Background. Knowledge and perceptions about smallpox would probably influence public behavior
following an intentional smallpox release. We assessed public knowledge, perceptions, and related
healthcare-seeking behavior in Connecticut during the period of heightened interest in smallpox preparedness
surrounding the Iraq invasion.
Methods. Smallpox-related questions were added to Connecticut's Behavioral Risk Factor Surveillance
System survey, an ongoing statewide adult population-based survey during December
2002–July 2003 and November–December 2003.
Results. Among 4,074 respondents, when asked about a hypothetical febrile illness, 72% would
first contact their primary care provider (PCP) on weekdays. During nights and weekends, respondents
would depend nearly equally on PCPs and emergency departments (37% versus 36%). Most
knew smallpox is transmissible from person to person (72%) but not that the majority infected with
smallpox survive (38%) or that smallpox is most contagious after the appearance of rash (11%).
Knowledge regarding transmissibility and mortality improved during the study period (p < 0.001).
Only 31% recognized that vaccinia vaccine is riskier than routine vaccines; 41% would choose vaccination
if available. Concern about smallpox's potential use as a weapon was high but decreased after
President Bush declared "mission accomplished" in Iraq in May 2003 (p < 0.001).
Conclusions. Despite national coverage of smallpox by the media, most respondents lacked basic
knowledge regarding the disease. Incorrect perceptions regarding vaccinia vaccine's risks could increase
inappropriate vaccine demand among nonexposed people with vaccine contraindications during
a mass vaccination campaign. Current perceptions should inform future smallpox preparedness
planning. In addition, both PCPs and emergency medicine clinicians should be targeted for education
regarding smallpox diagnosis.
