SMALLPOX CASE SCENARIO

1
SMALLPOX CASE SCENARIO

• WHO David Johnson, male college student,
• age 22, graduated from U of M in April
• and returned home to WV on April 30,
  2003
• 10 Downing Street, Charleston, WV 25301
• Phone [phone]
• DOB 01-01-1981
• Race White
• Ethnicity Non-Hispanic

IDEP / DSDC / OEHP / BPH
08 May,2003l
2

• WHEN Monday May 04, 2003
• WHERE Solo practice, Charleston WV,
• population 255 thousand
• WHAT - Sick for 1 ½ days
• - Severe muscle aches
• - Abdominal pain
• - Several episodes of vomiting
• - Oral temperature 103 F
• - Normal physical exam except for
  
• diffusely erythematous pharynx
  
• no exudates

IDEP / DSDC / OEHP / BPH
08 May,2003l
3

• Physician (Dr. Mathew Life) assumes that David
  may have a viral infection and sends him home
  with instructions to drink fluids and take
  aspirin or ibuprofen for muscle aches

IDEP / DSDC / OEHP / BPH
08 May,2003l
4

• WHEN Tuesday May 10, 2003
• WHERE Local emergency room
• WHAT - David Johnson appears acutely ill,
  presents with
• fever (oral temperature 101 F) and
  muscle aches
• for the last 5 days
• - He developed a lesion in his mouth
  on May 5
• followed by some raised spots
  (papules) on his
• face and arms the next day
• - Today the lesions are vesicular.
  Vesicles differ
• somewhat in size, but all appear
  to be in the
• same stage of development in any
  given area of
• the body

IDEP / DSDC / OEHP / BPH
08 May,2003l
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WHEN Tuesday May 10, 2003.continued
- He has negative or uncertain history of
chickenpox - The only medicine he is taking
is ibuprofen to relieve fever and muscle
aches. - He has never had any drug allergy
and has taken ibuprofen many times in the
past - No history of previous vaccination
IDEP / DSDC / OEHP / BPH
08 May,2003l
6
Physician collects blood specimens for chickenpox
and variola testing and patient is isolated in a
negative pressure room (Healing Hearts Hospital,
Charleston, WV). Emergency room staff is
advised on infection control practices

• WHEN Tuesday May 10, 2003.continued

IDEP / DSDC / OEHP / BPH
08 May,2003l
7
WHEN Tuesday May 10, 2003.continued

• - ER infection control nurse (Barbara Bush)
• informs Kanawha county health department.
• - Rhonda Kennedy (Surveillance nurse KCH)
• informs IDEP
• - IDEP starts collecting information on David
• Johnson and consults CDC
• - Joint decision is made to send isolates to
  CDC
• for testing

IDEP / DSDC / OEHP / BPH
08 May,2003l
8
FORM 1
IDEP / DSDC / OEHP / BPH
08 May,2003l
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WHEN Tuesday May 10, 2003.continued

• Preliminary Laboratory Results (May 10, 2003 PM)
• - Negative by DFA for Chickenpox
• - Awaiting variola results

IDEP / DSDC / OEHP / BPH
08 May,2003l
10

• WHEN Wednesday May 11, 2003
• WHAT - David Johnson now presents with a
• discrete pustular rash
• - Lesions are all in the same stage
  of
• development in any given area of
  his body
• - Laboratory tests confirm Variola
  major
• by CDC (evening May 11)
• - David is put on Cidofovir
• NEXT Raja continues active surveillance for
  smallpox
• Andrea begins to interview David
  Johnson

IDEP / DSDC / OEHP / BPH
08 May,2003l
11
FORM 2B
IDEP / DSDC / OEHP / BPH
08 May,2003l
12
Andrea starts interviewing David and collects the
following information

• Primary Contacts
• - Kim Johnson (mother) May 2 May 10
  
• - Bob Johnson (father) May 2 May
  10
• - Paige Johnson (brother) May 2 May 8
• - Travis Johnson (brother) May 6 May
  10
• - Susan Jordan (girlfriend) May 3 May
  9
• - Dr. Mathew Life (physician) May 4
  May 4
• - Rose Ann Michaels (nurse) May 4 May
  4
• - Margaret Taylor (friend) May 9
  May 9

IDEP / DSDC / OEHP / BPH
08 May,2003l
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FORM 2 A 2C
IDEP / DSDC / OEHP / BPH
08 May,2003l
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Travel History/Activities of David Johnson
since fever onset  May 2 Drive through
McDonalds. Slept all day May 3 Visit
girlfriend, watched a video with girlfriend.
Ate lunch with girlfriend and her
roommate (Delilah Samson).
May 4 Went to Dr. Lifes office with Mom
May 5 Walk with girlfriend to park down the
street at dusk May 6
Stayed home all day watching TV and working
on resume May 7 In bed half the
day reading and sleeping May 8 Rest and
called friends May 9 Rest all day May 10
Very sick, taken to ER by Mom and Dad 
IDEP / DSDC / OEHP / BPH
08 May,2003l
15
Delilah Love Add to primary contacts
IDEP / DSDC / OEHP / BPH
08 May,2003l
16

• Use Form 2D to collect additional information
  from David Johnson on each primary contact.

