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	{
	"disease": "Smallpox (Variola)",
	"background": {
	"diseaseInfo": "Smallpox is an acute contagious disease caused by variola virus, a member of the orthopoxvirus family. Other members of the genus include cowpox, camelpox, and monkeypox. Monkeypox virus has caused the most serious recent human poxvirus infections. The incubation period is followed by the sudden onset of influenza-like symptoms. Two to three days later, the temperature falls and the patient feels somewhat better, at which time the characteristic rash appears, first on the face, hands and forearms and then after a few days progressing to the trunk. Lesions also develop in the mucous membranes of the nose and mouth, and ulcerate very soon after their formation, releasing large amounts of virus into the mouth and throat. The centrifugal distribution of lesions, more prominent on the face and extremities than on the trunk, is a distinctive diagnostic feature of smallpox and gives the trained eye cause to suspect the disease. Lesions progress from macules to papules to vesicles to pustules. All lesions in a given area progress together through these stages. From 8 to 14 days after the onset of symptoms, the pustules form scabs which leave depressed depigmented scars upon healing.",
	"transmissionRoutes": "Smallpox is transmitted from person to person by infected aerosols and air droplets spread in face-to-face contact with an infected person after fever has begun, especially if symptoms include coughing. The disease can also be transmitted by contaminated clothes and bedding, though the risk of infection from this source is much lower. The frequency of infection is highest after face-to-face contact with a patient after fever has begun and during the first week of rash, when the virus is released via the respiratory tract.",
	"priorityReason": "Smallpox had two main forms: variola major and variola minor. The disease followed a milder course in variola minor, which had a case-fatality rate of less than 1 per cent. The fatality rate of variola major was around 30%. There are two rare forms of smallpox: haemorrhagic and malignant. In the former, invariably fatal, the rash was accompanied by haemorrhage into the mucous membranes and the skin. Malignant smallpox was characterized by lesions that did not develop to the pustular stage but remained soft and flat. It was almost invariably fatal. Smallpox killed as many as 30% of those infected. In 1967, when WHO launched an intensified plan to eradicate smallpox, the disease threatened 60% of the world's population and killed every fourth patient.",
	"riskFactors": "In the absence of immunity induced by vaccination, humans appear to be universally susceptible to infection with the smallpox virus.",
	"additionalInfo": "The incubation period of smallpox is usually 12-14 days (range 7-17), during which there is no evidence of viral shedding. During this period, the person looks and feels healthy and cannot infect others. Vaccine administered up to 4 days after exposure to the virus, and before the rash appears, provides protective immunity and can prevent infection or ameliorate the severity of the disease. Immediate Notification to WHO is formally required by IHR (2005)."
	},
	"surveillanceGoal": "To detect and immediately respond to any suspected case of smallpox.",
	"standardCaseDefinition": {
	"suspectedCase": "An illness with acute onset of fever > 38.3 C ( 101 F) followed by a rash characterized by vesicles or firm pustules in the same stage of development without other apparent cause.",
	"probableCase": "A case that meets the clinical case definition, is not laboratory confirmed, but has an epidemiological link to a confirmed or probable case.",
	"confirmedCase": "A clinically compatible case that is laboratory confirmed."
	},
	"respondToAlertThreshold": "If a single case is suspected: Report case-based information immediately to the appropriate levels. Implement airborne infection control precautions. Treat and manage the patient with supportive care. Collect specimen safely to confirm the case. Implement contact tracing and contact management. Conduct active surveillance to identify additional cases. Notify WHO.",
	"respondToActionThreshold": "If a single case is confirmed: Maintain strict infection control measures practices throughout the duration of the outbreak.Mobilize the community for early detection and care. Conduct community education about the confirmed case, how the disease is transmitted, and how to implement infection control in the home care setting and during funerals. Conduct active searches for additional cases. Request additional help from national and international levels. Establish isolation ward to handle additional cases that may be admitted to the health facility.",
	"analyzeAndInterpretData": {
	"person": "Immediate case-based reporting of cases and deaths. During the outbreak, count and report cases and deaths. Analyze age and sex distribution. Assess risk factors immediately.",
	"time": "Graph cases and deaths daily/weekly/monthly. Construct an epidemic curve",
	"place": "Map location of case households."
	},
	"laboratoryConfirmation": {
	"diagnosticTest": "Isolation of smallpox (Variola) virus from a clinical specimen Or Polymerase chain reaction (PCR) assay identification of Variola DNA in a clinical specimen. Note: Level C or D laboratories only.",
	"specimen": "Biopsy specimens, Scabs, Vesicular fluid, Lesion skin (roof) and Pustule material are preferred specimens for diagnosis of acute illness during rash phase. Blood samples. Note: blood samples from person where severe, dense rash may be difficult to draw as the skin may slough off. A central line may be needed for access in cases where a peripheral blood draw is difficult. ",
	"whenToCollect": "A suspected case of smallpox is a public health and medical emergency. Collect samples from every suspected case at available times to achieve specimen types recommended.",
	"howToPrepareStoreTransport": "Typical practices associated with collection of patient specimens are appropriate for collection of orthopoxvirus lesions as well. These include wearing personal protective equipment, including gloves and sanitizing the site prior to collection. If alcohol is used to prepare the lesion for collection it is important to allow the lesion to dry before it is collected. Biopsy specimens: Aseptically place two to four portions of tissue into a sterile, leak-proof, freezable container. Storage -20 °C to - 70 °C. Transport -6h at 4 °C. Note: package non-formalin lesion biopsy for shipping on dry ice, leave formalin fixed biopsy at room temperature. Do not freeze formalin fixed biopsy sample. Scabs: Aseptically place scrapings/material into a sterile, leakproof, freezable container. Storage -20 °C to - 70 °C. Transport -6h at 4 °C. Vesicular fluid: Collect fluid from separate lesions onto separate sterile swabs. Be sure to include cellular material from the base of each respective vesicule. Storage -20 °C to - 70°C. Transport -6h at 4 °C. Draw 10 cc of blood into a plastic marble-topped tube, or a plastic yellow-topped serum separator tube. Note: approval must be obtained prior to the shipment of potential smallpox patient clinical specimens to a Reference laboratory.",
	"results": "Diagnostic services for smallpox are not routinely available. Advance arrangements are usually required for smallpox diagnostic services. Contact the appropriate National authority or WHO."
