Treatment of patients with possible or known exposure to smallpox
The smallpox vaccine is the only known way to prevent smallpox in an exposed person. If given within 4 days of viral exposure, the vaccine can prevent or significantly lessen the severity of smallpox symptoms. Vaccination 4-7 days after exposure may offer some protection from the disease and may lessen its severity.
Isolate patients possibly infected with smallpox virus in negative-pressure rooms and vaccinate them within the first 4 days after exposure. Supportive and symptomatic treatment (eg, hydration, nutrition) should be provided.
Vaccinia immunoglobulin does not appear to offer a survival benefit when given to patients during the incubation or active-disease stages of smallpox. However, new drugs are under investigation. For example, cidofovir may be beneficial if given in the early stages of illness, although the effectiveness of this treatment has not been proven in humans.
 Smallpox Quickly Treatment Tips

Top Symptoms

Symptoms usually occur about 12 - 14 days after you have been infected with the virus. They may include:
Excessive bleeding
High fever
Raised pink rash -- turns into sores that become crusty on day 8 or 9
Severe headache
Back to TopExams and Tests
Tests include:
DIC panel
Platelet count
White blood cell count
Special laboratory tests can be used to identify the virus.
Top Treatment
If a the smallpox vaccine is given within 1-4 days after a person is exposed to the disease, it may prevent illness or make the illness less severe. Once symptoms have started, treatment is limited.
There is no drug specifically for treating smallpox. Sometimes antibiotics are given for infections that may occur in people who have smallpox. Taking antibodies against a disease similar to smallpox (vaccinia immune globulin) may help shorten the duration of the disease.
People who have been diagnosed with smallpox and everyone they have come into close contact with need to be isolated immediately. They need to receive the vaccine and be monitored.
Emergency measures would need to be taken immediately to protect the general population. Health officials would follow the recommended guidelines from the CDC and other federal and local health agencies.
Top Outlook (Prognosis)
In the past, this was a major illness with the risk of death as high as 30%.

Top Possible Complications

Arthritis and bone infections
Brain swelling (encephalitis)
Eye infections
Severe bleeding
Skin infections (from the sores)

Types of Smallpox
There were two common and two rare forms of smallpox. The two major forms were known as variola minor and variola major.
Variola minor was a less fatal type of smallpox. Only one percent of those infected died. However, it was less common than variola major.
Ninety percent of smallpox cases were Variola major. Historically, this type of smallpox killed 30 percent of those infected.

The two rare forms of smallpox were known as hemorrhagic and malignant. Both of these rare forms of smallpox carried an almost 100 percent fatality rate.

Hemorrhagic smallpox caused organs to leak blood into the mucous membranes and skin.

Malignant smallpox lesions did not develop into pustules or pus filled bumps on the skin. Instead, they remained soft and flat throughout the entire illness.

What Are the Symptoms of Smallpox?
Historical accounts show that when someone was infected with the smallpox virus, they had no symptoms between seven and 17 days. However, once the incubation period (or virus development phase) was over, the following flu-like symptoms occurred:

high fever
severe back pain
abdominal pain
These symptoms would go away within two to three days. Then the patient would feel better. However, just as the patient started to feel better, a rash would appear. The rash started on the face and then spread to the hands, forearms, and the main part of the body. The person would be highly contagious until the rash disappeared.

Within two days of appearance, the rash would develop into abscesses that filled with fluid and pus. The abscesses would break open and scab over. The scabs would eventually fall off, leaving pit mark scars. Until the scabs fell off, the person remained contagious.

How Do You Catch Smallpox?
One of the reasons smallpox was so dangerous and deadly is because it’s an airborne disease. Airborne diseases tend to spread fast.

Coughing, sneezing, or direct contact with any bodily fluids could spread the smallpox virus. In addition, sharing contaminated clothing or bedding could lead to infection.

Treatment for Smallpox
There is no cure for the smallpox virus. As a result of worldwide, repeated vaccination programs, the variola virus (smallpox) has been completely eradicated. The only people considered to be at risk for smallpox are researchers who work with it in a laboratory setting.
In the unlikely event that an exposure to the smallpox virus occurs, vaccination within one to three days can keep the illness from being so severe. In addition, antibiotics can help to reduce the bacterial infections associated with the virus.

Smallpox patients should be transferred as necessary, with appropriate respiratory and contact isolation.

Infectious disease specialists and public health officials should be consulted in cases of smallpox. CDC officials and state health authorities should be notified immediately.
One of the best ways to prevent smallpox is through vaccination. Vaccine given to individuals before exposure to smallpox can completely protect them. Vaccination within 3 days after exposure prevents or greatly lessens the severity of smallpox in most people. Vaccination 4-7 days after exposure likely offers some protection from disease or may decrease the severity of disease. Vaccination does not protect patients with smallpox who have already developed a rash.(For additional information, see Smallpox Vaccination: Vaccination Method and Reactions.)

Cross-protective immunity from vaccinia is most effective during the first 10 years after vaccination and slowly wanes thereafter. Persons who have been vaccinated several times are likely to have longer-lasting immunity of unclear duration.

The level of protection in individuals who were vaccinated 30 or more years ago, should they be exposed to smallpox today, is unclear.

Vaccinated persons normally exhibit an accelerated immune response. Thus, whenever possible, assigning those who have previously been vaccinated to duties involving close patient contact is prudent.

Persons with known or possible exposure to smallpox should be vaccinated if the exposure has occurred within 3 days, unless the patient has specific contraindications for which the risks of immunization are considered even greater than the dangers associated with contracting smallpox.

Persons with known cardiac disease (eg, previous myocardial infarction, angina, congestive heart failure, cardiomyopathy) should receive smallpox vaccination. Myocardial infarctions and angina without myocardial infarction have been reported following smallpox vaccinations. The association between smallpox vaccination and these cardiac events is not clear.

Pregnant women who receive the smallpox vaccine are at risk of fetal vaccinia, which usually results in stillbirth or death of the infant. Pregnant women should not receive smallpox vaccination, and women should be advised against becoming pregnant for 4 weeks after smallpox vaccination.
Additional Infection-Control Considerations
Avoid transporting the patient through the hospital (eg, use in-room portable radiographic equipment); if transporting the patient is unavoidable, have the patient wear a surgical mask and the health care worker a mask with an N-95 respirator.

If smallpox infection is confirmed, place contacts under fever surveillance for 18 days after their last contact with the infected patient.

Contacts or a supervisor should monitor the patient’s temperature twice daily. If the patient’s temperature is higher than 38.1°C (100.5°F), public health authorities should be notified immediately. (See the graph below.)
Typical temperature chart of a patient with smallp
Typical temperature chart of a patient with smallpox infection.

Deterrence and Prevention
Isolation and mass and/or ring vaccination can prevent the spread of smallpox. The reemergence of smallpox would constitute an international emergency, and failure to immediately report cases to public health authorities would severely impair their ability to contain the disease.

An informed public could better comply with vaccination and quarantine procedures if smallpox reemerged. If the disease did reemerge, management strategies would include the following:
Smallpox Vaccine
Reports vary concerning the number of existing smallpox vaccine doses in the U.S. and abroad. Studies are under way to determine how much a vaccine dose can be diluted without compromising its effectiveness. The Department of Health and Human Services' goal is to have one dose for every American in case of a bioterrorism attack. Until then, the executive branch of the federal government, via the CDC, decides who is vaccinated. The state health departments also have access to limited local stock. Reports also vary concerning the World Health Organization's current storage of smallpox vaccine.

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