Routine Smallpox Vaccination Research Articles

Smallpox vaccination and risk of allergy and asthma

Background: It has been proposed that childhood vaccinations may influence the development of allergy. Atopy and allergic diseases have increased after routine smallpox vaccination was stopped in the 1970s. Objective: We examined whether administration of smallpox vaccination during childhood was associated with a decreased risk of atopy, allergic rhinitis, and asthma. Methods: The occurrence of atopy, allergic rhinitis, and asthma was studied in nearly 2000 women participating in a national birth cohort study. Detailed information on smallpox vaccination was available from school health records. Atopic status was assessed serologically by a specific response to 11 common inhalant allergens by using serum samples obtained from the women during the period 1997 to 2001. Information on allergic rhinitis and asthma was available from telephone interviews. Results: We found no association between having been vaccinated against smallpox in childhood and risk of atopy or allergic rhinitis. Smallpox vaccination was associated with a slightly decreased risk of asthma. There was no association between age at smallpox vaccination and risk of atopy, allergic rhinitis, or asthma. Adjusting for birth cohort, sibship size, age of the woman's mother at birth, and social class in childhood did not change these results. Conclusion: Our findings do not suggest that childhood vaccination against smallpox, even if given early in life, influences the development of atopy or allergic rhinitis. The association with asthma should be interpreted with caution and needs further study. (J Allergy Clin Immunol 2003;111:1227-31.)

Smallpox vaccination and bioterrorism with pox viruses

Bioterrorist attacks occupy a special place amongst the innumerable potential types of terrorist attack, with the intentional release of pox viruses being especially feared in this connection. Apart from the variola virus, the agent responsible for smallpox in humans, the monkeypox virus and numerous other animal pox viruses pose potential risks for humans and animals. This risk scenario also includes recombinations between the various pox viruses, changes in hosts and genetically engineered manipulations of pox viruses. For over 200 years, the method of choice for combatting smallpox was via vaccination with a reproductive, original vaccinia virus. Worldwide eradication of smallpox at the end of the 1970s and the discontinuation of routine smallpox vaccination in 1980 can be credited to such vaccination. Unfortunately, these vaccinations were associated with a large number of postvaccinal impairments, sometimes resulting in death (e.g. postvaccinal encephalitis). The only way to restrict such postvaccinal complications was to carry out initial vaccination within the first 2 postnatal years. Initial vaccination at a later age led to such a sharp increase in the number of vaccines with complications that vaccination had to be discouraged. The dilemma of the smallpox vaccine stocks stems from the fact that a large portion of these stocks are produced with the same vaccinia strains as before. This is irresponsible, especially as the percentage of immune-suppressed persons in the population, for whom vaccination-related complications pose an especial threat, is increasing. One solution to the dilemma of the smallpox vaccine stocks is the MVA strain. It is harmless, protects humans and animals equally well against smallpox and can be applied parenterally.

Smallpox and Pregnancy

In Brief Health care personnel must be prepared for the threat of bioterrorism. Our objective is to educate primary care providers, obstetricians in particular, in the prevention, diagnosis, and treatment of smallpox. Smallpox poses a particularly serious threat because of its high case-fatality rate in unvaccinated populations (no one younger than 25 years has been vaccinated, and older persons have little remaining residual immunity). Routine nonemergency smallpox vaccination is restricted to laboratory staff working with smallpox-related viruses. Under these circumstances, contraindications to vaccination are pregnancy, immunodeficiency, exfoliative skin conditions (eczema), and allergy to vaccine components. In case of an intentional release of the smallpox virus, those directly exposed and their close contacts must be vaccinated and isolated. Under such emergency circumstances, pregnant women exposed to the variola virus should be vaccinated because of the lethality of the disease during pregnancy. Currently, there is a limited supply of vaccine available. The threat of terrorists to use smallpox mandates health care providers to learn to prevent, diagnose, and manage this eradicated disease, given its potential catastrophic consequences.

Smallpox and pregnancy: from eradicated disease to bioterrorist threat

Health care personnel must be prepared for the threat of bioterrorism. Our objective is to educate primary care providers, obstetricians in particular, in the prevention, diagnosis, and treatment of smallpox. Smallpox poses a particularly serious threat because of its high case-fatality rate in unvaccinated populations (no one younger than 25 years has been vaccinated, and older persons have little remaining residual immunity). Routine nonemergency smallpox vaccination is restricted to laboratory staff working with smallpox-related viruses. Under these circumstances, contraindications to vaccination are pregnancy, immunodeficiency, exfoliative skin conditions (eczema), and allergy to vaccine components. In case of an intentional release of the smallpox virus, those directly exposed and their close contacts must be vaccinated and isolated. Under such emergency circumstances, pregnant women exposed to the variola virus should be vaccinated because of the lethality of the disease during pregnancy. Currently, there is a limited supply of vaccine available.

