Protect and Care for Smallpox Patients

In a smallpox emergency, your facility may be called upon to care for patients with the disease, or suspected of having the disease. Plan now how your facility will respond quickly and effectively to identify and treat patients.

Identify and Diagnose Smallpox as Quickly as Possible

There has not been a case of smallpox in the world in almost 40 years. Most medical staff practicing today have never seen a case of smallpox, which might make diagnosing the disease in an emergency difficult.

CDC has developed tools to help clinicians recognize smallpox. Include how to recognize the signs and symptoms of smallpox in your facility’s regular training. Also ensure staff know your facility’s plans for how to respond, including how to contact local and state public health departments and CDC to confirm or rule out the disease.

Isolate Infected Patients from General Patient Population

If consultation with CDC and local and state public health departments suggests a patient is at high risk of having smallpox, or confirms a diagnosis of smallpox, isolate the patient from the general patient population as soon as possible. Follow standard, contact, and airborne precautions.

Transport the patient safely to an airborne infection isolation room (AIIR).

• AIIRs should have negative air pressure in relation to the corridor and surrounding areas with all exhaust externally vented away from air intakes or where people may pass.
• If possible the air should be externally vented after passing through a filter with a MERV rating* of at least 17.
• The filters should be disposed of in an appropriate manner (discarded in biohazard bags and autoclaved or incinerated).
• Air exhaust should also be separated by >25 feet from the air intake.

Take precautions to prevent the spread of disease during transport:

• If the patient has a rash, cover the patient with a sheet to prevent rash particles from becoming airborne.
• Cover the patient’s nose and mouth with a surgical mask or N95 respirator.
• Use only personnel who have been vaccinated against smallpox OR vaccinate personnel within 72 hours of their first exposure to the patient (preferably within 24 hours).
• Personnel should wear personal protective equipment (PPE) and adhere to standard, contact, and airborne precautions.
• After transporting the patient, disinfect any equipment used (such as gurneys, wheelchairs, etc.) using standard disinfection procedures and handle linens with care.

Patients will need to remain in an AIIR for the duration of their illness, which may last 3 to 4 weeks.

If the facility does not have an AIIR:

• Place the patient in an exam room and close the door.
• Give the patient a surgical mask or appropriately fitted N95 respirator and instruct them on using it.
• Transfer the patient to a healthcare facility that has an AIIR. Disinfect the ambulance after transporting the patient and before transporting anyone who does not have the disease.

Emergency plans should address the need to protect non-smallpox patients within the healthcare facility. Depending on the number of smallpox patients a facility is treating, the facility may need to discharge some patients (if medically indicated) or transfer others to different facilities in the area. In a smallpox emergency, work with local and state public health authorities to determine the best course of action.

Additional Resources

• Facility Guidelines Institute, American Society of Healthcare Engineering. Guidelines for Design and Construction of Hospitals and Outpatient Facilities. 2014 ed: American Hospital Association; 2014.
• *ANSI/ASHRAE. ASHRAE Standard 52.2-2012: Method of Testing General Ventilation Air-Cleaning Devices for Removal Efficiency by Particle Size. Atlanta, GA: American Society of Heating, Refrigeration, and Air-Conditioning Engineers, Inc.; 2012.
• Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).
• 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

Care for Smallpox Patients

The medical management of smallpox patients is generally supportive. Patients are considered infectious once lesions in the throat and mouth appear, throughout the course of the disease, and until the last scab falls off. The duration of ordinary type smallpox typically lasts 3 to 4 weeks.

In addition to providing medical care to the patient, consider other areas that support the patient’s general well-being. Patients in isolation may suffer from anxiety, depression, or report feeling stigmatized. They may also feel forgotten, as the need for PPE reduces the frequency of interaction with clinical staff. Include in your facility’s plans ways to allow for visitors, especially for pediatric patients. All visitors will need to be vaccinated and wear appropriate PPE.