Post-Event Operational Issues

Active Smallpox Surveillance

Active smallpox surveillance would entail distributing the case definitions to places that medically evaluate and treat patients. Other sources, such as medical examiners or schools, may also be targeted for active surveillance. It is also important to make sure that all the public health and medical authorities involved in the response have a standard set of data collection tools that have been developed for use in surveillance, contact tracing and monitoring, and vaccination record keeping. Distribution of case definitions and case classifications should be provided to:

  1. Public health staff involved in surveillance
  2. Hospitals
  3. Clinics
  4. Health care providers
  5. Other reporting sources

In active surveillance, there is active solicitation of cases. The frequency of reporting would be established by local public health authorities and may be daily in the initial stages of the outbreak. Daily contact with major reporting sources would be required in a post-outbreak scenario.

Some retrospective surveillance will also be required at the recognition of the outbreak to determine if cases occurred earlier than the first confirmed case. This would entail reviewing deaths over the last month, especially from all rash illnesses including hemorrhagic rashes.

In a post-event situation, daily reporting of case counts to state and national levels. Mechanisms for reporting identified contacts that have left a health jurisdiction must also be in place (e.g. state to state, providence to providence, or country to country). Report out of jurisdiction contacts to the National coordinating authorities or through identified jurisdiction to jurisdiction mechanisms.

Other important surveillance activities would include the confirmation of non-smallpox causes of rash illnesses with laboratory testing when possible in order to provide the appropriate treatment for the illness and more accurately reflect the number of true smallpox cases. Review of reported varicella cases will also be important to make sure they weren’t misdiagnosed smallpox cases.

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