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Smallpox |
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Controls |
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There are a variety of controls that should be implemented in order to protect
workers from exposure to smallpox. Workers that may be affected, either during
regular work activities or during an emergency response, include, but are not
limited to, emergency responders, healthcare workers, laboratory personnel, and
others. The Smallpox Disease and
Smallpox as a Bioweapon sections of this Safety
and Health Topics Page provide extensive information on the hazards associated
with smallpox and applicable controls. Additional guidance specific to various
types of workers, and associated issues on recognizing and controlling exposure
to smallpox is provided in the following sections.
Emergency Responders
What personal protective equipment should emergency responders use when
responding to a potential bio-attack involving smallpox? How should workers
decontaminate themselves if they think they have been exposed to smallpox?
In a covert attack involving aerosolized smallpox, there would be no emergency response activity involving emergency
responders. The first evidence that a potential attack had occurred would be diagnosis of the disease among exposed individuals, which
would happen several days after the actual release. However, it is possible that emergency responders would be required to respond to a
bio-attack incident, such as notification regarding an aerosol dissemination device or other suspicious release. The following references
provide additional information regarding personal protective equipment (PPE), decontamination, and other precautions for emergency responders to consider during such an
incident.
Healthcare Workers, Mortuary Workers, and
Others
What personal protective equipment (PPE), infection control, and related precautions should healthcare workers use when
treating patients with smallpox?
National infection control guidelines prescribe specific precautions to be taken when treating
patients with known or suspected smallpox. These precautions include "Standard", "Droplet", and "Airborne",
and "Contact" Precautions, under
certain circumstances. Patient isolation and similar precautions may also be necessary. The following references provide detailed
information regarding infection control procedures for smallpox.
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OSHA Best Practices for Hospital-Based First Receivers of Victims. OSHA,
(2005, January). Provides hospitals with practical information to assist them in
developing and implementing emergency management plans that address the
protection of hospital-based emergency department personnel during the receipt
of contaminated victims from mass casualty incidents occurring at locations
other than the hospital. Among other topics, it covers victim decontamination,
personal protective equipment, and employee training, and also includes several
informational appendices.
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Smallpox Response Plan and Guidelines (Version 3.0). Centers for Disease Control
and Prevention (CDC),
(2002, November 26). Outlines the public health strategies that
would guide the public health response to a smallpox emergency and many of the
federal, state, and local public health activities that must be undertaken in a
smallpox outbreak. Includes detailed work practices and engineering controls
to control infection, and other precautions that must be followed.
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Inglesby, Thomas V., et al. "Smallpox as a Biological Weapon: Medical and Public Health Management."
Journal of the American Medical Association (JAMA)
281.22(1999, June 9): 2281-2290. Considers the prospect of an aerosol release of variola virus, and provides information on epidemiology, infection signs and
symptoms, diagnosis and monitoring, vaccination, medical treatment, infection
control, environmental decontamination, and more.
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Bioterrorism Readiness Plan: A Template for Healthcare Facilities.
Association for Professionals in Infection Control and Epidemiology (APIC) and
Centers for Disease Control and Prevention (CDC), (1999, April 13), 112 KB PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on smallpox is contained in Section II, pp.
23-26.
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USAMRIID's Medical Management of Biological Casualties Handbook, Fifth Edition. US Army Medical
Research Institute of Infectious Diseases (USAMRIID), (2004,
August). Provides links to PDF documents
that contain information from this publication, known as the "Bluebook", and
recommendations regarding medical response to a biological warfare attack on a
civilian or military population. Includes information on smallpox, including infection control
recommendations, pp. 59-65. Appendix D describes these precautions in more
detail.
What precautions are necessary when handling the bodies of patients who have died from
smallpox?
Similar infection control precautions, as listed previously for live individuals, should be implemented for the
post-mortem care of smallpox patients. These precautions apply to all workers performing post-mortem procedures on
smallpox patients,
including healthcare workers, morticians, forensic personnel, or others.
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Inglesby, Thomas V., et al. "Smallpox as a Biological Weapon: Medical and Public Health Management."
Journal of the American Medical Association (JAMA)
281.22(1999, June 9): 2281-2290. Considers the prospect of an aerosol release of variola virus, and provides information on epidemiology, infection signs and
symptoms, diagnosis and monitoring, vaccination, medical treatment, infection
control, environmental decontamination, and more.
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Smallpox Response Plan and Guidelines (Version 3.0). Centers for Disease Control
and Prevention (CDC),
(2002, November 26). Outlines the public health strategies that
would guide the public health response to a smallpox emergency and many of the
federal, state, and local public health activities that must be undertaken in a
smallpox outbreak. Includes detailed work practices and engineering controls
to control infection, and other precautions that must be followed.
