Recall of skin conditions that increase risk of smallpox vacccine complications

May 05, 2003

PHILADELPHIA -- (May 5, 2003) A new study finds that standard screening questions do not identify all individuals who should be excluded from receiving the smallpox vaccine because of certain pre-existing skin problems. Annals of Internal Medicine is releasing the study early online at at 5 p.m. EDT, Monday, May 5. It will appear in July 1, 2003, print edition of Annals.

Current guidelines from the Centers for Disease Control and Prevention recommend that people with the skin conditions atopic dermatitis or eczema and their household contacts should not receive the smallpox vaccine. In a telephone survey of central Wisconsin residents who had had at least two clinic visits for the two diseases from 1979 through 2001, researchers found that 30 percent to 40 percent could not adequately recall a history of the skin conditions for themselves, their children or another family member. People with more distant skin disease were less likely to remember their skin conditions than were people with more recent disease.

"This is concerning, because the smallpox vaccine screening process relies on similar questions to make sure the vaccine is not given to people with a higher risk of complications," said Allison Naleway, PhD, of Marshfield Clinic and principal investigator of the study.

One complication of smallpox vaccination is a skin problem called eczema vaccinatum, which occurs when the vaccine virus spreads to cause a rash over large areas of skin.

"Eczema vaccinatum is usually mild and self-limited, but it can be severe or fatal, especially in young children," said Naleway. Children who have not been vaccinated also may be at risk, since the vaccine virus can sometimes be passed from a vaccinated person to household members.

In this study, researchers found that 59 percent of respondents correctly reported a skin condition in themselves; 60 percent correctly reported that a household member had such a condition; and 70 percent of parents correctly reported that their child had a skin condition.

The study also found that about one percent of central Wisconsin residents received diagnoses of atopic dermatitis or eczema in 2000 and 2001.

"This research points out the need to continually refine and improve the screening process to identify persons who should not receive the smallpox vaccine, especially if the current vaccination program is expanded," said Naleway.
A copy of the embargoed article, "Eczematous Skin Disease and Recall of Past Diagnoses: Implications for Smallpox Vaccination," is available by calling 800-523-1546, ext. 2656 or 215-351-2656.

Dr. Naleway and researcher Edward A. Belongia, MD, are available for interview by calling Teresa Derfus at the Marshfield Clinic, 715-387-9362.

American College of Physicians

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