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October 21, 2002

U.S. IMMUNIZATION NEWS

"Smallpox Vaccination: Risk Considerations for Patients With Atopic Dermatitis" Journal of Allergy and Clinical Immunology Online

(www2.us.elsevierhealth.com) (09/02) Vol. 110, No. 3,; Engler, Renata J.M.; Kenner, Julie; Leung, Donald Y.M.

As the threat of terrorist attack with the smallpox virus grows, it is increasingly important for researchers to consider ways to minimize the adverse events associated with smallpox vaccination--especially for those most at risk for negative events, such as those with atopic dermatitis, whether active or quiescent.  In addition, the risks associated with smallpox vaccination may have grown in the 20 years since its widespread use was ended, because new diseases and drugs have emerged that operate through the immune system, such as HIV, immunosuppressant drugs for patients with transplanted organs and tissues, and patients with atopic dermatitis.  Such patients must be kept from immunization and from infectious contact with a vaccine recipient.  Much is known about the effects of the vaccine on patients with atopic dermatitis, because the disease existed before the eradication of smallpox.  The smallpox vaccine caused 185 cases of eczema vaccinatum of 6.5 million people vaccinated in England and Wales in 1962, a group from which 11 patients died, after which it was discovered that 80 percent of the patients had atopic eczema, a symptom common among patients with atopic dermatitis.  Yet because between 10 percent and 15 percent of people have a history of active or quiescent eczema, and the Advisory Committee on Immunization Practices recommends that neither they nor those in contact with them be vaccinated, the group could include up to half the population.  As a result, better definitions of atopic dermatitis must be created as a relational tool to the smallpox vaccine and its effects, so that the highest number of people can be vaccinated against smallpox with the minimum number of adverse events.

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