17
Additional information on Primary contacts

• Paige Johnson
• - 10 Downing Street., Charleston, WV 25301
• - DOB 05-01-1987, Age 16
• - White, Non-Hispanic, Male
• - Phone [phone]
• - 5 ft. 11 in., medium build, blonde, light
  skin
• - English is primary language
• - Capitol High school Student

IDEP / DSDC / OEHP / BPH
08 May,2003l
18

• Delilah Love
• - 700 Oakwood, Charleston, WV 25302
• - DOB 4/20/1981, Age 22
• - White, Non-Hispanic, Female
• - Home Phone [phone]
• - 5 ft. 3 in., Small build, Brown Hair, Medium
  
• Complexion
• - English is primary language
• - University of Charleston student

IDEP / DSDC / OEHP / BPH
08 May,2003l
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Dr. Mathew Life - 56 Greenbriar,
Charleston, WV 25311 - DOB 08-19-1957, Age
45 - African American, Non-Hispanic, Male
- Home Phone [phone] - Work Phone
304-344-3698 - 6 ft. 1 in., small build,
dark brown hair, dark complexion -
English is primary language - Works at
Healthcare Associates of Charleston, 221
Lee St - Works 800am 600pm Mon - Sat
IDEP / DSDC / OEHP / BPH
08 May,2003l
20
Andrea finishes interviewing David Johnson about
the primary contacts and passes the information
on Form 2D to Harlan for contact tracing and
face-to-face interviews of primary contacts.
WHEN Wednesday May 11, 2003 (evening)
21

• FORM 2D AND 2E
• Use Form 2D for locating contacts and recording
  disposition
• Use Form 2E for recording daily surveillance
  interview

IDEP / DSDC / OEHP / BPH
08 May,2003l
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• WHEN Thursday May 12, 2003
• WHAT Face-to-face interview of contacts after
  receiving forms 2D
• All contacts were put under active surveillance
  using form 2D and 2E. Information from the
  following 3 interviews are used to illustrate
  this procedure.

IDEP / DSDC / OEHP / BPH
08 May,2003l
23

• WHEN Thursday May 12, 2003continued
• Paige Johnson
• - Fever 102 F) on May 12 fever (101.9 F)
• on May 11
• - Developed macular rash on May 14

IDEP / DSDC / OEHP / BPH
08 May,2003l
24

• WHEN Thursday May 12, 2003continued
• Delilah Love
• - Referred for vaccination and vaccinated on
• May 12, 2003
• - Fever onset on night of May 13 (101 F) and
• fever present on morning of May 14th
• - Fever resolves on night of May 15th
• - Vaccination take verified on May 19th

IDEP / DSDC / OEHP / BPH
08 May,2003l
25

• WHEN Thursday May 12, 2003continued
• Dr. Matthew Life
• - Referred for vaccination and vaccinated on
  May 12
• - Asymptomatic for 21 days after last
  exposure to
• David Johnson
• - Dr. Matthew Life has 3 household contacts

08 May,2003l
26
FORM 2FUse Form 2F to list
Dr. Lifes household members (secondary contacts
of David Johnson).
27
Dr. Lifes family members

• Hope (wife)
• Grace (daughter)
• Joy (daughter)

28
Use Form 2D to collect additional information on
each secondary contact. Also, mark date
vaccinated and date of vaccine take on Form 2F
for each secondary contact.
29
Additional Info on Secondary Contacts

• Hope wife, age 45 DOB 10/30/57 housewife
  African American 5 ft., 4 in slim, black hair,
  dark
• Grace daughter age 10, DOB 4/12/93 African
  American 4 ft., 5 in, slim, black hair, dark
  complexion
• Joy Ann daughter, age 5 DOB 1/2/98 slim,
  African American, black hair, dark complexion
• All household members vaccinated on May 12 and
  takes verified on 19th

30
Raja will update us on Case Investigation and
status of David Johnson.
31

• WHEN May 13, 2003
• - David is seriously ill
• - 3 additional probable cases have been
• identified
• - Exposure investigation is ongoing

IDEP / DSDC / OEHP / BPH
08 May,2003l
32
WHEN May 14, 2003 - David Johnson dies -
Active Surveillance continues - Initial
exposure still unknown