Therapeutics & Drug Brief: Recommendations for Smallpox Vaccination

Source: MMWR Morb Mortal Wkly Rep. 2001;50:RR-10:1-25.

The events of September 11 heightened concerns of a potential bioterrorist attack. Of the several agents of concern is smallpox (variola) virus, although experts believe that the probability of a deliberate attack using this agent is low. Physicians should be aware that, in the United States, the routine use of smallpox vaccine (vaccinia) in the general public stopped in 1971; vaccination of health care workers stopped in 1976; availability of vaccine to the public and to international travelers ceased in 1982; and the administration of vaccine to military personnel ended in 1990. Therefore, most people in the United States, with the exception of some military personnel, received vaccine more than 25-30 years ago, with the possible loss of protective immunity.

A new smallpox vaccine is currently being developed using cell-culture techniques (Infectious Disease Alert. 2000;20:24). At present, pre-exposure vaccination is not being recommended except for key military and laboratory personnel involved in this area of viral research. In the event of an outbreak, postexposure vaccine will be made available to persons who are directly exposed to a clinical case or who are likely to be exposed to contaminated medical waste and laundry. If at all possible, persons who received childhood vaccine (or who received vaccine > 3 years ago) should be revaccinated and assigned to direct patient care duties.

In the event of a suspected case, physicians in the United States should immediately contact their local and state health authorities, who will contact the CDC. (Physicians in countries outside the United States are to contact the World Health Organization).

The Therapeutics & Drug Brief was written by Carol A. Kemper, MD, FACP. Dr. Kemper is Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, Santa Clara, Calif.