The last naturally occurring case of Smallpox in the world was in Somalia in 1977. Since then all people previously immunized have lost their protection and the entire population is now susceptible to Smallpox. Because of concern about the slight possibility of Smallpox being used as a terrorist bioweapon, Mercy Clinics makes the following recommendations.

1. All MCI physician and mid-level providers will be able to identify Smallpox in the earliest possible stage (by the fifth day of illness).
2. Any case suspicious for Smallpox will be treated as a medical emergency with immediate infectious disease consultation and implementation of contact and airborne precautions.
3. MCI, following the current ISHD plan, does not recommend immunization of staff or the general population at this time because:
   • The risk of Smallpox in Iowa is very low.
   • There is a small but real risk of significant complications.
   • Immunization is still protective up to 5 days after exposure.