To develop consensus-based recommendations for
measures to be taken by medical and public health professionals
following the use of smallpox as a biological weapon against a civilian
The working group included 21 representatives from
staff of major medical centers and research, government, military,
public health, and emergency management institutions and agencies.
The first author (D.A.H.) conducted a literature search
in conjunction with the preparation of another publication on
smallpox as well as this article. The literature identified was
reviewed and opinions were sought from experts in the diagnosis and
management of smallpox, including members of the working group.
The first draft of the consensus statement was a
synthesis of information obtained in the evidence-gathering process.
Members of the working group provided formal written comments that were
incorporated into the second draft of the statement. The working group
reviewed the second draft on October 30, 1998. No significant
disagreements existed and comments were incorporated into a third
draft. The fourth and final statement incorporates all relevant
evidence obtained by the literature search in conjunction with final
consensus recommendations supported by all working group members.
Specific recommendations are made regarding smallpox
vaccination, therapy, postexposure isolation and infection control,
hospital epidemiology and infection control, home care, decontamination
of the environment, and additional research needs. In the event of an
actual release of smallpox and subsequent epidemic, early detection,
isolation of infected individuals, surveillance of contacts, and a
focused selective vaccination program will be the essential items of an
effective control program.