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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