1. Smallpox Vaccine Contraindications and Screening
WVDHHR/BPH
US Department of Health and Human Services
Centers for Disease Control and Prevention
December 2002 / January 2003

2. Smallpox Vaccine Contraindications and Screening
Learning Objectives:
Train clinic staff to screen potential vaccinees for contraindications of smallpox vaccine, including contraindications in potential vaccinees and in household contacts

3. Smallpox Vaccine Contraindications and Screening
Why such emphasis on this?
Selected Adverse Events are avoidable:
Contact transmission and autoinnoculation
Vaccinia necrosum and eczema vaccinatum
Some individuals are at increased risk
Primary vaccinees

4. Strategies in Phase 1
Restrict to ACIP recommendations of public health and hospital based response teams
Restrict to those at risk for exposure in an event
Express preference for revaccinees
Educate employees about vaccine, contraindications, and VAEs
Screen for contraindications both before and during clinic
HIV and pregnancy testing availability
Follow closely afterwards

5. Smallpox Vaccine Vaccine contains live vaccinia virus
Vaccine virus can be transmitted to household or other close contacts
Candidates for vaccination must be carefully screened for contraindications
Certain medical conditions in the person’s household contacts must also be considered as contraindications for vaccination

6. Smallpox Vaccine Contraindications and Precautions (Non-emergency Situations)
Serious allergic reaction to a prior dose of vaccine or vaccine component

7. Smallpox Vaccine Components
Dryvax
polymyxin B
streptomycin
tetracycline
neomycin
phenol
New vaccines do not contain antibiotics
No sulfa drugs in here… only sulfate compounds.

8. Smallpox Vaccine Contraindications and Precautions (Non-emergency Situations)
Serious allergic reaction to a prior dose of vaccine or vaccine component
Immunosuppression in the recipient or household contact

9. Causes of Immunosuppression Diseases
Leukemia
Lymphoma
Generalized malignancy
Solid organ or stem cell transplantation
Humoral or cellular immunity disorders
HIV infection

10. Causes of Immunosuppression Therapies
Alkylating agents
Antimetabolites
Radiation
High dose corticosteroid therapy
2 mg/kg/day, OR
20 mg/day for  14 days

11. Screening for HIV Infection
Mandatory HIV testing not recommended, but:
Recommended for persons who have history of risk factors and do not know status
Should be readily available for anyone concerned who wishes testing

12. Smallpox Vaccine Contraindications and Precautions (Non-emergency Situations)
Serious allergic reaction to a prior dose of vaccine or vaccine component
Immunosuppression in the recipient or household contact
Pregnancy or pregnant household contact

13. Screening for Pregnancy
In pre-event setting, vaccine should NOT be given to:
pregnant women
women trying to become pregnant
Educate women of child-bearing age about fetal vaccinia
Advise avoidance of pregnancy for 4 weeks following vaccination

14. Screening for Pregnancy
Pregnancy test not recommended
If concerned, administer home test for pregnancy
Establish pregnancy registry for women inadvertently vaccinated

15. Smallpox Vaccine Contraindications and Precautions (Non-emergency Situations)
Serious allergic reaction to a prior dose of vaccine or vaccine component
Immunosuppression in the recipient or household contact
Pregnancy or pregnant household contact
Breastfeeding

16. Smallpox Vaccine Contraindications and Precautions (Non-emergency Situations)
Eczema or atopic dermatitis (current or past history) in the recipient or household contact
Acute, chronic or exfoliative skin conditions (until improved or resolved)

17. Screening for Eczema or Atopic Dermatitis
Questions and Information:
Have you or member of your household been diagnosed with eczema or atopic dermatitis?
Eczema/atopic dermatitis usually is itchy, red, scaly rash that lasts more than 2 weeks and comes and goes
If you or household member EVER has a rash like this, you should NOT receive smallpox vaccine

18. Screening for Eczema and Atopic Dermatitis
Do not administer vaccine if history of eczema OR atopic dermatitis
Do not administer vaccine if household members have history of eczema OR atopic dermatitis
Other acute, chronic or exfoliative skin conditions – wait until resolved or under good control

19. Smallpox Vaccine Contraindications and Precautions (Non-emergency Situations)
Eczema or atopic dermatitis (current or past history) in the recipient or household contact
Acute, chronic or exfoliative skin conditions (until improved or resolved)
Children < 12 months of age

20. Smallpox Vaccine Contraindications and Precautions (Non-emergency Situations)
Eczema or atopic dermatitis (current or past history) in the recipient or household contact
Acute, chronic or exfoliative skin conditions (until improved or resolved)
Children < 12 months of age
Moderate or severe acute illness

21. Volunteer Pre-Clinic Screening
Provide packet of materials for self-screening and information to volunteers considering vaccination
Emphasize review of materials
Encourage volunteers to discuss materials with their physician if unsure of any conditions
Personal medical history does not have to be disclosed
Personal decision to opt-out of vaccination program for ANY reason

22. Pre-Clinic Screening Materials
Participant Advice Letter
Vaccine Information Sheet
Smallpox Vaccine
Immune System Problems
Skin Conditions
Pregnancy
Pre-Clinic Checklist

23. For More Information West Virginia Immunization Program
Jeff Neccuzi, Program Manager OR

24. For More Information CDC Smallpox website www.cdc.gov/smallpox
National Immunization Program website