Smallpox as a biological weapon - Medical and public health management

Objective. To develop consensus-based recommendations for measures to be ta ken by medical and public health professionals following the use of smallpo x as a biological weapon against a civilian population. Participants. The working group included 21 representatives from staff of m ajor medical centers and research, government, military, public health, and emergency management institutions and agencies. Evidence. The first author (D.A.H..) conducted a literature search in conju nction with the preparation of another publication on smallpox as well as t his article. The literature identified was reviewed and opinions were sough t from experts in the diagnosis and management of smallpox, including membe rs of the working group. Consensus Process. The first draft of the consensus statement was a synthes is of information obtained in the evidence-gathering process. Members of th e working group provided formal written comments that were incorporated int o the second draft of the statement. The working group reviewed the second draft on October 30, 1998. No significant disagreements existed and comment s were incorporated into a third draft. The fourth and final statement inco rporates all relevant evidence obtained by the literature search in conjunc tion with final consensus recommendations supported by all working group me mbers. Conclusions. Specific recommendations are made regarding smallpox vaccinati on, therapy, postexposure isolation and infection control, hospital epidemi ology and infection control, home care, decontamination of the environment, and additional research needs. In the event of an actual release of smallp ox and subsequent epidemic, early detection, isolation of infected individu als, surveillance of contacts, and a focused selective vaccination program will be the essential items of an effective control program.