1) WHAT IS THE SMALLPOX VACCINE?
The smallpox vaccine is made from a virus called vaccinia, which is a
pox-type virus related to smallpox. The vaccine contains live vaccinia
virus-not dead virus like many other vaccines. For that reason, the vaccination
site must be cared for carefully to prevent the virus from spreading.
The vaccine does not contain
the smallpox virus and cannot give you smallpox.
2) WHY SHOULD SOMEONE WHO HAS ECZEMA OR ATOPIC DERMATITIS AND THEIR
FAMILY MEMBERS NOT RECEIVE THE VACCINE?
The smallpox vaccine contains a live virus that can be harmful or even
fatal to those with eczema or atopic dermatitis. Family members of
eczema sufferers should not take the vaccine unless they have been
exposed to smallpox, because the live virus in the vaccine can harm
the afflicted family member on contact.
3) WHAT ARE THE SIDE EFFECTS OR RISKS IN RECEIVING THE SMALLPOX
There are side effects and risks associated with the smallpox vaccine.
Most people experience normal, usually mild reactions such as a sore
arm, a fever, and body aches. But other people experience reactions
ranging from serious to life threatening. People with atopic dermatitis
or other eczemas may develop a spreading vaccinia infection called
eczema vaccinatum, which can be fatal. Even people who have had atopic
dermatitis just once in the distant past may contract this infection.
It is estimated that there are approximately 17 million individuals
in the United States who have atopic dermatitis, and many of these
people would be susceptible to eczema vaccinatum if vaccinated or in
with a vaccinee.
4) WHEN WAS THE LAST TIME PEOPLE WERE VACCINATED FOR SMALLPOX?
Routine vaccination against smallpox stopped in the United States and
many other countries in 1972. In 1979, the World Health Organization
(WHO) recommended that such vaccinations be stopped in all countries.
Vaccination was recommended only for special groups, such as researchers
working with smallpox and related viruses. By 1982, routine vaccination
had been officially discontinued in 149 of the 158 member countries
of WHO. By 1986, routine vaccination had ceased in all countries.
5) WHO IS AT RISK OF HAVING ECZEMA VACCINATUM?
In the past, eczema vaccinatum has occurred in persons suffering from
eczema or with a history of atopic dermatitis who were vaccinated
or came into contact with someone else who was vaccinated. Eruption
initially occurred at sites on the body that were affected at that
time by eczema or had previously been affected. These eruptions became
intensely inflamed and sometimes spread to healthy skin. Symptoms
were severe. The prognosis was especially grave for infants with
large areas of affected skin.
6) WHAT ARE THE DANGERS OF PEOPLE WITH ATOPIC DERMATITIS/ECZEMA
ACQUIRING VACCINIA FROM A VACCINATED PERSON?
People with atopic dermatitis/eczema should avoid contact with recent
vaccinees. Vaccinia is generally transmitted from person to person
through direct contact, so precautions should be taken to reduce the
likelihood of such contact. If you accidentally come in contact with
someone who has been vaccinated or with something that may be contaminated
with live virus, wash immediately and thoroughly with soap and warm
water. The period during which a recently vaccinated person is a threat
is three weeks to one month.
7) HOW IS VACCINIA TRANSMITTED FROM THE VACCINATION SITE?
Vaccinia is spread by touching a vaccination site before it has healed
or by touching any materials that might be contaminated with live
virus from the site-materials such as bandages, towels, clothing,
or washcloths used by a person who has been vaccinated. Vaccinia
is not spread through airborne contagion. Transfer of the vaccinia
virus can occur from touching the vaccination site before it has
healed and then touching other parts of the body, or from contact
with a vaccinee whose lesion is in the florid stages.
8) WHAT ARE THE OPTIONS FOR A PERSON WITH ATOPIC DERMATITIS/ECZEMA
WHO COMES INTO CONTACT WITH VACCINIA?
With early recognition and appropriate use of Vaccinia Immune Globulin
(VIG), mortality can be reduced to zero, and morbidity alleviated.
However, even if there is a delay in recognition, prompt institution
of VIG should be undertaken. Untreated patients become quite ill and
evidence systemic symptoms. If unrecognized and untreated, the patient
will manifest severe systemic symptoms resembling septic shock, and
9) WHAT IF I HAVE ATOPIC DERMATITIS/ECZEMA AND BECOME EXPOSED TO
If exposure to smallpox occurs, then vaccination is recommended, even for those
people with atopic dermatitis/eczema. Vaccination within three days of exposure
will completely prevent or significantly modify smallpox in the vast majority
of persons. Vaccination four to seven days after exposure likely offers some
protection from smallpox or may modify the severity of that disease.