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18 : Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers

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Abstract:

This chapter deals with the smallpox vaccine, its benefits, its risks, and the current state of its use. To ensure the future availability of appropriate amounts of smallpox vaccine, the U.S. government has funded the manufacture of tissue culture vaccine; the most likely candidate is an Acambis/Baxter Laboratories’ product, grown in Vero monkey kidney cell culture. It is critical to emphasize that the vast majority of vaccinees (nearly all) undergo vaccination without serious complications. The potential vulnerabilities to adverse events after smallpox vaccination are described. It is known that in the era when smallpox vaccination was routine, many patients with hypogammaglobulinemia but with intact T-cell function underwent smallpox vaccination without incidents, presumably because their T-cell immunity was sufficient to contain the virus and to rid the body of infected skin cells, preventing further spread to other areas of the body. It also known that a few individuals with progressive vaccinia virus infection had a lack of T-cell function but intact antibody capacity to various degrees. These individuals had lesser degrees of progression, often without viremic spread. Due to our lack of knowledge of the degree of susceptibility, if any, of individuals with non-T-cell immunodeficiencies, the recommendation has evolved to exclude such individuals from elective smallpox vaccination. The minimal reactions are split into noninfectious consequences of smallpox vaccination and infectious complications.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Figures

Image of Figure 1.
Figure 1.

Bifurcated needle for smallpox vaccination; note the vaccine trapped in the bifurcation. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 2.
Figure 2.

Recommended smallpox vaccination technique. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 3.
Figure 3.

Appearance of primary vaccination site on days 6 (upper left), 8 (upper right), 10 (lower left), and 14 (lower right). Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 4.
Figure 4.

Normal robust vaccination reactions. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 5.
Figure 5.

Example of a major reaction after revaccination. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 6.
Figure 6.

Bacterial superinfection of vaccination site. (Left) streptococcal infection (stained with mercurochrome); (right) staphylococcal impetiginous infection. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 7.
Figure 7.

Autoinoculation. The photograph shows vaccinia transferred to the nose and face of a child with allergic rhinitis. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 8.
Figure 8.

True generalized vaccinia. Note that each viremic lesion appears as a normal primary vaccination. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 9.
Figure 9.

Eczema vaccinatum showing characteristic rash and distribution in patients with atopic dermatitis. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 10.
Figure 10.

Vaccinia keratitis showing infection of the cornea and conjunctiva in a mother with allergic conjunctivitis whose infant was recently vaccinated. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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Image of Figure 11.
Figure 11.

Graft-versus-host disease in a child with progressive vaccinia who received a blood transfusion with viable lymphocytes. Copyright © Logical Images, Inc.

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
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References

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Tables

Generic image for table
Table 1.

Potential vulnerabilities after smallpox vaccination

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
Generic image for table
Table 2.

Classification by severity of adverse events after smallpox vaccination

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18
Generic image for table
Table 3.

Estimated rates of adverse events postvaccination

Citation: Fulginiti V. 2007. Smallpox Vaccination: a Review of Adverse Events for Contemporary Health Care Providers, p 343-365. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch18

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