As with other infectious diseases, health-care workers must have a containment and treatment plan in case there is an exposure to smallpox. First, decontamination procedures are unnecessary.
Second, the only effective treatment available is to vaccinate during the incubation period. The two types of immunizing material are smallpox vaccine (vaccinia virus) and vaccinia immune-globulin (VIG). The vaccine alone is sufficient if the victim receives it within three days of the exposure. If more than three days have elapsed, then the infected person must receive both the vaccine and VIG. The vaccine is now commercially available, and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) holds all available stock of VIG.
Third, the next step is to isolate the infected persons. If there were a large-scale epidemic, quarantine quarters would have to be big enough to house all exposed individuals. Isolation of people with smallpox is difficult. The hospitals will need special equipment. Because of the danger, testing of specimens can only take place in BSL-4 laboratories. Such facilities are only available at USAMRIID. In BSL-4 laboratories, everyone wears spacesuits and oxygen tanks. The smallpox containment protocol would be as follows:
- Install ventilation system with negative air pressure, six to twelve air exchanges per hour, and monitored filtration of air prior to expulsion.
- Wear head cover, gown, and gloves before entering isolation area.
- Wear respirator mask with micro filter for particles less than five microns in width (must meet the minimal National Institute for Occupational Safety and Health standards for particulate respirators).
- Wash hands using antimicrobial agent before and after each contact.
- Limit patient transport as much as possible.
The release of variola virus over even a small area would cause a devastating epidemic. There are not enough facilities available with negative-pressure air-filtration systems to contain this bug. Containment can only happen one of two ways: inoculate everybody or equip several gymnasiums in every city with negative-pressure airflow systems and build thousands of BSL-4 laboratories.