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VACCINATED PEOPLE CAN TRANSMIT VACCINIA VIRUS
By Gina Hill
Tuesday, October 15, 2002
(CNN) -- Experts poring over data from past widespread smallpox vaccinations
conclude the live virus used in the vaccine may result in cases of contact
vaccinia -- the spreading of the vaccinia virus from someone recently
vaccinated to someone who has not had the shot.
Vaccinia, a less virulent relative of smallpox, is the live virus used in
smallpox vaccinations. People with skin disorders like eczema can spread the
virus across their own skin and potentially infect others who aren't
vaccinated. The vaccinia virus may cause a rash, fever and head or body
The researchers, led by Dr. John Neff, a former researcher with the Center
for Disease Control and Prevention's Smallpox Eradication Program, discussed
what they found in a commentary in this week's Journal of the American
Medical Association released today.
Their research focused on mass vaccinations in the United States, United
Kingdom and Sweden from 1947 to 1968. Overall, in the U.S. studies, the rate
of contact vaccinia was in the range of 2 to 6 per 100,000 vaccinations.
The majority of cases -- a few of which resulted in death -- occurred in
children with eczema, a skin disorder characterized by itchy red skin and
even blisters in severe cases. And the disease was more likely to be spread
to people with a history of eczema even though they had no active skin
Age distribution of those U.S. cases shows young people are more vulnerable
to contact vaccinia:
* Younger than 1 year: 25 cases
* One to 4 years of age: 113 cases
* Five to 19 years of age: 40 cases
* Twenty years or older: 44 cases
That translates to 62 percent of the cases occurring in children 5 years old
or younger and almost 20 percent in those 20 years or older, according to
Most cases happened in the home, with many victims getting the virus from
vaccinated family members or playmates. In rare cases, transmission occurred
from a vaccinated nurse to a patient.
"The risk (of contact vaccinia) is not large," the researchers write. "This
risk needs to be kept in perspective."
But they do admit that -- in this day and age -- we're more susceptible than
past generations. Why?
* Since widespread smallpox vaccinations stopped in 1972, almost everyone
born since then has no immunity to vaccinia, according to the authors. If
vaccinated, this group could spread the virus for up to 19 days. Even those
who have had a smallpox shot in the past could shed more of the virus and
for a longer period of time depending on how long it's been since their last
vaccination and how many shots they've had in all. In short, most people
born before 1972 have had only one smallpox shot and they would probably
react as if they've never had one at all.
* Eczema -- also called atopic dermatitis -- is more prevalent today. In
the United States, rates have increased from 3 percent to 6 percent to 6 to
22 percent in the past 30 years, according to the researchers.
* Today there are more people with weak immune systems. The authors
theorize that's likely due to the spread of HIV and wider use of drugs to
suppress the immune system for cancer patients and organ transplant
recipients, for example. "Contact vaccinia in this population could be
especially serious," the authors write.
Preparation and a carefully crafted vaccine policy is key to keeping contact
vaccinia under control should mass smallpox vaccinations become a reality,
according to the commentary.
They recommend public health officials carefully screen for those with a
history of eczema and compromised immune systems. The public should be
informed about how contact vaccinia is spread and how to avoid it. Finally,
a surveillance system needs to be in place to document and track adverse
reactions to the vaccine.
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