Transfusion-associated graft-versus-host disease.

Transfusion-associated graft-versus-host disease.

The transmission potential of monkeypox virus in human populations.

Data on monkeypox in Zaire over the five years 1980-1984 are analysed to assess the protection imparted by past smallpox vaccination and the transmission potential of the virus in unvaccinated communities. Attack rates in individuals with and without vaccination scars indicated that smallpox vaccination (discontinued in 1980) imparted approximately 85% protection against monkeypox. It is predicted that monkeypox virus will continue to be introduced into human communities from animal sources, and that the average magnitude and duration of monkeypox epidemics will increase as vaccine-derived protection declines in the population. On the other hand, current evidence indicates that the virus is appreciably less transmissible than was smallpox, and that it will not persist in human communities, even in the total absence of vaccination. The findings thus support the recommendation of the Global Commission for the Certification of Smallpox Eradication to cease routine smallpox vaccination in monkeypox endemic areas, but to encourage continued epidemiological surveillance.

Editorial: Methylene blue for eczema herpeticum.

Eczema herpeticum has emerged as the most common form of Kaposi varicelliform eruption since the discontinuation of routine smallpox vaccination. It can be a serious complication of infantile eczema, with a death rate as high as 9%.1Successful treatment with systemic administration of cytarabine has been reported, but the true value of this drug remains to be determined.2Furthermore, cytarabine is not without toxic effects—notably bone marrow depression— after being administered systemically. Methylene blue, a phenothiazine derivative, has been shown to be viricidally active toward herpesvirus hominis in the presence of light exposure, both in vitro3and in vivo.4The dye enters living cells, but transiently, thus inactivating both extracellular and intracellular viruses with minimal damage to the cells. Recently, a controlled study indicated methylene blue's therapeutic effectiveness in eczema herpeticum.5Local application of 0.1% methylene blue solution to half of the diseased area followed

LIVE-VIRUS VACCINES IN PREGNANCY: RISKS AND RECOMMENDATIONS

Epidemic situations and the prospect of overseas travel are increasingly posing the problem of whether or not to offer immunisation to pregnant women. Several papers have been published on the relative risks to mother and fetus of exposure to attenuated vaccine strains as compared with virulent wild strains. A review of these publications suggests that immunisation against poliomyelitis and yellow fever is indicated in women contemplating travel to affected areas; for rubella and mumps vaccination and routine smallpox vaccination pregnancy is a contraindication, but vaccination (with immune-globulin cover) should be mandatory for the pregnant woman travelling to a smallpox-endemic area; measles vaccination is not indicated in pregnancy.

The James D. Bruce Memorial Award Lecture: Is Routine Smallpox Vaccination Necessary?

Meeting Abstracts1 May 1973The James D. Bruce Memorial Award Lecture: Is Routine Smallpox Vaccination Necessary?Alexander D. Langmuir, M.D.Alexander D. Langmuir, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-78-5-812_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptFor more than a century, vaccination has been accepted as the essential measure for the control of smallpox, and, indeed, the elimination of the scourge from the Western world was associated with widespread use of vaccination. In October 1971, however, the Surgeon General of the U.S. Public Health Service recommended that this long-established practice was no longer indicated as a routine procedure.Since that time a serious outbreak of malignant smallpox has occurred in Yugoslavia, and an extensive epidemic has developed in northern India and Bangladesh. In spite of these adverse events, I believe that the Surgeon General's decision was... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1973Volume 78, Issue 5Page: 812-812KeywordsAdverse eventsMedical servicesSurgeons Issue Published: 1 May 1973 PDF DownloadLoading ...

THE END OF ROUTINE SMALLPOX VACCINATION IN THE UNITED STATES

1971 was the year in which the Surgeon General of the United States Public Health Service, the Redbook Committee of the American Academy of Pediatrics, and the Territorial Health Officers agreed that the time had come to discontinue routine primary smallpox vaccination for American children. As a result of this it may also be expected that school vaccination laws presently in effect in some 28 states will soon be repealed or will not be enforced with vigor. The American pediatrician views these developments with mixed feelings, since there have been extensive and often spirited debates regarding the timing for discontinuation of routine smallpox vaccination.

End of routine smallpox vaccination in childhood.

