Illness Evaluation
Ruling Out Smallpox in Those
who Present with a Rash
Illness
JOB DESCRIPTION OF
MEDICAL STAFF
Evaluate clients who were identified as ill during
triage to determine whether they are sufficiently
healthy to receive a smallpox vaccination or
should be referred to a hospital for diagnosis
and/or treatment of possible smallpox infection.
May be required to assist in other areas,such as
Medical Screening and Counseling or Contact
Evaluation.
Discharge of Clients
Clients determined to be eligible for
vaccine will be referred to Forms
Distribution Area. (Clients with
symptoms and signs of minor illness
such as URI with temperature less than
100 degrees or gastroenteritis may be
considered for vaccination.
Discharge of Clients
Clients with febrile rash illness or considered to
possibly have smallpox prodrome will be
directed to a hospital for diagnosis and
treatment.
Other clients considered to be too ill to receive
vaccine will be advised to seek medical
attention.
Clients with contraindications to vaccination and
decline to be vaccinated will exit the vaccination
clinic at this stage of the process.
Smallpox Surveillance
Clinical Case Definition
An illness with acute onset of fever > 101o
followed by a rash characterized by firm,
deep-seated vesicles or pustules in the
same stage of development without other
apparent cause
Smallpox: Major Criteria
Prodrome (1-4 days before rash onset)
o
o
– Fever >101 F (38.3 C) and
– >1 symptom: prostration, headache,
backache, chills, vomiting, abdominal
pain
Classic smallpox lesions
– Firm, round, deep-seated pustules
All lesions in same stage of development
(on one part of the body)
Smallpox: Minor Criteria
Centrifugal (distal) distribution
First lesions: oral mucosa, face, or
forearms
Patient toxic or moribund
Slow evolution (each stage 1-2 days)
Lesions on palms and soles
High Risk: All 3 Major Criteria
Prodrome (1-4 days before rash onset)
Classic smallpox lesions
All lesions in same stage of development (on
one part of the body)
Immediate Action for Patient with
Generalized Vesicular or Pustular Rash
Illness
Airborne and contact precautions instituted
Infection control team alerted
Assess illness for smallpox risk
Moderate Risk
Prodrome AND 1 other major criteria
OR
Prodrome AND >4 MINOR smallpox
criteria
Low Risk
No febrile prodrome
OR
Febrile prodrome AND <4 MINOR
smallpox criteria
CDC Rash Illness Response Team
Experience with Use of Algorithm
23 calls to CDC January 1 – November 30, 2002
– 14 states and New York City
– 17 adults and 6 children
– Smallpox risk classification:
High risk = 0. No indications for variola
virus testing
Moderate risk = 4
Low risk = 19
CDC Rash Response Team
Experience with Use of Algorithm
>50% of the cases including 2 deaths have
been varicella
12 diagnoses confirmed by lab and/or
pathology; 11 clinically diagnosed
Other diagnoses:
– drug reaction
– erythema multiforme
– disseminated herpes zoster
– disseminated HSV2
– contact dermatitis
– other dermatological disorders