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November 4, 2002

U.S. IMMUNIZATION NEWS

"Contact Vaccinia--Transmission of Vaccinia From Smallpox Vaccination" Journal of the American Medical Association (www.jama.com)

(10/16/02) Vol. 288, No. 15, P. 1901; Neff, John M.; Lane, J. Michael; Fulginiti, Vincent A.

As the government debates how it would vaccinate the public against smallpox, it is worthwhile to investigate how the vaccine affected patients when it was used to combat the disease in the United States several decades ago.  During surveillance activities by the Centers for Disease Control and Prevention

(CDC) in the 1960s and 1970s, it was determined that a vaccinated patient could transmit to a non-vaccinated person one of three infections: vaccinia necrosum, a progressive disease that begins with spreading necrosis at the site of vaccination; eczema vaccinatum, lesions on the skin at the vaccination site or elsewhere on the body in patients with a history of eczema; and accidental infection, which causes vaccinial lesions when the vaccine is unintentionally transferred to the eye or mouth or other parts of the body.  The transmission of these illnesses is well-documented, dating back to the 19th century, but more in-depth risk assessment studies in the 1960s in the United States and the United Kingdom provide greater detail.  One U.K. study that checked 3.8 million primary vaccinations and 1.2 million revaccinations found just 16 examples of eczema vaccinatum, four of which were fatal in the primary vaccination group, all among children younger than one year.  A similar study involving 3.2 million vaccinations found 185 cases of eczema vaccinatum.  In the United States, meanwhile, two separate national studies in the 1960s found strikingly similar results between them, finding in 6.2 million primary vaccinations in 1963 and 5.6 million vaccinations in 1968 that the vaccine caused 54 vaccinee deaths of eczema vaccinatum in 1963 and 58 deaths in 1968, as well as 54 contact deaths in 1963 and 60 contact deaths in the later round.  Furthermore, 85 deaths from accidental infection were caused among vaccinees in 1963, compared with 142 deaths in 1968, and 22 infection deaths through contact with vaccinees in the earlier series and 44 deaths in 1968.  These figures help to give a general idea of what will happen upon mass vaccination, but the real results are unpredictable today.  The findings underscore the importance of strict screening, counseling, and monitoring of all patients, but especially of those who have contact with others that have skin conditions.

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