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Oct. 17, 2002 (San Diego) — Although the practice of medicine has come a long way since the smallpox vaccine was given routinely in the U.S., new and troubling concerns have arisen regarding who should receive the smallpox vaccine and what recipients should do to minimize complications, a bioterrorism expert at the Annual Scientific Assembly of the American Academy of Family Physicians in San Diego, California, said Wednesday.

Because the smallpox vaccine uses a live virus, it may disseminate from the vaccination site in a number of ways. Some of these represent new practices since the earlier times of smallpox vaccination in the U.S. and need special consideration, according to. Jonathan L. Temte, MD, associate professor of family medicine, University of Wisconsin at Madison. "My concern is what happens to kids in day care," he told the packed audience at the assembly.

In addition, the widespread use of contact lenses could spread virus from the vaccination site to the eyes, resulting in ocular infection, Dr. Temte noted. And the rise of HIV infection presents a new population at risk of contracting disseminated disease from vaccination sites, he added. Similarly, the use of daily prednisone at certain doses may be a contraindication to vaccination, he pointed out. Furthermore, patients presenting for vaccination could be unsure of whether or not they have been diagnosed with eczema, and therefore would be at risk for eczema vaccinatum, Dr. Temte said.

Regardless of how these issues are solved, family physicians represent the leading edge of responders to a bioterrorism attack, he noted. "Not only are you the front line,...but also the best defense against bioterrorism," he said. "Be prepared for a new generation of diseases and disorders," Dr. Temte had recommended one year ago and reiterated Wednesday. He also suggested that family physicians establish a contact within the public health community and gather relevant reference material to be prepared.

AAFP Annual Scientific Assembly. Presented Oct. 16, 2002.

Reviewed by Gary D. Vogin, MD

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David Danar, MD is program director of Medscape Internal Medicine. Medscape Medical News is edited by Deborah Flapan, a news coordinator at Medscape. Send press releases and comments to news@webmd.net.   Medscape Medical News 2002. © 2002 Medscape

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