October 14, 2004
UK details smallpox response plan
The United Kingdom (UK) Department
of Health has provided a detailed and very useful update online of their
“Interim Guidelines for Smallpox Response and Management in the
Post-Eradication Era (Smallpox Plan)”. The 59 page core document ranges from
training and planning for smallpox, to management of initial cases and their
contacts, to vaccination strategies, to communication with the media and the
public. The document is found on the website of the UK Department of Health at www.dh.gov.uk by entering the search term
“smallpox” on the homepage.
Appendix
1-17 follows with further specific guidelines including algorithmic flow
diagrams on management of initial suspected cases when they occur: at home, in
the Emergency Department, in the Intensive Care Unit, on the Medical, Surgical, or Infectious Disease wards or
clinics, or at a Port Health Control Unit.
In
the text of the plan, pages 44-47, there are six “Alert Levels” listed, and
specific preparedness measures defined for each level. The levels are:
Level
0: No credible threat of a smallpox release.
Level
1: At least one case of smallpox outside the UK.
Level
2: At least one case inside the UK.
Level
3: A smallpox outbreak in the UK.
Level
4: A large outbreak of smallpox not controlled by “ring vaccination”
Level
5: Outbreak controlled and no further cases.
Guidelines
for these UK “alert levels” are very helpful when considering and comparing
with the four general smallpox “scenarios” described for the USA by the
Institute of Medicine (IOM) of the National Academies Committee on Smallpox
Vaccination Program Implementation in their letter # 5 to the US Centers for
Disease Control (http://books.nap.edu/catalog/10875.html)
The UK smallpox containment strategy
begins with the same measures as the USA and the WHO strategy recommendations
including: isolation of cases, tracing-surveillance of contacts, quarantine of
contacts and “ring vaccination” of cases and cases. In the UK plan, however,
there is also an Alert Level 4 defined (page 46 of 59) as when a large outbreak
occurs that is not controlled by the traditional and field-proven “ring
vaccination” strategy. Such hypothetical “circumstances may arise when mass
vaccination may be required to raise the level of immunity to smallpox such as
when:
Daniel R. Lucey, MD,
MPH
Director, Center for
Biologic Counterterrorism and Emerging Diseases