After the horror of the terrorist attacks on New York, Washington and rural Pennsylvania on September 11, 2001 and the anthrax attacks that followed, a heightened awareness of the possibility of further terrorism developed among the general population and healthcare providers in particular. Multiple governmental, educational and private agencies have responded with information for healthcare providers about the identification, prevention and treatment of a variety of biological, chemical and radiological terrorism threats.
One of the most destructive potential threats is that of smallpox, if it were to be used as a biological agent of terror. Smallpox is a serious, highly contagious, and sometimes fatal infectious viral disease. The name is derived from the Latin word for "spotted" and refers to the raised bumps that appear on the face and body of an infected person.
Smallpox outbreaks have occurred episodically for thousands of years, but the disease was considered eradicated after a successful worldwide vaccination program. The last naturally acquired case of smallpox in the United States was in 1949, and the last naturally occurring case in the world was in Somalia in 1977. The last case of smallpox, acquired from a laboratory exposure, occurred in the United Kingdom in 1978. In the United States, routine vaccination against smallpox ended in 1972 (CDC, 2001d). Smallpox was declared globally eradicated on May 8, 1980 by the World Health Assembly, the supreme decision making body of the World Health Organization. After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention. However, it remains a biological threat because of its potential ease of large-scale production and subsequent use in a deliberate biological attack (CDC, October, 2002).
The use of the smallpox virus as a biological weapon may be less likely than other biological agents because of its restricted availability. However, over the last several years, multiple claims have arisen about terrorist groups or foreign governments having the smallpox virus.
Even one suspected case of smallpox is an international public health emergency. It will require rapid identification, a definitive diagnosis with rapid laboratory confirmation at the Centers for Disease Control and Prevention (CDC), and vaccination to contain and prevent further smallpox transmission. In the US, in 2003, volunteer healthcare providers were vaccinated in order to have a team of healthcare providers who could rapidly begin the vaccination process among the general public, if a smallpox outbreak occurred. These immunized healthcare workers had to have been vaccinated themselves prior to being able to give the vaccination.
Currently, specific therapies with proven treatment effectiveness for smallpox are unavailable. Medical care of more seriously ill smallpox patients would be resource intensive and would include primarily supportive measures and antiviral treatment. If the patient's condition allows, medical and public health authorities should consider isolation and observation outside a hospital setting to prevent healthcare associated smallpox transmission and overburden of healthcare resources.
Government and public health officials have been working on an organized, coordinated response to the threat of smallpox as a biological weapon. In December 2002, The CDC Smallpox Response Plan and Guidelines was released. This document 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. It can be accessed at http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp#annex.
This course will address the pre-event information needed by healthcare
providers. It will include an overview of smallpox, including identification
of smallpox, distinguishing it from other rash illnesses, vaccination,
adverse reactions and their management. Additionally, the process of vaccination
will be covered. This course is divided into three sections: Part I provides
an overview of smallpox including information about its use as a weapon
of terror; Part II addresses smallpox immunization benefits, risks, and
the vaccination procedures; and Part III includes the role of healthcare
providers in preparing for the potential use of smallpox as a weapon of
mass destruction. It is expected that healthcare providers will follow-up
this course with a locally available experiential educational activity
that will allow them the opportunity to have hands-on practice with the
vaccination process.
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