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Bioterrorism Readiness Plan: A Template for Healthcare Facilities.
Association for Professionals in Infection Control and Epidemiology (APIC) and
Centers for Disease Control and Prevention (CDC), (1999, April 13), 112 KB PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on smallpox is contained in Section II, pp.
23-26.
How should workers decontaminate themselves if they
think they have been exposed to smallpox virus?
The risk of re-aerosolization of smallpox virus from contaminated persons is considered low. In situations where
there may have been gross exposure to smallpox, personal decontamination can be performed by removing contaminated clothing and washing
exposed skin with soap and water. Additional decontamination procedures can be found in the following document:
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Bioterrorism Readiness Plan: A Template for Healthcare Facilities.
Association for Professionals in Infection Control and Epidemiology (APIC) and
Centers for Disease Control and Prevention (CDC), (1999, April 13), 112 KB PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on smallpox is contained in Section II, pp.
23-26.
What cleaning and disinfection procedures should be utilized in facilities that treat
smallpox patients or handle
the bodies of patients who have died from smallpox?
The principles of Standard Precautions are generally applied for the cleaning, disinfection, and sterilization of
equipment and environmental control in facilities. For more information, refer to the following:
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Bioterrorism Readiness Plan: A Template for Healthcare Facilities. Association for Professionals in Infection Control and Epidemiology (APIC) and
Centers for Disease Control and Prevention (CDC), (1999, April 13), 112 KB PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on smallpox is contained in Section II, pp.
23-26.
Laboratory Workers
What biosafety procedures should laboratory personnel utilize when handling
materials potentially contaminated with smallpox?
Specific biosafety procedures, including PPE, engineering controls, and additional work practices have
been established for handling smallpox virus in laboratories. Refer to the following references for more information.
- Office of Health and Safety – Biosafety. Centers for Disease Control
and Prevention (CDC). Provides links to
material on biosafety regulations, references, and related material.
- Biosafety in Microbiological and Biomedical Laboratories (BMBL), 4th Edition. Centers for
Disease Control and Prevention (CDC) and National Institutes of Health (NIH), (1999, May).
Comprehensive reference on laboratory biosafety practices, including specific
information on smallpox.
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Hawley, R.J. and E.M. Eitzen,
Jr. "Biological Weapons - A Primer for Microbiologists." Annual Review of Microbiology 55(2001, October):
235-253.
Provides biosafety information for laboratory and field personnel, including
discussions on engineering controls, PPE, and decontamination methods.
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Smallpox Response Plan and Guidelines (Version 3.0). Centers for Disease Control
and Prevention (CDC), (2002, November 26). Outlines the public health strategies that
would guide the public health response to a smallpox emergency and many of the
federal, state, and local public health activities that must be undertaken in a
smallpox outbreak. Includes detailed work practices and engineering controls
to control infection, and other precautions that must be followed.
-
Inglesby, Thomas V., et al. "Smallpox as a Biological Weapon: Medical and Public Health Management."
Journal of the American Medical Association (JAMA)
281.22(1999, June 9): 2281-2290. Provides information on sample collection,
transport, and laboratory procedures for handling smallpox.
Environmental Persistence, Identification, and Decontamination
How long would aerosolized smallpox virus from a bioweapon persist in the environment?
Aerosolized smallpox virus may persist for up to 24 hours, or somewhat longer
under favorable conditions. However, the virus can be destroyed within 6 hours
under conditions where there is high temperature and high humidity. In the
presence of ultraviolet light, it will die even more quickly. However, it is
believed that the smallpox virus can remain viable in contaminated laundry for
extended periods.
Can smallpox be detected in the environment following a bioterrorist attack?
There are various methods that can be utilized for
detecting bioterrorist agents, including smallpox. These include surface and air
sample gathering techniques, followed by identification methods such as culture
growth or polymerase chain reaction (PCR). However, smallpox virus is relatively
fragile, would not persist for long in the environment, and therefore sampling
and analysis would not be considered necessary. In the event of a bioterrorist
attack involving smallpox, local, state, and federal responders would determine
the need for sampling based on the specific circumstances associated with the
release.
What environmental decontamination would be required following a release of aerosolized
smallpox?
There is no evidence to suggest that environmental decontamination following an
aerosol release is warranted. By the time patients became ill and it had been
determined that an aerosol release of smallpox virus had occurred, there would
be no viable virus in the environment. The following references provide
additional information on environmental detection, persistence, and
decontamination of smallpox virus:
Public Health Response
What actions would be taken by public health authorities in the event of a bioterrorist attack involving
smallpox?
