Contraindications

Potential vaccinees must be screened for contraindications to smallpox vaccination. For details refer to specific adverse events.

Anyone with whom the potential vaccinee has contact and who has a susceptibility to complications must be identified to:

Non-Emergency vs. Emergency
The vaccinia vaccine should not be administered for nonemergency indications if any of the conditions in the accompanying table are present or if the vaccinee will be in close contact with someone, either in their household, or in a hospital setting, who has one of these conditions.

Note, however, that in the event of a smallpox outbreak where there is a high risk of contact with a patient, these contraindications would not apply. For further information, please visit the Progressive Vaccinia page.

Allergies to Vaccine Components
Each vaccine lot may contain antibiotics and preservatives. Specific allergies to these products may occur.

Appropriate history of such allergies should be obtained and may negate vaccine administration when smallpox is not present.

If smallpox is present and the risk of contact great, the vaccine should be administered with subsequent use of an appropriate antihistamine or other medication.

Current Dryvax contains:

Contraindications to Vaccination
(for vaccinees as well as their potential contacts)

Condition

Notes

Pregnancy

Immunodeficiency

Includes any disease with immunodeficiency (congenital or acquired) as a component, e.g.:

ï

HIV Infection

ï

AIDS

ï

Many cancers

Immunosuppressive therapy

ï

Cancers

ï

Organ/transplant maintenance

ï

Steroid therapy (1)

ï

Topical steroids for a skin disease

ï

Inhaled steroids (2)

ï

Many cancers

Eczema

History or presence of eczema, including "healed" eczema (3)

Skin Disorders (4)

Disruptive or eruptive skin disorders, e.g.:

ï

Acne

ï

Burns

ï

Wounds

ï

Contact dermatitis

ï

Current surgical incisional wounds

Eye disease of
the conjunctiva
or cornea (5)

In particular:

ï

Pruritic lesions

ï

Florid inflammation

Vaccine component allergy

Current Dryvax contains:

ï

Polymyxin B sulfate

ï

Streptomycin sulfate

ï

Chlortetracycline hydrochloride

ï

Neomycin sulfate

(1)

Equivalent to 2 mgm/kg or greater of prednisone daily, or 20 mgm/day, particularly if given for longer than 14 days.

(2)

Consult an expert allergist/immunologist or the CDC. Requires individualized decisions as the absorption varies both with the steroid used and the dosage and frequency of administration.

(3)

Even patients with healed eczema may manifest complications. They should not be vaccinated and they should avoid contact with a vaccinee.

(4)

The size and extent of the skin disorder may be sufficiently small that vaccination can be safely performed. However, all such patients must be counseled to take great care to avoid any transfer from the primary site to the affected skin.

(5)

Eye disease may predispose to itching and rubbing of the eye with concomitant transfer of virus from the vaccination site.