dr. Fred Murphy, Sylvia Whitfield40
![Page 69: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/69.jpg)
January 2003
Management
• Isolation of suspected cases
• No effective antivirals
• Supportive care– Fluid, electrolyte balance
– Hemodynamic, ventilatory support
• Antibiotics for secondary infections
• +/- vaccination with smallpox vaccine
![Page 70: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/70.jpg)
January 2003
Post-Exposure Prophylaxis
• For exposure to aerosol or suspected case– Household or face-to-face contacts
![Page 71: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/71.jpg)
January 2003
Post-Exposure Prophylaxis
• Vaccine– Protective within 3-4 days of exposure
– Reduces incidence 2-3 fold
– Decreases mortality >50%
• Cidofovir– Effective vs other poxviruses
– Nephrotoxic antiviral agent
![Page 72: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/72.jpg)
January 2003
Vaccination
• Vaccinia live virus vaccine
• U.S. stock– >20 years old, still viable– 10 fold dilution still >95% effective– Jennerian pustule = protection
Photo Courtesy of CDC41
![Page 73: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/73.jpg)
January 2003
Vaccination
• Efficacy– 10 fold reduction 2o attack rate
– Full protection for 3-10 years
– Modest protection from mortality up to 20 yr
– Multiple vaccinations boost duration
![Page 74: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/74.jpg)
January 2003
Vaccination
• Adverse Effects– 3/100,000 vaccinees
• Death– 1/million vaccinees historically
• Highest risk– Infants
– Primary vaccinees
• Absolute contraindications– None in outbreak setting
![Page 75: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/75.jpg)
January 2003
Vaccination
• Relative contraindications– Age <1 year old
– Pregnancy
– Immunocompromised
– Skin Disorders• Eczema• Atopic Dermatitis
– Contact with high-risk persons
![Page 76: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/76.jpg)
January 2003
Vaccination
• Serious complications– Encephalitis
• 1:300,000 primary vaccinees• 25% mortality• No treatment• Often permanent neurological defects
– Progressive Vaccinia• (a.k.a. vaccinia gangrenosum/necrosum)• Untreated mortality near 100%
– Eczema vaccinatum• History of eczema or chronic skin disorder• 40% mortality in young children
![Page 77: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/77.jpg)
January 2003
Vaccination
• Mild complications– Generalized vaccinia
– Autoinoculation
– VIG can treat or prevent
![Page 78: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/78.jpg)
January 2003
Infection Control
• Isolation of Cases– Contact precautions
• Gloves, gowns
– Airborne precautions• Negative pressure HEPA filtered room, N95
masks
– Home isolation an option
– Immunized persons should provide care
![Page 79: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/79.jpg)
January 2003
Infection Control
• Management of Case Contacts– Period of infectiousness
• Oral lesions all scabs
– Fever precedes rash• Fever Isolation
– Contact identification• Exposure to case after fever onset
– Face-to-face contact– < 3 meters
– Immediate vaccination– 17 day observation
• Isolate if > 38o
![Page 80: January 2003 Variola Virus Photo Courtesy of CDC/Public Health Image Library 1](https://reader035.vdocuments.us/reader035/viewer/2022062307/55167cc15503469d698b5c10/html5/thumbnails/80.jpg)
January 2003
Infection Control
• Nosocomial transmission– All patients and staff in hospital with a
case should be vaccinated
• Quarantine may be necessary