title: Responding to suspected smallpox cases in the Los Angeles County from 2002 to 2006: identifying areas for education.
abstract: 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.
authors.affiliation: Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA 90012, USA. Electronic address: mokim@ph.lacounty.gov.
authors.forename: Moon
authors.initials: M
authors.lastname: Kim
authors.affiliation: Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA 90012, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Terashita
authors.affiliation: Public Health Laboratory, Los Angeles County Department of Public Health, CA 90012, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Borenstein
authors.affiliation: Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA 90012, USA.
authors.forename: Laurene
authors.initials: L
authors.lastname: Mascola
mesh_terms: 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