Responding to suspected smallpox cases in the Los Angeles County from 2002 to 2006: identifying areas for education.
BACKGROUND
Although smallpox has been eradicated, health care providers in emergency departments (EDs) need to remain vigilant to its recognition. Smallpox can be confused with chickenpox. We describe suspected smallpox cases reported in Los Angeles County from 2002 to 2006 and highlight areas for education.


METHODS
We retrospectively reviewed suspected smallpox reports from 2002 to 2006. Laboratory testing was performed. Photographs of rashes were taken.


RESULTS
Five suspected smallpox cases were reported. Two presented first to an ED. Smallpox was suspected based on rash features. Previous history of chickenpox or varicella vaccination may have caused increased suspicion for smallpox. All 5 were determined to have a final diagnosis of chickenpox. Health care providers notified public health appropriately and responses were immediate.


CONCLUSIONS
Public health investigated 5 suspected smallpox cases in the past 5 years. Two presented initially to EDs. Education differentiating smallpox from chickenpox and collaboration between public health, EDs, and health care providers remains important. The ability to respond rapidly to a potential bioterrorism emergency was tested.
Kim
Moon
M
Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA 90012, USA. Electronic address: mokim@ph.lacounty.gov.
Terashita
Dawn
D
Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA 90012, USA.
Borenstein
Lee
L
Public Health Laboratory, Los Angeles County Department of Public Health, CA 90012, USA.
Mascola
Laurene
L
Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA 90012, USA.
D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D018563:Disease Notification; D005260:Female; D006801:Humans; D055552:Infectious Disease Medicine / Q000193:education*; D015141:Los Angeles; D008297:Male; D012189:Retrospective Studies; D012899:Smallpox / Q000175:diagnosis*; D013663:Teaching; D055815:Young Adult