Contraindications to Smallpox Vaccination

Eczema/atopic dermatitis: No one with these skin conditions, a history of eczema, or household contacts with these skin conditions should receive the smallpox vaccine.

Pregnancy: Smallpox vaccine should not be administered in a pre-event setting to pregnant women or to women who are trying to become pregnant. Before vaccination, women of child-bearing age should be asked if they are pregnant or intend to become pregnant in the next four weeks. Women who respond positively should not be vaccinated. In addition, women who are vaccinated should be counseled not to become pregnant during the four weeks after vaccination. However, routine pregnancy testing of women of child-bearing age was not recommended.

Altered immunocompetence: People with conditions that makes them immunodeficient, such as leukemia, lymphoma, organ transplant, or generalized malignancy, or those with household contacts who have such a condition, should not receive the vaccine.

HIV infection: People with HIV infection or AIDS are at increased risk of progressive vaccinia or vaccinia necrosum following smallpox vaccination. Therefore, smallpox vaccine should not be administered to those with HIV infection or AIDS. Before vaccination, potential vaccinees should be educated about the risks of severe complications from smallpox vaccine among people with HIV infection or other immunosuppressive conditions. People who think they may have one of these conditions should not be vaccinated. ACIP does not recommend mandatory HIV testing prior to smallpox vaccination, but recommends that HIV testing should be readily available to all those considering smallpox vaccination. HIV testing is recommended for people who have any history of a risk factor for HIV infection and who are not sure of their HIV infection status.

Children and adolescents: Routine, nonemergency smallpox vaccination is not recommended for infants and children younger than 18.

Allergy to vaccine components: When using the Dryvax vaccine, individuals with anaphylactic reactions to polymyxin B sulfate, streptomycin sulfate, chlortetracycline hydrochloride, and neomycin should not be vaccinated.

Source: Advisory Committee on Immunization Practices, Atlanta. Oct. 17, 2002.