Proper inoculation: Learn from the past

Improper smallpox inoculation techniques can actually threaten the health of the patient, says one expert. The issue is more pressing than it appears at first, he notes, because so few of today’s practitioners have ever administered the vaccine.

"It is most important that you be trained by someone who knows how to do it," says Jack Richman, MD, medical director of AssessMed Inc., in Mississauga, Ontario. "It is basically no more than a fine puncture of the skin, but not going through the skin — in other words, barely scratching the surface."

If the puncture goes too far you can carry the virus to subcutaneous tissue, from where it can spread to the body and cause what’s called a vaccinia reaction. This would then cause lesions all over the body, as well as high fever. "This can be fatal in an immune-compromised person," says Richman.

Because no one has administered smallpox vaccine for 27 years, it stands to reason you need to be taught the technique by somebody who was practicing 27 years ago. There are other alternatives, however. For example, the Centers for Disease Control and Prevention offers a video on vaccination techniques. "Still, it is better to have it demonstrated in person," says Richman. "Barring that, my second choice would be to see the video."

In the ideal training situation, however, a knowledgeable person would be present to answer questions, and articulate the technique in different ways. "A video will show only one way to vaccinate, but people do not all learn in the same way," Richman explains. "In addition, it is extremely helpful to bring up each individual and, using a needle, show them what it feels like. This doesn’t hurt at all, but it’s a much more preferable way of demonstrating the technique."

Who should get this training?

"Public health docs, occupational medicine physicians [workers] and all emergency doctors, as well as family doctors," Richman advises. "Beyond that, any doctor who wants to be trained."