Isolation & Quarantine
Measures in Response to a Smallpox Emergency
Isolation
Strategies
In
a smallpox outbreak, there are 3 groups to consider when formulating
isolation strategies. The first group is confirmed or suspected
cases that would be considered immediately infectious to others.
Vaccinating contacts to smallpox cases that become febrile and
may be developing smallpox or may be febrile from the vaccination
or some other reason (potentially infectious). The third group
is vaccinated contacts to smallpox case that don’t have any
symptoms but who are still in the surveillance period for the development
of smallpox (not currently infectious but could still develop smallpox)
Smallpox cases
require precautions that were previously discussed to prevent available,
could be isolated individually in hospital isolation rooms. Patients
could also be isolated with other suspected cases in a separate
facility that is designed for their use only and does not have
a shared ventilation system with any other facility. All persons
(including patients) within facility would have to be protected
by vaccination. Vaccination will:
- Prevent patients
that are mistaken for smallpox patients (varicella) from becoming
infected when they are exposed to true smallpox patients.
- Prevent others
that enter facility from becoming infected following exposure
via shared airspace.
Also, there
must be the capability of providing some medical care if non-medical
facility used for group isolation.
If groups of
suspected patients are isolated in a facility designated only for
care of smallpox patients, then:
- There is NO need
to have special isolation rooms
- Make sure
that ventilation system (including heating and air conditioning
systems) are shared with any other facility.
- All persons
entering facility must have been successfully vaccinated recently
(including patients admitted to facility).
Strategies
for Isolation of Febrile Contacts
Recently vaccinated
contacts who have a fever but do not have a rash, may or may not
be manifesting the first signs of smallpox. They need to be watched
carefully to see if the fever is from the prodrome of smallpox
or if it is from the recent vaccination, could be infectious if
developing early symptoms of smallpox.
These people
can also be isolated in hospital negative pressure rooms if available
while observing for development of rash, or they can isolated in
a different facility with other febrile contacts or cases. The
same facility requirements exist for febrile contacts as for confirmed
cases. An additional option is to keep person isolated at home
and moving to smallpox isolation facility only if develops rash.
If home isolation is followed, then ALL people entering or living
in home must be vaccinated.
Strategies
for Isolation of Asymptomatic Contacts
Recently vaccinated
contacts to smallpox cases that do not have any symptoms are not
infectious so don’t require facilities with any special ventilation.
They can be monitored in their home for development of a fever
(check at least twice a day). They can be asked to stay at home
during surveillance period for symptoms or may be allowed to travel
outside of home if distance is restricted such that a quick return
to home is possible if develops fever. All others staying in home
must be vaccinated in case the contact develops smallpox. Other
household members with vaccination contraindications that can’t
be vaccinated to protect themselves if the contact does develop
smallpox while at home under surveillance should stay elsewhere
until the contact is no longer at risk of developing the disease.
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