Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Lesser notes that the DoD has
been vigilant about minimizing potential transfer risks since implementing
the vaccinia immunization program. The 2 pivotal standards for medical exemptions
from smallpox vaccination are the US Food and Drug Administration–licensed
recommendations from the vaccine manufacturer and the recommendations from
the Advisory Committee on Immunization Practices.1,2 The
DoD followed these recommendations to minimize close physical contact with
infants until the scab falls off. However, the DoD did not universally restrict
immunization of service members with infants younger than 12 months in the
home in April 2003, as suggested by Lesser. The US Navy and Marine Corps adopted
the more stringent exclusion, administratively exempting troops with an infant
in the household, until these troops were no longer in contact with the infant.
The screening form Lesser cites was written to identify people with an infant
in the household, to allow either additional education for them or temporary
administrative exemption (Col John D. Grabenstein, Military Vaccine Agency,
US Army Medical Command, Office of the Surgeon General, written communication,
April 1, 2004).
Garde V, Harper D, Fairchok MP. Risk of Contact Vaccinia From Immunization Sites—Reply. JAMA. 2004;291(19):2313-2314. doi:10.1001/jama.291.19.2314-b