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Smallpox vaccination essential part of being prepared

Released: Feb. 21, 2003

By Lt. Col. Fred Kelsey
U.S. Air Forces in Europe Public Health Officer

RAMSTEIN AIR BASE, Germany (USAFENS) - Although the world's last case of smallpox was over twenty-five years ago, concerns that the virus could be used in a biological attack has lead to the implementation of the smallpox vaccination program.

The deadly disease caused by smallpox virus is nothing new. However, routine vaccinations of the American public against the virus stopped in 1972, after the disease was eradicated in the United States. Until recently, the U.S. government provided the smallpox vaccine only to a few hundred scientists and medical professionals who work with the smallpox and similar viruses in a research setting. The events of Sept. 11, 2001 changed all of that. The Defense Department's smallpox vaccination program is part of our national strategy to safeguard Americans against smallpox attack from nations or terrorist organizations that might use it against us.

Although military members are protected against biological weapons using detection devices, protective gear and training, these means of force protection have their limitations. Smallpox vaccination provides additional protection to preserve the health of our people and reduce the likelihood that this disease will disrupt our military missions.

Keeping these things in mind, our government is taking steps to improve our level of preparedness against terrorism. For smallpox, this includes vaccinating medical personnel who would respond to a smallpox outbreak, in addition to certain military and civilian personnel who are or may be deployed to high threat areas.

Smallpox vaccine is made from a virus called vaccinia, another "pox"-type virus related to smallpox. It's important to note that the smallpox vaccine helps the body develop immunity to smallpox. It does not contain smallpox virus and cannot spread smallpox virus.

The vaccine is given in the upper arm by using a two-pronged needle. This needle, with the vaccine on the tip, is used to prick the skin a number of times in a few seconds. The pricking is not deep, but it will cause a sore spot and one or two drops of blood to form.

If the vaccine is successful, a red itchy bump develops at the vaccination site in three or four days. In the first week after vaccination, the bump becomes a large blister, fills with pus, and begins to drain. During week two, the blister begins to dry up and a scab forms. The scab falls off in the third week, leaving a small scar. People who are being vaccinated the first time may have a stronger "take", or successful vaccination, than those who are being revaccinated.

While the normal vaccination process may seem extreme to some people, the smallpox vaccine is the best protection you can get if you are exposed to the smallpox virus. Most people experience normal, usually mild reactions, which include a sore arm, fever and body aches.

In the past, about 1,000 out of every 1 million people vaccinated for the first time experienced reactions that, while not life-threatening, were serious. These reactions include a vigorous reaction at the site of the vaccination and spread of the vaccinia virus (the live virus in the smallpox vaccine) to other parts of the body and to other people. These reactions typically do not require medical attention.

Rarely, people have had very bad reactions to the vaccine. In the past, between 14 and 52 people per 1 million vaccinated experienced potentially life-threatening reactions. These include skin reactions and inflammation of the brain. Based on past experience, it is estimated that between 1 and 2 people out of every 1 million people vaccinated will die as a result of life-threatening reactions to the vaccine. However, careful screening of potential vaccine recipients is being done to help reduce the chances of serious reactions, and to ensure that those at increased risk do not receive the vaccine.

There are also some people who should not get the vaccine prior to a smallpox outbreak. These include anyone who is allergic to the vaccine or any of its components; pregnant women; women who are breastfeeding;; people who have, or have had, skin conditions such as eczema and atopic dermatitis; and people with weakened immune systems, such as those who have received a transplant, are HIV positive, are receiving treatment for cancer, or are taking medications (like steroids). Additionally, a person should not receive the smallpox vaccine if they have family members at home with any of these conditions or circumstances exist.

There are also some concerns as to how the vaccine virus can be spread. While this concern is valid, it's important to note that it can only be spread by touching a vaccination site before it has healed or by touching bandages, towels or clothing that have become contaminated with live virus from the vaccination site. Vaccinia is not distributed through the air.

People receiving the vaccine should take special care to minimize the risk of spreading vaccinia. These measures should be followed until the scab that forms at the vaccination site falls off on its own.

Do not touch the vaccine site or any materials that might be contaminated with live virus from the site. This includes bandages, towels, clothing or washcloths used by the person who got the vaccine.

Anyone who individual accidentally comes in contact with the vaccine site, or something that may be contaminated with live virus, should immediately wash with soap and warm water.

Anyone sharing a bed with a vaccinated person should be sure the individual who was vaccinated is wearing a gauze bandage held in place with first aid adhesive tape over the vaccination site. Additionally, the person who got the vaccine should wear a shirt or pajamas that cover the bandaged vaccine site.

A separate laundry hamper should also be kept for items like clothing, towels, or bedding that have come in direct contact with the vaccine site or drainage from the site. Launder these items, using hot water with detergent or bleach, and wash hands carefully afterwards.

Airing the site will keep the vaccine site dry and promote healing; but, air it only when there is no chance of direct contact with another person and be careful not to scratch the site.

Finally, one of the most important things to remember is to follow site care and hand-washing instructions.

Preparation is key in the fight against terrorism, and receiving the smallpox vaccine is a vital and essential step in this preparation process. As long as the vaccination site is kept covered, and a vaccinated person's hands and laundry are washed thoroughly, the chance that the vaccinia virus could spread from one person to another is nearly eliminated.