Editorial Notes1 February 1972End of Routine Smallpox Vaccination in ChildhoodWILLIAM H. FOEGE, M.D., J. MICHAEL LANE, M.D.WILLIAM H. FOEGE, M.D.Search for more papers by this author, J. MICHAEL LANE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-76-2-324 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn October 1971 the United States Public Health Service recommended the cessation of routine childhood smallpox vaccination. This decision was reached after several years of study and was based on a number of considerations.The World Health Organization's global smallpox eradication program has been highly successful and is expected to reach its objective of a smallpox-free world by 1976. Only eight countries still remain endemic for smallpox, and several of the eight are currently reaching a smallpox-free state.Largely because of the dramatic decrease in smallpox-endemic areas, the likelihood that smallpox will be imported to the United States has decreased... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Center for Disease Control Atlanta, Ga. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByThe discontinuation of routine smallpox vaccination in the United States, 1960-1976: an unlikely affirmation of biomedical hegemony 1 February 1972Volume 76, Issue 2Page: 324-325KeywordsGlobal healthMedical services Issue Published: 1 February 1972 PDF DownloadLoading ...

The case for abolishing routine childhood smallpox vaccination in the United States.

The case for abolishing routine childhood smallpox vaccination in the United States.

Routine childhood vaccination against smallpox reconsidered.

Abstract The United States can expect 210 deaths caused by smallpox vaccination between now and the end of the century if present policies, emphasizing routine childhood vaccination, persist. The risk of importation of smallpox is extremely low. Only two out of every three importations have resulted in spread, and only eight deaths on the average have occurred in each outbreak. To outweigh the health hazards of routine vaccination, the United States would have to have a smallpox importation nearly every year. The benefits of routine childhood smallpox vaccination no longer outweigh its risks, and consideration should be given to its discontinuance.

MEDICAL NEWS

<h3>Physicians Debate Routine Smallpox Vaccinations</h3> Debate over routine smallpox vaccination for infants and children continues, and, in the opinion of at least one expert, the debate may confuse both physicians and laymen. At the American Academy of Pediatrics meeting in Chicago, Samuel L. Katz, MD, said confusion may exist because two investigators from the National Communicable Disease Center in Atlanta have suggested abandoning routine smallpox vaccination in all but high risk groups in the United States. These investigators say that morbidity and mortality associated with routine childhood vaccinations are greater public health problems than the risk of contracting the disease. However, the Public Health Service and the Academy of Pediatrics are not recommending changes in the present policy of routine vaccinations for most children. The Academy's recommendations will appear this month in the 1970<i>Red Book, A Report from the Committee on Infectious Diseases</i>. Dr. Katz, professor and chairman

SMALLPOX VACCINATION: BEFORE OR AFTER ONE YEAR OF AGE?

Data have been reported recently indicating that complications following smallpox vaccination occur more frequently in children less than 1 year old than in any other age group. A review of illnesses attributed to smallpox vaccination in England and Wales from 1951 to 1960 demonstrated that dermal complications, particularly generalized vaccinia, occurred two to three times as frequently in children vaccinated before the first birthday as in any other childhood age group.1,2 A review of smallpox vaccination complications in the United States in 1963 yielded similar results.3,4 As a result, the American Academy of Pediatrics Committee on the Control of Infectious Diseases and the Public Health Service Advisory Committee on Immunization Practices have recommended that primary smallpox vaccination be deferred until after the first birthday.5,6 Despite this, many physicians have expressed reluctance to adopt this recommendation as was most evident by the general comments made at the recent panel on immunization at the meetings of the American Academy of Pediatrics in October 1967 and by letter to members of the Smallpox Eradication Program at the National Communicable Disease Center. The purpose of this paper is to review briefly the arguments for and against routine smallpox vaccination in children under 1 year of age. The principal objections to deferring vaccination until after the first birthday are as follows: 1. If vaccination is not routinely practiced during the first several well-baby clinic visits, many children, particularly those from clinics in the large cities. might not return for subsequent clinic visits and therefore might not have the benefit of a smallpox vaccination.

Vaccination Against Viral Disease

The present possibilities and prospects for immunization against viral disease were presented at a conference held Nov 7 to 11, 1966, at the Pan American Health Organization in Washington, DC ( JAMA 199 :112 [Jan 9] 1967). In countries now free from endemic smallpox there is a difference of opinion as to the advisability of routine smallpox vaccination, because of the risks of complications with the vaccine now available. Work is in progress on more attenuated vaccine strains with maintained immunogenic capacity. For poliomyelitis the efficacy of live or inactivated vaccines is established. Systematic continuation of vaccination of the infant population is required. Live measles virus vaccines have not caused serious reactions and have provided solid and presumably long-acting immunity. Preliminary studies of combining measles and smallpox vaccines have given promising results. Rubella occurs in serious epidemics in the United States about every seven years. While the majority of cases are

Cregan and Burslem: Pregnancy and Successful Caesarean Section After Hemipelvectomy for Malignant Disease

abnormalities among the vaccinated and unvaccinated women. There were no significant differences either in duration of pregnancy, weight at birth, or sex of the infants. Although these rcsuits do not indicate a harmful influence of vaccination on the fetus, the authors warn against routine primary smallpox vaccination of the pregnant woman to avoid the rare condition of prenatal vaccinia. I~'dward E. Wallach