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A 41-year-old nurse is evaluated because of fever. Three days ago, she was exposed to a patient who now has confirmed smallpox. The nurse has never received smallpox vaccine and is concerned about developing this disease.

On physical examination, her temperature is 37.4 °C (99.3 °F), and no rash is noted. She is furloughed from hospital duties until the incubation period for smallpox is ended.

In addition to taking her temperature twice daily and watching for development of a rash, which of the following is most appropriate for the nurse at this time?

A No additional interventions are indicated
B Administer smallpox vaccine
[] C Administer smallpox vaccine and vaccinia immune globulin
] D Administer smallpox vaccine, vaccinia immune globulin, and cidofovi

C? not sure

Correct Answer = B)
Key Points

* Contacts of patients with possible smallpox should receive smallpox vaccine.
* Contacts of patients with possible smallpox should take their temperature twice daily for 17 days; a contact who develops a temperature over 38 °C (100.4 °F) during this time should be isolated.

The fever is unlikely to be due to smallpox because the incubation period is usually longer (7 to 14 days). However, the nurse should be given smallpox vaccine, which offers partial protection if administered within 4 days of exposure. Even if given more than 4 days after exposure, the vaccine will reduce the mortality rate from smallpox by about 50%. She should also take her temperature twice daily for 17 days. If her temperature exceeds 38 °C (100.4 °F), she should be isolated until smallpox is ruled out.

Vaccinia immune globulin is only administered to high-risk persons (e.g., pregnant women, immunosuppressed patients) in whom smallpox vaccine is contraindicated but who are exposed to patients with possible smallpox. In these high-risk situations, the risk of smallpox may outweigh the risk of vaccination, and, if available, vaccinia immune globulin should be given to prevent complications. Cidofovir, which is approved for treatment of cytomegalovirus infection, has in vitro activity against smallpox. However, its effectiveness in treating clinical smallpox is unknown.