Justice
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Two days ago, a previously healthy 27-year-old man came to the emergency department because of a 2-day history of fever, headache, and general malaise. Other than a temperature of 37.9 °C (101.2 °F), physical examination was normal. Complete blood count, serum electrolytes, blood urea nitrogen, serum creatinine, CT scan of the head, and cerebrospinal fluid examination were normal. The patient was given an antipyretic agent and sent home with instructions to rest and drink sufficient fluids.
The next day, he returned to the emergency department because of new skin lesions on his face and neck. These measured 2 to 3 mm in diameter and were erythematous and papular with a slight tendency to becoming vesicular. Chickenpox was diagnosed on clinical grounds. No additional laboratory tests were done, no medications were prescribed, and he was sent home again. Today, the patient returns to the emergency department because his general symptoms and the facial rash are worse, and more lesions are present on his face, arms, and legs. The original facial lesions now measure 5 to 6 mm in diameter and are frankly pustular, and the lesions on his arms and legs resemble the facial lesions seen yesterday.
Which of the following prophylactic measures should be done first for all persons (health care workers, family members, friends, and coworkers) who had close contact with the patient?
A. Administer vaccinia immune globulin
B. Administer ribavirin
C. Administer vaccinia vaccine
D. Administer vaccinia vaccine concurrently with vaccinia immune globulin
E. Send all health care workers who had contact with the patient home from day 6 to day 18 after the exposure
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| arlete
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D
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| nyimalay
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E?
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| dr.wad
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A...
i guess if we give the vaccine and immunoglobulins simultaneously >>>the immunoglobulins will kill the vaccine >>so there will be no benefit.
give the vaccine later on if the contacts are varicella IG negative.
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| sandra
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a
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| arlete
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dr. wad:
Don't we do that for tetanus? 
We are talking about vaccinia (smallpox, variola), not varicella (chicken pox). Smallpox is much more lethal! 
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| nyimalay
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OMG. Is that vaccinia?
Sorry for my nonsense answer.
Also i don't have clear idea about what to do for vaccinia yet.
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| Justice
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Surprise: The correct answer is C
The diagnosis of smallpox must be considered in this case. Vaccination with vaccinia can modify or prevent disease in contacts of this patient if given within several days of exposure to smallpox. One should not wait for confirmatory evidence of smallpox infection because confirmation may take too long to allow effective prevention.
Vaccinia immune globulin has no effect on smallpox. Ribavirin also has no known effect on smallpox. Vaccinia immune globulin and vaccine should not be administered concurrently, as this may negate the protective effects of the vaccine. The health care workers should not be sent home at this time.
Furlough is not recommended by the Centers for Disease Control and Prevention for health care workers who receive vaccinia vaccine. However, if they do not receive the vaccine, they should remain relatively isolated at home for the usual incubation period (7 to 17 days) in order not to expose others to the disease if they possibly become infected.
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| arlete
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Thank you, nice question!
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| sandra
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small pox in this era?! im sapped 
never even in my wildest dreams would i've thought about that possiblity
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| guangyu
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smallpox? where is the question coming from?
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