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http://www.nytimes.com/2002/12/13/health/13CONT.html?tntemail1

Plan for Vaccinations Carries Risk of Infecting Other People

By DENISE GRADY

or about three weeks after a smallpox vaccination, the site on the upper arm can shed the live virus used in the vaccine and infect other people who come into contact with it, making some of them very ill.

As the United States prepares to vaccinate large numbers of people for the first time in 30 years, one of the greatest concerns of public health experts is that vaccinated people may inadvertently infect others who have a high risk of being harmed by the vaccine, which contains the virus vaccinia, a relative of smallpox.

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Vulnerable people include pregnant women, babies younger than a year old and people with H.I.V. or other immune disorders, some types of cancer, organ transplants or histories of skin problems like eczema. No one who lives with a person at high risk should be vaccinated, said Dr. Lisa Rotz, an epidemiologist with the bioterror program at the Centers for Disease Control and Prevention.

To reduce the chance of transmission, Dr. Rotz said, patients will be told to keep the vaccination site covered with a gauze bandage and tape for two to three weeks, until the scab falls off. Vaccinated health care workers will wear special semipermeable bandages at work, because they are better than gauze at preventing transmission.

Vaccinated people have to wash their hands often, especially after changing bandages, and avoid touching the site or letting anyone else touch it. Used bandages are supposed to be sealed in plastic bags and thrown out with the rest of the household trash. The scab should be discarded in the same way.

Activities are not restricted, Dr. Rotz said. Even swimming and hot tubs should be safe, she said, as long as the person wears a waterproof bandage. People can play sports, as well, though she advises against wrestling. Problems may arise if a person sweats so much that the bandage falls off.

Researchers say very close contact is required to spread vaccinia, like touching the vaccination site or an article that has been in contact with it like clothing or a bandage. Infection occurs when the virus enters a break in the skin caused by a cut or a rash.

According to a study of 11.8 million Americans in the 1960's, for every 100,000 people vaccinated for the first time, vaccinia spread to two to six others who had not been vaccinated. Most who caught the virus developed "accidental infections," sores that healed on their own. But one or two became very ill.

People vaccinated for the first time were more likely to transmit the virus. Most person-to-person infections, 68.5 percent, occurred in children younger than 5 who caught the infection from a recently vaccinated sibling or close relative. One baby was infected by a nurse, and two children by contacts in day care. Several adults were infected by vaccinated children, and one woman by sleeping with a recently vaccinated soldier. A wrestler infected his opponent.

Researchers say that the low rates of transmission are reassuring, but that rates could be higher today, because skin conditions like eczema are more common than in the past, as are organ transplants.

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.