ACIP says people living with babies can get smallpox shot

Jan 15, 2003 (CIDRAP News) Ð The federal AdvisoryCommittee on Immunization Practices (ACIP) affirmed yesterday that it's safefor people who live with a baby less than 1 year old to get a smallpox shot,though the shots are contraindicated for babies themselves.

The safety of smallpox shots for household contacts ofbabies was one of several issues the ACIP discussed in a telephone conferencecall, to which reporters were allowed to listen. Healthcare institutions acrossthe country are preparing to begin vaccinating public health and hospitalworkers who volunteer to serve on smallpox response teams. The Centers forDisease Control and Prevention (CDC) posted an unofficial summary of the ACIP discussionon its Web site.

The ACIP said that smallpox shots should not be given tobabies under the age of 1 because, compared with older children, they have anincreased risk of serious adverse events. However, "The presence of aninfant in the household is not a contraindication to vaccination of othermembers of the household; data suggest that the risk of serious complicationsfrom transmission from an adult to a child is extremely small," the CDCsummary states.

At the same time, the committee recognized that some healthagencies may not vaccinate household contacts of infants, in view of the evidencethat infants who are vaccinated have a higher risk of adverse events, accordingto the CDC summary.

The New York City Health Department will advise people wholive with a baby not to be vaccinated, but will not stop them from getting theshot, the New York Times reported today.New York City Health Commissioner Thomas R. Frieden, noting that two New York infantsdied in 1947 because of secondary cases of vaccinia virus infection, urged theACIP in December to advise people living with infants against vaccination, accordingto the Times report.

But in the conference call, Dr Seymour Williams of the CDCpresented data from the 1960s showing that vaccinia transmission from adults toinfants was very rare, the Times reportsaid.

In other discussion, the committee concluded that it may be wisefor people who have severe autoimmune diseases but are not receiving drugtreatment to avoid smallpox vaccination. The committee felt that people whohave diseases like systemic lupus erythematosus, dermatomyositis, andscleroderma may have suppressed immunity even if they aren't under medical treatment,according to the CDC summary. "Therefore, it may be prudent in a settingwithout known smallpox transmission and with an uncertain risk of a smallpoxattack to not vaccinate these persons at this time."

According to the CDC report, the committee also:

  • Recommended that healthcare workers who are vaccinated should cover the site with gauze and a semipermeable dressing while on the job to prevent transmission of the virus to others
  • Affirmed the recommendation that those administering smallpox shots, including primary and repeat vaccinations, should use 15 "insertions" of the bifurcated needle, even though the vaccine package insert recommends only two to three insertions. The committee recommendation was based on experience during the global eradication program and recent clinical trials.
  • Said people being treated with steroid drugs for eye disease should not get a smallpox shot until their therapy is finished

The CDC said the ACIP recommendations will not be officialuntil the CDC reviews and approves them.

See also:

CDC summary of the ACIP telephone conference

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