Medical
Protocol
[Refer to CDC’s
Smallpox Response Plan for current protocol. http://www.bt.cdc.gov/agent/smallpox/prep/index.asp]
[Diagnostic
Criteria for a Moderate Risk Case.]
Response:
Moderate Risk Case (22:V4:52)
Obtain an infectious
diseases and possibly dermatology consultation to confirm the risk
status. Lab testing for varicella and other rash diseases should
be conducted as appropriate at the hospital, local, or state level
health department or through a private lab. Rapid lab tests for
VZV are the DFA test that can provide results within an hour or
PCR which takes 4-8 hours. A Tzanck smear can often be performed
locally, which will confirm an alpha herpes virus infection. A
skin biopsy may be useful and can also be performed and read by
a pathologist rapidly. Obtain digital photos, if possible. Re-evaluate
risk level at least daily to determine if risk level has changed
(i.e. if person has moved into high or low risk category as rash
illness progresses and testing results for other etiologies becomes
available). Lab testing for smallpox would be indicated if the
person’s risk level was elevated to high during their daily
re-evaluation, or if all testing was negative for different etiologies
and a clinical diagnosis of smallpox was strongly considered on
the basis of history and the clinical picture being consistent
with an atypical presentation for smallpox. Local public health
authorities should be made aware that a moderate risk rash patient
is being evaluated for other etiologies of the rash illness.
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