Illness Evaluation

1
Illness Evaluation

• Ruling Out Smallpox in Those who Present with a
  Rash Illness

2
JOB DESCRIPTION OF MEDICAL STAFF

• Evaluate clients who were identified as ill
  during triage to determine whether they are
  sufficiently healthy to receive a smallpox
  vaccination or should be referred to a hospital
  for diagnosis and/or treatment of possible
  smallpox infection.
• May be required to assist in other areas,such as
  Medical Screening and Counseling or Contact
  Evaluation.

3
Discharge of Clients

• Clients determined to be eligible for vaccine
  will be referred to Forms Distribution Area.
  (Clients with symptoms and signs of minor illness
  such as URI with temperature less than 100
  degrees or gastroenteritis may be considered for
  vaccination.

4
Discharge of Clients

• Clients with febrile rash illness or considered
  to possibly have smallpox prodrome will be
  directed to a hospital for diagnosis and
  treatment.
• Other clients considered to be too ill to receive
  vaccine will be advised to seek medical
  attention.
• Clients with contraindications to vaccination and
  decline to be vaccinated will exit the
  vaccination clinic at this stage of the process.

5
Smallpox SurveillanceClinical Case Definition

• An illness with acute onset of fever gt 101o
  followed by a rash characterized by firm,
  deep-seated vesicles or pustules in the same
  stage of development without other apparent cause

6
Smallpox Major Criteria

• Prodrome (1-4 days before rash onset)
• Fever gt101oF (38.3oC) and
• gt1 symptom prostration, headache, backache,
  chills, vomiting, abdominal pain
• Classic smallpox lesions
• Firm, round, deep-seated pustules
• All lesions in same stage of development (on one
  part of the body)

7
Smallpox Minor Criteria

• Centrifugal (distal) distribution
• First lesions oral mucosa, face, or forearms
• Patient toxic or moribund
• Slow evolution (each stage 1-2 days)
• Lesions on palms and soles

8
High Risk All 3 Major Criteria

• Prodrome (1-4 days before rash onset)
• Classic smallpox lesions
• All lesions in same stage of development (on one
  part of the body)

9
Immediate Action for Patient with Generalized
Vesicular or Pustular Rash Illness

• Airborne and contact precautions instituted
• Infection control team alerted
• Assess illness for smallpox risk

10
Moderate Risk

• Prodrome AND 1 other major criteria OR
• Prodrome AND gt4 MINOR smallpox criteria

11
Low Risk

• No febrile prodrome
• OR
• Febrile prodrome AND lt4 MINOR smallpox criteria

12
CDC Rash Illness Response Team Experience with
Use of Algorithm

• 23 calls to CDC January 1 November 30, 2002
• 14 states and New York City
• 17 adults and 6 children
• Smallpox risk classification
• High risk 0. No indications for variola virus
  testing
• Moderate risk 4
• Low risk 19

13
CDC Rash Response Team Experience with Use of
Algorithm

• gt50 of the cases including 2 deaths have been
  varicella
• 12 diagnoses confirmed by lab and/or pathology
  11 clinically diagnosed
• Other diagnoses
• drug reaction
• erythema multiforme
• disseminated herpes zoster
• disseminated HSV2
• contact dermatitis
• other dermatological disorders