Various actions may be taken by public health authorities to treat and prevent further infections due to a release of
smallpox virus. These measures may include mass distribution of medications, surveillance, quarantine, and communication procedures. The
following references provide additional information.
- Emergency Preparedness & Response: Smallpox.
Centers for Disease Control and Prevention (CDC). Contains extensive
smallpox information, including fact sheets, overviews, FAQs, diagnosis and
evaluation, infection control, laboratory testing, surveillance and
investigation, selected publications, and education and training materials.
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Smallpox Response Plan and Guidelines (Version 3.0). Centers for Disease Control
and Prevention (CDC),
(2002, November 26). Outlines the public health strategies that
would guide the public health response to a smallpox emergency and many of the
federal, state, and local public health activities that must be undertaken in a
smallpox outbreak. Includes detailed work practices and engineering controls
to control infection, and other precautions that must be followed.
- Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness. Agency
for Healthcare Research and Quality (AHRQ), (2004, August). Also available as a
677 KB
PDF, 76 pages. Includes information on surveillance, stockpiling,
distribution, dispensing, followup, and other planning and organizational
concerns. Also describes the implementation of a comprehensive operational
structure for dispensing/vaccination clinics based on the National Incident
Management System (NIMS).
- Strategic National Stockpile (SNS). Centers for Disease Control
and Prevention (CDC), (2005, January 20).
Provides basic information on the SNS system.
- Barbera, Joseph, et al. "Large-Scale Quarantine Following Biological Terrorism in the United States: Scientific Examination, Logistic and Legal Limits, and Possible Consequences."
Journal of the American
Medical Association (JAMA) 286.21(2001,
December 5): 2711-2717. Includes information on possible logistics, legal limits, and
possible consequences of initiating quarantine procedures. Discusses quarantine
vs. isolation, legislative framework, considerations in making quarantine
decisions, and recommendations for developing a disease containment strategy.
Is a vaccine available to prevent
smallpox?
Currently, the smallpox vaccine is the only way to prevent the disease. This vaccine was used to successfully
eradicate smallpox from the human population, and therefore routine vaccination of the American public stopped in 1972. However, the U.S.
government has recently implemented plans to ensure there is sufficient vaccine available, and procedures in place to immunize everyone
who might need it in the event of an emergency. Certain emergency healthcare teams, military, and civilian personnel who are or may be
deployed in high threat areas have already been given the vaccine. In addition, vaccination within 3 days of exposure will completely
prevent or significantly modify smallpox in the vast majority of persons. Vaccination 4 to 7 days after exposure likely offers some
protection from the disease or may modify the severity of the disease. The following references provide additional information on
the smallpox vaccine.
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Smallpox Vaccination. Centers for Disease Control and Prevention (CDC).
Contains extensive smallpox information regarding the smallpox vaccine.
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Smallpox Response Plan and Guidelines (Version 3.0). Centers for Disease Control
and Prevention (CDC),
(2002, November 26). Outlines the public health strategies that
would guide the public health response to a smallpox emergency and many of the
federal, state, and local public health activities that must be undertaken in a
smallpox outbreak. Includes detailed information on the smallpox vaccine.
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Inglesby, Thomas V., et al. "Smallpox as a Biological Weapon: Medical and Public Health Management."
Journal of the American Medical Association (JAMA)
281.22(1999, June 9): 2281-2290.
- Vaccine Information: Smallpox. National Network for Immunization Information
(NNii),
(2005, February 25).
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Vaccinia (Smallpox) Vaccine, Recommendations of the Advisory Committee on
Immunization Practices (ACIP). Centers for Disease Control and
Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 50(RR10);1-25, (2001, June 22).
Contains the Advisory Committee on Immunization Practices (ACIP)
recommendations for the use of vaccinia vaccine if smallpox (variola) virus
were used as an agent of biological terrorism or if a smallpox outbreak were
to occur for another unforeseen reason.
- OSHA Recordkeeping Requirements for Smallpox
Vaccinations. OSHA. Contains answers
to frequently asked questions about OSHA's recordkeeping requirements for
smallpox vaccinations.
- Frequently Asked Questions: OSHA's Occupational Exposure to Bloodborne Pathogens Standard (29 CFR 1910.1030) and Smallpox Vaccination Programs.
OSHA. Addresses questions about how the
provisions of OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) apply to
healthcare workers who administer smallpox vaccinations during the current
vaccination program.
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