	},
	"reference": "WHO Fact Sheet, Smallpox. http://www.who.int/mediacentre/factsheets/smallpox"
	}



	---


	[
	{
	"prompt": "What is Smallpox (Variola)?",
	"completion": "Smallpox is an acute contagious disease caused by the variola virus, a member of the orthopoxvirus family. Other members of the genus include cowpox, camelpox, and monkeypox. Monkeypox virus has caused the most serious recent human poxvirus infections. The disease has an incubation period followed by the sudden onset of influenza-like symptoms. Two to three days later, a characteristic rash appears, first on the face, hands, and forearms, and then progresses to the trunk. Lesions also develop in the mucous membranes of the nose and mouth. Lesions progress from macules to papules to vesicles to pustules. From 8 to 14 days after the onset of symptoms, the pustules form scabs which leave depressed depigmented scars upon healing."
	},
	{
	"prompt": "How is Smallpox (Variola) transmitted?",
	"completion": "Smallpox is transmitted from person to person by infected aerosols and air droplets spread in face-to-face contact with an infected person after the fever has begun, especially if symptoms include coughing. The disease can also be transmitted by contaminated clothes and bedding, though the risk from this source is much lower."
	},
	{
	"prompt": "Why is Smallpox (Variola) considered a priority?",
	"completion": "Smallpox had two main forms: variola major and variola minor. The disease followed a milder course in variola minor, which had a case-fatality rate of less than 1 per cent. The fatality rate of variola major was around 30%. There are two rare forms of smallpox: haemorrhagic and malignant. Smallpox killed as many as 30% of those infected. In 1967, when WHO launched an intensified plan to eradicate smallpox, the disease threatened 60% of the world's population and killed every fourth patient."
	},
	{
	"prompt": "Is there any additional information on Smallpox (Variola)?",
	"completion": "The incubation period of smallpox is usually 12-14 days, during which there is no evidence of viral shedding. During this period, the person looks and feels healthy and cannot infect others. Vaccine administered up to 4 days after exposure to the virus, and before the rash appears, provides protective immunity and can prevent infection or ameliorate the severity of the disease. Immediate Notification to WHO is formally required by IHR (2005)."
	},
	{
	"prompt": "What are the surveillance goals for Smallpox (Variola)?",
	"completion": "The goal is to detect and immediately respond to any suspected case of smallpox."
	},
	{
	"prompt": "What is the standard case definition for Smallpox (Variola)?",
	"completion": "Suspected Case: An illness with acute onset of fever > 38.3 C (101 F) followed by a rash characterized by vesicles or firm pustules in the same stage of development without other apparent cause. Probable Case: A case that meets the clinical case definition, is not laboratory confirmed, but has an epidemiological link to a confirmed or probable case. Confirmed Case: A clinically compatible case that is laboratory confirmed."
	},
	{
	"prompt": "How should an alert be raised for Smallpox (Variola)?",
	"completion": "If a single case is suspected, immediate actions include: Reporting the case to the appropriate levels, implementing airborne infection control precautions, treating and managing the patient with supportive care, collecting specimens safely to confirm the case, implementing contact tracing and contact management, conducting active surveillance to identify additional cases, and notifying WHO."
	},
	{
	"prompt": "What actions should be taken if a case of Smallpox (Variola) is detected?",
	"completion": "If a single case is confirmed, actions include: Maintaining strict infection control measures, mobilizing the community for early detection and care, conducting community education about the confirmed case, conducting active searches for additional cases, requesting additional help from national and international levels, and establishing an isolation ward for potential additional cases."
	},
	{
	"prompt": "How should data about a person with Smallpox (Variola) be analyzed and interpreted?",
	"completion": "Immediate case-based reporting of cases and deaths should be conducted. During the outbreak, cases and deaths should be counted and reported. The age and sex distribution of cases should be analyzed, and risk factors should be assessed immediately."
	},
	{
	"prompt": "How should data about time in the context of Smallpox (Variola) be analyzed and interpreted?",
	"completion": "Graph cases and deaths daily/weekly/monthly. Construct an epidemic curve to monitor the progress of the outbreak."
	},
	{
	"prompt": "How should data about place in the context of Smallpox (Variola) be analyzed and interpreted?",
	"completion": "Map the location of case households to identify potential clusters or areas of concern."
	},
	{
	"prompt": "How is Smallpox (Variola) diagnosed in the laboratory?",
	"completion": "Diagnostic tests for Smallpox (Variola) include the isolation of the variola virus from a clinical specimen or Polymerase chain reaction (PCR) assay identification of Variola DNA in a clinical specimen. These tests are only conducted in Level C or D laboratories. Specimens for testing include biopsy specimens, scabs, vesicular fluid, and blood samples. Specimens should be collected safely and stored appropriately before being transported to a reference laboratory. Diagnostic services for smallpox are not routinely available, and advance arrangements are usually required. The appropriate National authority or WHO should be contacted before shipping potential smallpox patient clinical specimens."
	},
	{
	"prompt": "What are the references for Smallpox (Variola)?",
	"completion": "1. WHO Fact Sheet, Smallpox. http://www.who.int/mediacentre/factsheets/smallpox"
	}
	]