In
the absence of smallpox, patients with T-cell abnormalities
should not receive smallpox vaccine. Not all patients
suffering from immune defects, cancer, HIV or receiving
immunosuppressive therapy are T-cell deficient. Consultation
with an immunologist is advised for patients in these
categories, but prudence would dictate they not receive
vaccine in non-emergent situations. Patients in these
categories should also be cautioned not to come in contact
with vaccinated individuals.
If a smallpox outbreak occurs, the ACIP and CDC have
recommended that all patients in these categories at
risk of exposure be vaccinated. That recommendation
is likely to be reviewed as deliberations about smallpox
vaccine policy continue. For further information, please
visit the
Advisory Committee on Immunization Practice (ACIP)
website and the
CDC Public Health Emergency Preparedness & Response
Smallpox website.
An appropriate history suggestive of T-cell immunodeficiency,
either on a congenital basis or secondary to some other
disease or treatment identifies a person as potentially
susceptible to Progressive Vaccinia.
The following areas should be explored with the potential
vaccinee. These potential susceptibilities apply to
the: |
|
Immunodeficiency, congenital or acquired |
Is there a known immunodeficiency, congenital or acquired? |
| • | History of prior infections compatible with CMI deficiency |
|
Disease associated with immunodeficiency |
•
•
• | HIV
AIDS
Many Cancers |
|
Immunosuppressive therapy |
Is the patient or the contact receiving any
immunosuppressive therapy? |
| • |
For maintenance of an organ or other transplant |
| • |
Steroid therapy equivalent to 1-2 mgm per kg of prednisone daily |
| • |
For any disorder that requires the use of immunosuppressive therapy, especially that which reduces T-cell immune
function |
|
Is the patient suffering from any autoimmune
disorder? |
|
What medications is the patient receiving for these conditions?
Are they immunosuppressive?
|
