Can unvaccinated health care workers rely on patient isolation and personal protective equipment to protect them from smallpox?
No. Isolation and personal protective equipment are critical to the management of smallpox cases, but may not be sufficient to provide adequate protection for the unvaccinated. There has been no experience in using personal protective equipment in the absence of vaccination as part of prevention of transmission of smallpox. Studies of infection control for smallpox were performed in an era in which the vast majority of people involved in care had been vaccinated and had been exposed to vaccinia virus (an in many cases smallpox) on many occasions (leading to boosting of immunity) and before the modern era of infection control practice. The only airborne infection that has been adequately studied in respect to using personal protective equipment is tuberculosis, and tuberculosis is not as communicable as smallpox and is not transmitted by contact. The current official infection control recommendation is that everyone providing care for cases of smallpox be vaccinated and use isolation an
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