Frequently asked Questions

Smallpox is an illness with high fevers and a severe rash caused by a virus called variola. The rash spreads and progresses to raised bumps and pus-filled blisters that crust, scab, and fall off after about three weeks, leaving a pitted scar, which can leave permanent scars when healed. The smallpox virus is contagious, though less contagious than viruses such as influenza and chickenpox. Up to one-third of persons who are infected may die.

The smallpox virus no longer occurs naturally, due to the success of the vaccination program led by the World Health Organization to rid the world of this disease. The last natural case of smallpox in the world was in 1977.

2) Is there any treatment for smallpox?

No. There is currently no proven treatment for smallpox. But scientists are evaluating new anti-viral medications. Early results from laboratory studies suggest that the anti-viral drug, cidofovir, may work against the smallpox virus; currently, studies with animals are being done to better understand this drug's ability to treat smallpox disease. However, this medicine has never been used to treat patients with smallpox so we do not know if it will work in people.

Patients with smallpox can benefit from supportive therapy (for example, intravenous fluids, medicine to control fever or pain) and antibiotics for any secondary bacterial infections that may occur.

3) What is smallpox vaccine?

The smallpox vaccine is a live virus vaccine that helps the body develop immunity (antibodies) to smallpox virus. It contains vaccinia virus, which is closely related to, but a different virus than smallpox virus. The vaccine does not contain the smallpox virus, and cannot give you smallpox disease.

The vaccine is the best way to prevent smallpox disease and death in someone who may be or has been exposed to the smallpox virus. The vaccine protects against smallpox even if given up to 3 days after exposure. In the United States, we stopped routine use of smallpox vaccine for all persons in 1972, except for certain laboratory workers and the military. The military stopped using the vaccine routinely in the mid 1980s. In most parts of the world, smallpox vaccinations ended by 1980. Immunity against smallpox decreases over time so that most Americans today would be susceptible to smallpox even if they were vaccinated as a child.

4) What is this new smallpox vaccination program being started by the United States government?

The United States government has decided to offer smallpox vaccine to a small group of hospital, public health and public safety workers, as well as to some military troops. About 500,000 civilian health care, public health and public safety workers in the United States will be offered smallpox vaccine during the next several months.

5) Since there is no longer any smallpox in the world, why is the United States government starting a new vaccine program?

The smallpox virus is still kept in government research laboratories in the United States and Russia. There are concerns that countries or terrorist groups hostile to the United States may have stockpiles of the smallpox virus. The risk of a deliberate release
of smallpox as a biologic weapon is unknown, but if it did occur, there could be a large outbreak with many people becoming seriously ill, and up to one third dying. Therefore, the United States government has decided to prepare for a smallpox outbreak by vaccinating teams of volunteer hospital staff, public health and public safety workers before such an attack occurs. These persons would then be able to care for the first few patients until other hospital staff who are not yet vaccinated get the vaccine.

6) What might we expect if an outbreak of smallpox occurred today?

If an outbreak of smallpox were to occur, several factors could contribute to a more rapid spread of smallpox than was usually seen before this disease was eradicated in 1977.

These factors include:

There are almost no persons who are immune (have protective antibodies) to smallpox due to the absence of naturally occurring disease worldwide and the end of routine vaccinations in the United States in 1972,
It may take longer for doctors to recognize the first cases of smallpox, as many doctors today are not familiar with smallpox disease, and
Smallpox virus may spread faster today due to the ease of travel and crowding of the population compared to 30 years ago, when routine vaccination stopped.

Though outbreaks in the past have been controlled by rapidly vaccinating close contacts of smallpox patients (ring vaccination strategy), the success of this control was based on rapidly recognizing and isolating the first smallpox patients. The concern is that many doctors today have not seen smallpox and might not be able to recognize it in a timely manner before the outbreak spreads.

For these reasons, just one case of smallpox would require an immediate and coordinated public health and medical response to control the outbreak and to prevent further infection of susceptible individuals (people without immunity {antibodies} to smallpox). We would need vaccinated health care workers to care for the first victims. We would also need public health staff to work at emergency smallpox vaccine clinics as well as to find the close contacts of the initial smallpox cases that would be most at risk for smallpox infection.

We need to protect these health care teams who will be essential to our response in the event of a smallpox outbreak. It is best if these first responder teams receive smallpox vaccine ahead of time, so they are ready to respond immediately as soon as the first smallpox cases are identified.

If there were an outbreak of smallpox, the federal government has enough smallpox vaccine for the entire country, if needed. By vaccinating health care and public health response teams ahead of time, we also would have emergency workers ready and able to give vaccine to all others who needed to be vaccinated after a smallpox outbreak had been confirmed.

