Health Issues

Interim

Emergency response to an outbreak of smallpox

• Published by authority of The Minister of Health Canada
• This document revises the Canadian Quarantine Contingency Plan.
• Centre For Emergency Preparedness And Response Population And Public Health Branch

Executive Summary

Smallpox is a devastating, contagious, life-threatening disease with no cure and a fatality rate of approximately 30%. Its clinical course includes numerous painful, deep pustules throughout the skin that become filled with foul-smelling puss, burst, and leave pitted scars ("pock marks"). Complications include encephalitis and blindness.

Global eradication of naturally occurring smallpox was declared by the World Health Assembly in 1980. Stocks of the smallpox virus, variola, are officially stored in maximum-security laboratories in the United States and Russia, although there are unconfirmed reports that unauthorized stocks may also be stored elsewhere.

The deliberate or accidental release of the smallpox virus into today's largely unvaccinated and highly mobile population would wreak far-reaching havoc in medical, social, and economic terms. The World Health Organization regards even a single case of smallpox anywhere worldwide as a global health emergency.

In the event of a smallpox outbreak within Canada or worldwide, Canada will employ a "search and contain" strategy. The key components to Canada's search and contain strategy against smallpox are as follows:

• Early detection and immediate notification of suspected, presumed or confirmed cases of smallpox to authorities.
• Immediate isolation of suspected, presumed or confirmed cases.
• Immediate deployment of smallpox responders from National Smallpox Reponse Force (NSRF) to the area(s) of smallpox outbreak. Members of NSRF will have been pre-vaccinated and trained for smallpox duties by Health Canada. Other than during a smallpox outbreak, NSRF members will work and reside across the country according to a proportionally representative formula. Membership selection for NSRF will rest with CMOH's, and will be based on the vaccination protocol's screening criteria.
• Upon deployment to a smallpox outbreak area, NSRF members will immediately vaccinate all those directly exposed to a deliberate smallpox virus release, all known direct contacts to suspected or presumed cases, and all local personnel who will be performing any duties.
• Upon receiving their smallpox vaccination, local smallpox personnel will commence intensive contact tracing; followed by immediate vaccination, fever and rash surveillance (and possibly isolation) of all contacts to the cases. "Contacts" is defined here as a) those who have experienced direct face-to-face (within two meters) contact with a case from onset of fever to separation of scabs, and b) household contacts (or other exceptionally close contacts) to the direct contacts. Assistance with these activities will be provided by NSRF members who have been deployed to the outbreak area.
• Rapid set-up of isolation facilities
• Rapid set-up of local Smallpox Assessment Centres in affected areas in order to divert potentially contagious smallpox patients from crowded medical facilities.

Key federal government measures to support the search and containment of smallpox are as follows:

• Immediate international notification and consultation with the World Health Organization, the Pan American Health Organization, and the U.S. Centers for Disease Control and Prevention.
• Maintain of a cadre of pre-vaccinated and trained National Smallpox Response Force who work across the country in various health professions and are deployed by Health Canada in the event of a smallpox outbreak.
• Mobilize and transport vaccine stocks (including VIG, bifurcated needles, and cards showing successful "takes") to outbreak sites.
• Supply provisional medication, supplies, mobile beds, etc. from Health Canada's Emergency Stockpile System, upon request from provinces and territories.
• Activate Health Canada's 24/7 Emergency Operations Centre, which will include toll-free smallpox advice lines for professionals and the public, a smallpox reporting and surveillance system, and advice on media communications from Health Canada.
• Engage in constant international consultation.
• Where necessary, designate federal facilities for smallpox isolation and quarantine services.
• Manage smallpox in populations under federal jurisdiction (Native Reserves, DND, prisons, international travelers, etc.).
• Ensure consistent, coordinated and effective public communications together with provincial and territorial governments and other involved health partners.
• If deemed necessary, the government of Canada will invoke the Emergencies Act, and the National Counter-Terrorism Plan.

Key search and contain measures that fall within provincial, territorial and local jurisdiction and that are outlined in this Plan are as follows:

• Early detection, diagnosis and notification of cases
• Immediate isolation of suspected, presumed or confirmed cases
• Rapid set-up of local Smallpox Control Centres for "command and control" functions by local health authorities
• Effectively handling the community's first cases
• In collaboration with National Smallpox Response Force members, provide for the immediate vaccination and deployment of local smallpox personnel.
• Specimen collection, storage and local transport to Health Canada's National Microbiology Laboratory (NML) in Winnipeg, Manitoba.
• Establishment and management of Smallpox Isolation Sites for smallpox cases.
• Tracing, vaccination and surveillance of contacts to smallpox patients
• Rapid set-up of Smallpox Assessment Centres to divert potentially contagious smallpox patients away from crowded medical facilities
• Where necessary, rapid set-up of Vaccination Clinics
• Local and regional public communications activities, particularly those focused on public notification and education on local smallpox control measures.

For more information, please contact the PHAC Media Relations Team.