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According to the Centers for Disease Control and Prevention (CDC), the following groups should be a high priority for smallpox vaccination should a bioterrorism release of the pathogen occur:
1. Face-to-face close contacts (less than or equal to 6.5 feet or 3 meters), or household contacts to smallpox patients after the onset of the smallpox patient’s fever. Although individuals with smallpox are not infectious until the onset of rash, vaccinating contacts from the time of the onset of fever helps provide a buffer and assures that contacts who may have been exposed at the early onset of rash, when the rash may have been faint and unrecognized, have been vaccinated.
2. People exposed to the initial release of the virus (if the release was discovered during the first generation of cases and vaccination may still provide benefit).
3. Household members (without contraindications to vaccination) of contacts to smallpox patients’ (to protect household contacts should smallpox case contacts develop disease while under fever surveillance at home).
Household members of contacts who have contraindications to vaccination should be housed eparately from the other vaccinated household members until the vaccination site scab has separated (approximately two weeks) to prevent inadvertent transmission of vaccinia virus. They should also be housed separately from the contact until the incubation period for smallpox has passed and the contact is released from surveillance.
4. People involved in the direct medical care, public health evaluation, or transportation of confirmed or suspected smallpox patients (this includes personnel whose public health activities involve direct patient contact such as case interviewing).
5. Laboratory personnel involved in the collection and/or processing of clinical specimens from suspected or confirmed smallpox patients.
6. Other people who have a high likelihood of exposure to infectious materials (e.g., personnel responsible for hospital waste disposal and disinfection).
7. Personnel involved in contact tracing and vaccination, or quarantine/isolation or enforcement, or law-enforcement interviews of suspected smallpox patients.
8. People permitted to enter any facilities designated for the evaluation, treatment, or isolation of confirmed or suspected smallpox patients. (Only essential personnel should be allowed to enter such facilities.) Only personnel without contraindications to vaccination should be chosen for activities that would require vaccination for their protection. Personnel with contraindications should not perform duties that would place them at risk for smallpox exposure and should otherwise only be vaccinated if an exposure already has occurred.
9. People present in a facility or conveyance with a smallpox case if fine-particle aerosol transmission was likely during the time the case was present (e.g. hemorrhagic smallpox case and/or case with active coughing). Evaluation of the potential risk for aerosol transmission and initiation of vaccination for non-direct contacts will be done by CDC, state, and local public health personnel. The decision to offer vaccination to non-direct contacts of smallpox cases will be made jointly by federal and the state health officials.