Autoimmune News: Index

Autoimmune Patients Need to Be Aware of Smallpox Vaccine Risks (October 2002)

As the federal government makes plans for potential widespread smallpox vaccination, experts are cautioning that those with dysfunctional immune systems may be at higher risk of side effects from the vaccine itself, as well as exposure to those who have just had the vaccine. The smallpox vaccine contains vaccinia, which is a live a virus that is similar to the smallpox virus. It is exposure to the vaccinia that creates immunity to smallpox. In a small percentage of people – mainly children and those with weakened immune systems – receiving the smallpox vaccine can cause severe and even fatal side effects, including brain damage. There is also a small chance that high-risk individuals who have not themselves received the vaccine can contract vaccinia by being exposed to those who have recently had the vaccine and are “shedding” the virus.

In studies of smallpox vaccination from the 1950s-60s, there were from 2 to 6 cases of what’s known as “contact vaccinia” for every 100,000 people receiving the vaccine. Currently, however, with the population under 30 never having been vaccinated for smallpox, these people are likely to shed vaccinia for longer periods, increasing the risk of contact vaccinia to those around them. There are also more people who are immunologically compromised, and are therefore at higher risk.

According to the CDC, there are several key risk factors that when present, advise against non-emergency smallpox vaccination:

History or Presence of Eczema or Other Skin Conditions: Because of the increased risk for a complicated called eczema vaccinatum, the smallpox vaccine should not be given to persons with eczema of any degree, those with a past history of eczema, those whose household contacts have active eczema, or whose household contacts have a history of eczema. Persons with other acute, chronic, or exfoliative skin conditions (e.g., atopic dermatitis, burns, impetigo, or varicella zoster [herpes]) might also be at higher risk for eczema vaccinatum and should not be vaccinated until the condition resolves.

Pregnancy: Live-viral vaccines are contraindicated during pregnancy; therefore, the vaccine should not be given to pregnant women.

Altered Immunocompetence / Suppressed Immunity: Smallpox vaccine is not recommended for people with immunodeficiency diseases and among those with immunosuppression (e.g., as occurs with leukemia, lymphoma, generalized malignancy, solid organ transplantation, cellular or humoral immunity disorders, or therapy with alkylating agents, antimetabolites, radiation, or high-dose corticosteroid therapy (which is common in some autoimmune diseases.) Persons with immunosuppression also include hematopoietic stem cell transplant recipients who are less than 24 months posttransplant. Also people whose household contacts have such conditions should not receive the vaccine.

Other groups not advised to receive the vaccine include:

• Persons Infected with HIV
• Infants and Children
• Persons with Allergies to Vaccine Components , including polymyxin B sulfate, streptomycin sulfate, chlortetracycline hydrochloride, and neomycin sulfate. Persons who had had allergic reactions to any of these antibiotics should not be vaccinated.

SOURCES: Journal of the American Medical Association 2002;288:1901-1904, Vaccinia (Smallpox) Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001, Centers for Disease Control and Prevention,Morbidity and Mortality Weekly Report

NOTE: Do vaccines trigger autoimmune diseases? The question of vaccines and their linkage to autoimmune conditions is explored further in Living Well With Autoimmune Disease.

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