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October 16, 2002

Contact Vaccinia—Transmission of Vaccinia From Smallpox Vaccination

JAMA. 2002;288(15):1901-1905. doi:10.1001/jama.288.15.1901

Concern that smallpox virus might be used as a biological weapon has led to proposals that smallpox vaccination be offered to at least some of the US population.1-4 In June 2002, the US Department of Health and Human Services' Advisory Committee on Immunization Practice recommended that vaccination be offered to limited numbers of health care personnel who may be investigating possible cases of smallpox and to those who might be caring for patients in selected hospitals.5 On September 23, 2002, the Centers for Disease Control and Prevention (CDC) distributed detailed operational and logistic guidelines for implementing a large-scale volunteer smallpox vaccination program in response to introduction of smallpox as an act of terrorism.6 These events raise concern about the frequency of serious adverse events, including death, that may occur from vaccination. These have been well documented.7-13 Such severe reactions are far more frequent following smallpox vaccination than following any other vaccine. Most complications occur in the vaccinees themselves, but vaccinia virus can be transmitted inadvertently from vaccinees to others, sometimes causing serious and even fatal adverse reactions.