Knowledge about the Initial Presentation of Smallpox among Emergency Physicians in Washington, DC

Objectives: To assess the current knowledge of full‐time emergency physicians in Washington, DC, regarding the initial diagnosis of smallpox and the initial care of the patient with smallpox. Methods: A written true/false test was prepared based on information accessed from the current Centers for Disease Control and Prevention (CDC) Web site on smallpox. The 20‐question test was administered to full‐time emergency physicians practicing emergency medicine in all seven adult civilian hospitals in Washington, DC. Results: The overall response rate was 81% (52 of the 64 eligible full‐time emergency physicians). The average score was 59% correct. The facts most likely to be known were 1) that the symptoms of smallpox begin with a two‐ to four‐day prodrome of fever and myalgia (before the appearance of any rash), 2) that no antiviral treatment is of more proven value than vaccination of contacts, and 3) that a person with smallpox may be contagious before any rash appears (average, 90% correct). The facts least likely to be known were 1) that when dealing with a known case of smallpox, fit‐tested N95 masks are not needed by treating personnel if they have been vaccinated; 2) that the rash of smallpox begins with 24–48 hours of flat, erythematous macules (not papules or vesicles); and 3) that very typically the rash of smallpox begins in the mouth (average, 22% correct). Conclusions: Some facts from the current CDC Web site on smallpox are known by a large majority of full‐time emergency physicians in Washington, DC, whereas questions based on other facts were answered incorrectly by a majority of the physicians tested.