March 17, 2009
=
Smallpox
Vaccine Guidance Updated by CDC
=
On Friday, March =
13,
the U.S. Centers for Disease Control and Prevention (CDC) posted (www.cdc.gov) on their Emergency Preparedne=
ss and
Response website updated information on smallpox vaccination.
=
Practical
information, mostly in the format of nearly 100 “Questions and
Answers”, was provided on topics including:
---Pre-event and
Post-event vaccination
---Vaccine storage
and distribution
---Contraindicati=
ons
and screening
---Vaccination wh=
ile
pregnant or breastfeeding
---“About
smallpox vaccine”
=
Key examples (bold
type added by this author, not CDC) include:
=
Q.---What is the ACIP recommendation about the # of needle
sticks?
A. …’The Dryvax
vaccine…is no longer available and has been replaced by ACAM2000. ACAM
2000 uses 15 insertions for both primary and revaccination and has no provi=
sion
for additional insertions if no trace of blood is visible after vaccination=
…’
=
Q.---Can diluted vaccine (1:5 or 1:10) be used for mass
vaccination?
A.---…there are no protocols for using diluted ACAM2000=
.’
=
Q.---Is there any need for people who have been vaccinated fo=
r
smallpox as children to be vaccinated?
A.---‘Yes. Smallpox vaccination provides high immunity =
for
3 to 5 years and decreasing immunity thereafter…Now, the CDC is
recommending that members of smallpox health care response teams who have n=
ot
been vaccinated for smallpox in the past 3 years get the vaccine…R=
17;
=
Q.---If someone is exposed to smallpox, is it too late to get=
a
vaccination?
A.--- ‘Vaccination within 3 days of exposure will
completely prevent or significantly modify smallpox in the vast majority of
people. Vaccination 4 to 7 days after exposure likely offers some protection
from disease or may modify the severity of disease.’
=
Q.---‘If an outbreak of smallpox occurs, will the Strat=
egic
National
Stockpile (SNS) be able to quickly ship
smallpox vaccine?’
A.--- “The SNS plans to distribute smallpox vaccine on =
the
first day of a bioterrorism event to anyone who has been exposed. After that
initial shipment, CDC will ship smallpox vaccine over the next 5-6 days to =
the
rest of the country as needed.”
=
On the other hand=
, a
rare example appears that could be more clearly answered in this updated CDC
guidance, such as the question “Why is aspirin not to be used to treat
robust reactions (takes) from smallpox vaccine?” (see the
“Questions and Answers About Smallpox Contraindications and
Screening” section. The CDC answer focuses on varicella vaccine and
natural varicella infection, but does not explicitly mention the
virologically-unrelated smallpox vaccine, or oth=
er
live virus vaccines such as MMR).
=
Overall, this is a
very practical and helpful update from the CDC.
=
=
Daniel R. Lucey, =
MD, MPH
EROne Institutes,
Department of Emergency Medicine
Washington Hospit=
al
Center
Adjunct Professor=
of
Microbiology and immunology
Georgetown
University Medical Center, Washington, D.C.
Website for this
posting (requires Internet Explorer): ww=
w.BePast.org
DRL23@Georgetown.=
edu
=
=
=
=
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