J. Michael Lane, MD, MPH; Joel Goldstein, MD
Potential Financial Conflicts of Interest:Consultancies: J.M. Lane (Centers for Disease Control and Prevention, National Institutes of Health, Walter Reed Army Institute of Research, Acambis, and Dynport).
Requests for Single Reprints: J. Michael Lane, MD, MPH, 869 Clifton Road NE, Atlanta, GA 30307-1223.
Current Author Addresses: Dr. Lane: 869 Clifton Road NE, Atlanta, GA 30307-1223.
Dr. Goldstein: The Children's Clinic, 1000 Corporate Center Drive, Morrow, GA 30260.
The United States stopped vaccinating against smallpox in 1972 because the risks were judged to outweigh the benefits. The possibility of a terrorist attack using smallpox has led to renewed interest in a vaccination program. Smallpox vaccination carries considerable risks, which may be of greater concern today than in the late 1960s because of the increased prevalence of immunosuppression and atopy in the population. This paper reviews the clinical presentations of major adverse events after vaccination and the rates of occurrence of these events observed in the 1960s. The normal dynamics of the spread of smallpox is slow, and usually only persons who have had close personal contact with an overtly ill patient are affected. There are several preattack vaccination policy options, but immunization of medical workers, especially those who might have close contact with infected patients, is sufficient in the absence of a known threat of a bioterrorist attack or the identification of a smallpox-infected person.
Table 1. Frequency of Adverse Events in 1968 after Primary Smallpox Vaccination with New York Board of Health Strain Vaccinia, by Age and Type of Adverse Event
Table 2. Frequency of Adverse Events in 1968 after Smallpox Revaccination with New York Board of Health Strain Vaccinia, by Age and Type of Adverse Event
Table 3. Conservative Estimate of Deaths from Smallpox Vaccination after Implementation of a Policy of Indiscriminate Widespread Vaccination
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
J. Michael Lane, Joel Goldstein. Evaluation of 21st-Century Risks of Smallpox Vaccination and Policy Options. Ann Intern Med. 2003;138:488–493. doi: 10.7326/0003-4819-138-6-200303180-00014
Download citation file:
Published: Ann Intern Med. 2003;138(6):488-493.
Bioterrorism Infectious Agents, Infectious Disease, Prevention/Screening, Vaccines/Immunization.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use