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March 26, 2003

Inpatients at Risk of Contact Vaccinia From Immunized Health Care Workers

JAMA. 2003;289(12):1512-1513. doi:10.1001/jama.289.12.1512-a

To the Editor: The US government recently announced a program to offer smallpox immunization to hospital health care workers (HCWs). The vaccine contains live vaccinia virus and carries a risk of significant adverse events for vaccinees and their close contacts. From experience in the 1960s, for every 100 000 primary vaccinees, there would be an expected 2 to 6 transmissions of virus to unvaccinated contacts, with 1 to 2 cases of eczema vaccinatum.1 Individuals at high risk of serious complications from contact vaccinia (CV) include immunocompromised contacts, those with chronic dermatologic conditions, and children younger than 5 years.1 In the past, most transmission occurred in the home setting and rarely as a result of hospital-related contact. However, because hospital transmission to patients has been documented,1 vaccinating HCWs may expose patients to undue risk. The number of patients currently at increased risk in hospitals is unknown, but is certainly higher than in the 1960s.