7) Why is smallpox vaccine being offered to all hospitals in Utah?

If there were a smallpox outbreak in Utah, it is likely that there would be more than a few cases. As we can not predict which hospitals might see the first cases, it is important to be sure that all hospitals that care for acutely ill patients have staff available who are protected against the smallpox virus, and who would be available to take care of these patients until other staff could be vaccinated.

8) How many people are being vaccinated at each hospital?

The Advisory Committee on Immunization Practices (ACIP) provided general guidelines. Based on those guidelines, larger hospitals may choose to vaccinate about 100 staff. Smaller hospitals will probably vaccinate smaller teams. Each Utah hospital has been asked to consider their individual needs based on the general guidelines by the ACIP.

9) Why are only certain hospital personnel being asked to volunteer?

This is the first step in the United States government's smallpox vaccination program. In this first step, hospitals like yours have been asked to reach out to only those staff who would be needed to care for the first few smallpox patients that might come to your hospital if there were an outbreak in the city.

This includes medical and nursing staff who work in the emergency department, intensive care unit, the adult and pediatric wards, and certain specialty areas as well as respiratory therapists, radiology technicians, security, housekeeping, and other clinical support staff.

Each hospital that decides to participate in this program will be responsible for deciding what types of staff are needed for their health care smallpox response teams.

10) Will other staff be vaccinated in the future?

In the future, during the second step of this vaccine program, the United States government may be offering smallpox vaccine to other health care workers.

11) I work in an outpatient clinic setting, why am I not able to volunteer during this first step of the program, as it is possible that I might see the first smallpox cases?

The goal of this first step of the pre-event smallpox vaccination program is to protect those health care workers who would be asked to "care for" the initial smallpox victims in the hospital once an outbreak is recognized or suspected.

For this first phase, as the amount of licensed smallpox vaccine is limited, we are not able to vaccinate any one who might be the first "to see" the initial victims in their medical office or clinic. During the second step of this program, possibly starting later in 2003 when more licensed vaccine is available, smallpox vaccine may be offered to all other health care workers. So you may have the opportunity to get the vaccine at that time..

12) What smallpox vaccine is being used?

The vaccine that is being used is the "Dryvax" vaccine. It is the same vaccine that was used in the United States up until 1972. This vaccine was recently tested in clinical trials and was shown to be effective. The vaccine lots that will be used were recently licensed by the Food and Drug Administration.

13) If I received smallpox vaccine in the past, am I still protected?

Protection against smallpox lasts about 3 to 5 years, and then the immunity to the smallpox virus begins to decrease. If exposed to the smallpox virus, persons who were vaccinated over 10 years ago may no longer be fully protected and may become infected with smallpox. They might have less severe disease and be less likely to die than someone who was never vaccinated. There is very little information available on the amount of residual protection offered by vaccinia vaccine given 30 years prior to an event.

14) Since the smallpox vaccine contains a live virus, vaccinia, can this virus spread to other persons?

Yes. The virus in the smallpox vaccine, the vaccinia virus, can be found at the site of the vaccination until the scab falls off (which usually takes about 3 weeks). Because the vaccine site contains a live virus, vaccinia virus can spread to other people and even to other parts of the body far from the vaccine site. This can be prevented by not touching the vaccine site and by proper care of the vaccine site, including covering the site with the recommended dressing, carefully washing your hands after touching the site or the dressing, and by disposing of used dressing materials in sealed plastic (zip-locked) bags when at home and in the infectious waste containers (red bags) at work.

15) How is the vaccine given?

The smallpox vaccine is given using a different method than all other vaccines. The vaccine is given using a bifurcated (two-prong) needle that is dipped into the vaccine solution. This needle is then used to quickly prick a small area on the skin in just a few seconds. The pricking is not deep, but it will cause a sore spot and a few drops of blood at the site. The vaccine is usually given on the outside of the upper arm.

16) How do you know if the vaccination was successful?

If the vaccination is successful, a red and itchy bump will form at the vaccine site in 3 to 4 days. About a week after vaccination, the bump becomes a large blister, fills with pus, and begins to drain. In about 2 weeks, the blister begins to dry up and a scab forms. The scab usually falls off in about 3 weeks, leaving a small scar. If someone is getting the vaccine for the first time, this reaction may be stronger (with more redness and swelling) compared to someone who got the vaccine in the past.

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Frequently Asked Questions about Smallpox Vaccine and the Voluntary Program for Vaccination of Heath Care Smallpox Response Teams

Frequently Asked Questions about Smallpox Vaccine and the
Voluntary Program for Vaccination of Heath Care Smallpox Response Teams